Social Care Solutions Ltd (Herts & Bucks)

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: Need for consent

This service scored 42 (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 were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. Local health and care professionals had identified improvements needed to be made to people’s support plans to ensure care was delivered effectively. On-going improvements to support plans needed to be embedded and sustained so there was a consistent approach to assessing needs and delivering care and support.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. People’s support plans did not always contain information which was personalised and outlined people’s care and support needs. Not all staff had completed person specific training to better understand people’s individual needs and ensure quality of life.

People’s nutrition and hydration needs were not always being met. Records of people’s daily intake were not always completed in full where required, nor did they match dietary information recorded in people’s support plans. For example, a person identified to be at risk of choking had their dietary requirements recorded as ‘moist food or cut up small’ but observed throughout the day to eat 3 packets of crisps, not in line with the guidance in the support plan and without any information about staff intervention or further risk assessment. People were not always encouraged to follow, maintain healthy and balanced diets. Comments included, “The food is not nutritious” and “[Person] is overweight they live on packets.” We did receive some positive feedback related to people being involved in their meal planning and support. Comments included, ‘I go to [Name of supermarket] shopping; [Name] is taking me on Monday. I choose my food; I like bread and bagels. The staff help me to cook,’ and ‘Staff come shopping with me as I need help with my money skills. I choose the food I buy, and now I am trying to eat healthy and watch my portion sizes. I am batch cooking with staff."

The provider had not always work well across teams and services to support people. Feedback we received was mixed, although most people and relatives told us they felt the communication at both supported living settings was okay, and as far as they knew staff worked well with other health and care services. A relative told us, “Staff seem to communicate well, however some staff more than others understand [person’s] autism. As far as I know staff communicate with other professionals.” However, a common theme amongst staff were related to the seniorleadership and lack of external support being given by the provider. Staff described the high turnover of managers having a negative impact on internal communications. Staff told us when they raised concerns, they felt the manager would listen and escalate to the senior leadership team however they were not convinced actions were or would be taken to make improvements in a timely way. A member of staff told us, “It is a good place to work, and the staff get on very well, however, the changes of managers can impact on us. It really stops with [name of manager], but I am confident they escalate our concerns, but we are not always confident they [head office] listen to us.”

The provider’s systems for recording people’s health appointments, follow up appointments and any actions taken were not managed consistently. At 1 supported living setting the manager was unable to provide us with information relating to people’s healthcare related appointments over the last 12 months. For example, Chiropody, Optician or GP appointments, this information was not readily available for staff should they have needed it to assist them with the people they were providing support to. They could not demonstrate people were always supported to manage their health and wellbeing or supported to live healthier lives, and where possible, reduce their future needs for care and support. Following day 3 of our onsite assessment visits, the regional manager advised a manager would collate this information and forward to us which they did, however this information was not available on the day of our visit.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. People’s daily care records were not routinely monitored which meant any documented information regarding people’s health and wellbeing had the potential to be missed and followed up. For 1 person staff had documented from 17 May 2025 to 27 May they were constipated. The person’s support plan failed to provide clear guidance for staff relating to their continence support needs and stated, “[Name] is unable to tell staff if they are in pain or unwell, so staff need to look out for any unusual behaviours.” Staff failed to escalate concerns, and no action had been taken to seek medical advice until the inspector requested a follow up. This then took the manager a further week to make contact with the triage nurse and then make an appointment to request some laxative medicine for this person.

Constipation, while often a temporary discomfort, can lead to various complications if chronic. These range from minor issues like haemorrhoids and anal fissures to more serious conditions like faecal impaction, bowel obstruction, and even rectal prolapse. Straining during bowel movements can exacerbate these issues, and in some cases, chronic constipation can contribute to urinary tract infections. This is also a risk where people may struggle to communicate how they are feeling or ability to alert staff to take action.

The provider did not demonstrate people were told about their rights around consent or respect these when delivering care and treatment. People’s views and wishes were not always considered when their care was planned. The provider failed to demonstrate that systems and practices to ensure that people understand the care and treatment, being offered or recommended, helped them make an informed decision. Where necessary, people with legal authority or responsibility can make decisions within the requirements of the Mental Capacity Act 2005. This includes the duty to consult others such as carers, families and/or advocates, where appropriate. We found there to be a lack of consultation and involvement to obtain views from people using the service, relatives or their legal representative in the completion of their Mental Capacity Assessments and Best Interests decision. Most decisions documented were made and signed by members of staff.