DDLTAC(UK) - LONDON

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 provider did not ensure the effectiveness of people’s care and support was consistent.

The service was in breach of legal regulation in relation to good governance.

This service scored 58 (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 always make sure people’s care and treatment could be as effective as possible because they did not always sufficiently and accurately record people’s health, care, wellbeing and communication needs.

The person’s needs assessment required improvement because it did not include sufficiently detailed person-centered information regarding their needs, presentation and preferences. The information it did contain was vague and included statements such as, “…appearance, behaviour and mood seem fine” and “…thought content and ideas look fine.” There was no information about what appearance, behaviour, mood, thoughts and ideas were considered fine and not fine for the individual and using the term seem was not sufficiently instructive for staff. There was confusing information regarding the person’s dietary preferences about what foods they no longer liked and the section about the person’s weight simply stated, “…added a bit of weight recently” without explaining how much weight and whether it was considered normal and healthy for the person. The assessment included the statement, “…arthritic of the hip” but did not contain any further information about this or other conditions the person was known to live with.

This meant staff did not always have the best information with which to plan the person’s care and support.

The provider planned people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The provider followed the Mental Capacity Act 2005 and the NICE (National Institute for Health and Care Excellence) guidelines for ‘Managing medicines for adults receiving social care in the community’, for example. NICE is a public body that provides evidence-based guidelines, quality standards, and advice to help providers deliver the best care.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The provider’s ‘transfer document’ for the person included information about their needs and support. This enabled the provider to share information about the person with other professionals when they accessed different services. This meant the person did not have to repeat their needs and preferences to different professionals every time they accessed different health and social care services.

A member of staff said, “Communication is good, we work well together. If one of us is running late on to a care visit, we call and inform the manager.” Another member of staff said, “Staff work fine together. We share information with each other.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

The provider supported the person to make informed decisions about their care and support, and staff supported the person to manage their health and wellbeing to reduce their future need for care and support. Staff supported the person to mobilise to prevent injury from falls and ensured they ate and drank enough to maintain their health. The provider liaised with healthcare services to ensure the person accessed services and received the right treatment in a timely manner.

The provider did not ensure staff always monitored and recorded people’s care and support effectively to continuously improve it.

The person’s charts for monitoring their skin integrity, bowel movements and pads were incomplete; there were no records between 18/03/2026 and 21/04/2026. The person’s bowel movement charts did not always contain the correct information; sometimes staff had recorded yes and no instead of recording the type of movement, for example. In addition, the charts were almost illegible in places, which meant the charts were bordering on being of little value.

The person’s food charts and their care plan did not state the required level of food intake for the person or what the person’s healthy weight should be and did not include instructions for staff about how to monitor the person’s weight and what to do if the person’s food intake was below the required level.

The person’s fluid charts did not state the required level of fluid intake for the person, and not all the entries included the amount of fluid the person had drunk. In addition, the charts and the person’s care plan did not include instructions for staff about what to do if the person’s fluid intake was below the required level.

This meant the person’s food and fluid charts were not always effective.

The provider told us they carried out care plan reviews every 6 to 8 weeks. However, the evidence we reviewed showed they had carried out 1 care plan review for the person in the last 12 months. In addition, there was no evidence the provider had reviewed the person’s needs assessment and risk assessments since they were first completed in January 2025.

Staff knew the person and their needs well and had ensured they maintained their health. However, our findings meant the provider did not accurately monitor and record the person’s care and support and had not ensured all the person’s care records were accurate, complete and contemporaneous.

This put the person at risk of potential harm.

This was a breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 17: Good governance

However, we found no evidence the person had been harmed. Staff completed daily notes of the care and support they provided. The person told us, “There is paperwork in my house and staff fill it in.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

The provider followed the Mental Capacity Act 2005 and obtained the person’s consent regarding their care and support, and staff asked for the person’s permission before carrying out tasks. However, some improvement was required because the person’s views were not recorded at the bottom of their care plan and their needs assessment was not signed and dated by them, and there was no explanation recorded for why these things had not been done.

This meant we could not be assured the person had always agreed with the information in their assessments and plans and had always agreed to the care and support they received.