Eureka Care Services Limited

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to consent at the service.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The provider and care staff spoken with were aware of some of people’s needs and could describe the care and support they needed. However, feedback from people using the service and relatives were that staff were caring and kind, but that they were also very busy with limited knowledge about people’s care needs that were more complex. Care plan guidance for staff lacked assessments and care plans to direct staff in how to support people and reviews of people’s support needs were infrequent and not in a timely way when their needs changed. There was an inherent risk that staff would not know how to support people safely and effectively due to the lack of information provided. For example, staff told us 1 person used a nebuliser, but this was not documented anywhere in their assessment or care plan. Relatives told us one person had developed swallowing difficulties and again this was not documented or assessed.

People told us that they felt listened to during the initial assessment. One relative said how they felt the provider understood their needs and that they felt assured by their approach. However, they said this changed soon after care began and the provider was less engaged and reviews of the care dwindled. They told us due to this they were looking to transfer to another care company.

There was insufficient management oversight of ongoing assessments and care planning. As a result, we could not be assured people consistently received safe care that met their individual needs.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Care plans for people with specific health conditions such as choking, physical health needs or dementia were not in place, therefore did not provide staff with clear guidance to meet those needs which was aligned with best practice.

This meant that the provider could not apply national standards or evidence-based frameworks such as National Institute for Health and Care Excellence [NICE] guidance when planning and reviewing care. The provider was not aware of the frameworks for providing support for people with a learning disability and / or autism. They did not use recognised clinical assessment tools, such as the Waterlow assessment tool (a tool used to assess people's risk of developing pressure ulcers), to identify and monitor pressure ulcer risk particularly where 2 people spent a significant period in bed or sat immobile. While no one currently had a pressure ulcer, people were assessed as being at risk of developing pressure ulcers. We found similar gaps in areas such as risk of choking, dementia care, moving and handling and physical disabilities.

The provider did not always work well across teams and services to support people.

People and relatives said that staff worked with various health care professionals to seek support and review care when needed. We were able to see this from people’s care records, for example we could see confirmation from a social worker in the process of arranging a referral to occupational therapy following the registered manager’s request. However, this wasn’t everyone’s experience. One relative told us, “We raised a concern about how [relative] was hoisted. [Provider’s] attitude was, this is how it should be done, and they then said, ‘Well you show me how it’s done’ Once we got the occupational therapist in to review, we found out the way it had been done was not safe, so it was changed.”

Although some people and relatives were happy with the way services worked together, we identified examples where this had not occurred. For example, referrals had not been made for support with choking, use of equipment, and dementia care. The provider was therefore unable to work across teams as they had not assessed or identified those risks for themselves.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Care plans when completed did assess how people could retain their independence when supported with personal care. For example, one care plan described how a person should be able to wash areas they could manage, how and when they wanted a shower, hair wash and how to assist with preparation of meals.

In some cases, preferences were clearly recorded, for example a person requesting female only care staff. However, when care was delivered, this was done by either 1 or 2 male care staff. When we spoke with the provider about this, they said it was because they did not have sufficient female staff to meet this preference. We further found that staffing impacted other people’s choices and control. For example, where staff were late people’s or relative’s daily plans were affected.

Despite our findings, people and their relatives did not raise concerns about how staff supported them with their day-to-day support needs. Feedback we received indicated that staff were kind and willing to help, but the variation in care plan details meant this was not reliably embedded across the service.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Care records did not demonstrate that people's health and wellbeing needs were monitored. There were some that had no assessment and care plan, and for others that were documented, information was limited. There was no evidence within the assessment or care plan to show how the provider had supported people to understand what good outcomes would look like for them. For example, people’s views around increased autonomy, maintaining relationships, reduced loneliness, feeling safe and respected. As these outcomes for people were not assessed then the provider was unable to track, review and assess people's needs and risks focusing on what looked good for them.

Incidents and accidents were not monitored which meant patterns or trends may have been missed and opportunities to improve outcomes for people were not identified. The provider did not have a robust approach to monitoring the effectiveness of care. When our findings were discussed during this assessment the provider informed us they would update their audits and undertake training to support them with their management approach to improving outcomes.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The provider did not fully understand the circumstances when they were required to consider whether a person lacked capacity to make decisions. They spoke to us about two people, both who they considered to have the capacity to make their own decisions about their care. They then told us as part of the care reviews carried out; they routinely assessed to confirm those people retained capacity. This approach by the registered manager did not follow the principles of the Mental Capacity Act 2005. This states that staff must start from the assumption that the person has the capacity to make the decision. Demonstrate that every effort to encourage and support the person has been explored to make the decision themselves and should be decision specific. The registered manager had not applied these principles and the assessments completed were general assessments, not relating to a specific decision that was related to their care.

We saw that consent records for those people who were considered to have the capacity to consent were signed by a representative. There were no records to show that the person had been asked or agreed for others to act on their behalf.