Baobab Care UK 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 inadequate.

This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

This service scored 29 (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 was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

Three people and 4 of the 5 relatives we spoke with told us they had not been involved in the assessment of needs; we found support was not always delivered in line with current standards. We found that people's care and support did not always achieve effective outcomes.

The provider failed to consistently review people's support plans to ensure these reflected people's current needs. This meant the provider could not be assured the support staff were providing was as people required. For example, for 1 person their support plan included medicines which were no longer prescribed this had not been changed. Another person told us that they now required a much higher level of staff support due to deterioration of their diagnosed condition, however, support plans had not been reviewed to reflect the level of support we were told was provided. The person told us they did not feel the provider listened to them when raising concerns with them about the currently property and level of support no longer being appropriate.

This meant that support plans were not reflective of the people as individuals, to demonstrate a holistic, person-centered approach.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

The provider failed to ensure people’s changing needs were consistently assessed and support plans fully reflected all of the person’s needs, including health, personal care, social interests and activities and cultural, religious and spiritual needs.

The provider’s processes for ensuring people were consistently involved in their care planning and the information recorded in support plans was accurate, was not effective. Important information about people’s care and support needs had been omitted from some support plans. People’s support plans did not reflect national and best practice guidance in relation to support with specific health care needs such as diabetes or strokes of for people with learning disabilities or autistic people.

For a person whose previous known risks indicated they required enhanced monitoring in relation to their skin integrity, there were gaps in records showing care was not consistent. This meant there was a risk of deterioration in the person’s skin.

The provider did not work well across teams and services to support people. They did not share their assessment of people’s needs when moving between different services.

The lack of robust systems and documentation meant information available to share with other services and health professionals was not comprehensive. For example, we found for vulnerable people, at high risk of leaving their homes for long periods of time, the assessment and escalation to alert other professionals was unclear and lacked detail.

We also found where incidents had occurred these had not always been escalated and action taken in a timely way to respond to concerns. Such as seeking advice and guidance from other health professionals to identify the cause and potential actions to reduce such behaviours. This did not demonstrate a robust response to medical emergencies.

We were told by staff and the provider, and we saw that weekly ‘citizen’ meetings took place. We found there was a lack of evidence to demonstrate where people who were deemed to be high risk, other professionals had been contacted to provide advice and guidance.

Staff told us they had supervision, but these were infrequent without any structured approach to the frequency, ensuring all staff had taken part in such meetings. Records were not always detailed or fully completed. This meant we could not be assured what had been discussed, or if these meetings were supportive and gave staff opportunities to discuss important aspects of their well-being and performance. However, staff told us they felt supported by the registered manager.

The provider failed to consistently work with and notify commissioners when moving service users between supported living locations. They failed to involve key people in this decision-making process.

People and their relatives told us they knew who the registered manager and provider were.

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.

The provider’s system and processes to ensure care records and risk assessments reflected the support needs of people were ineffective. This meant staff did not always have the correct guidance on how to support people appropriately to manage their health and wellbeing, whilst encouraging independence.

Staff could tell us how they would contact healthcare professionals to help people manage their health, should this be required and support and encourage them to attend appointments. However, records demonstrated that staff had not received training to support people with all their specific health or lifelong conditions known to the provider, such as people with a learning disability or autistic people; sensory impairments; mental health; epilepsy and diabetes to name a few.

We were told by some relatives that they felt their loved ones were not supported to access the community and open spaces as much as possible or provide encouragement to do so and advise them of the benefits of this.

Some people and relatives told us how people had been supported to improve their diets and this had positive outcomes for the person.

People told us they were able to make choices and decisions and we observed this in some of the locations we visited.

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.

Support plans had not been consistently developed for people with long term health conditions. This meant the provider could not evidence how people’s outcomes would be improved.

Compliments about the service were recorded. The registered manager told us they had received some complaints, but they did not have a record of these. However, the provider gave us a compliments and complaints register which did not include the detail of the compliment or complaint. There was no analysis of such compliments or complaints to identify themes and trends. We found that complaints relatives told us they had raised with the provider were not included on this register. All compliments and complaints on this register remained active and the provider could not demonstrate these had been acted upon as per their own policy and procedure. This meant opportunities had been missed to use this information and the outcomes to help drive improvements across the service.

We saw staff supervisions had taken place; however, these were sporadic rather than a planned approach. There was a system of tracking supervisions, but the provider was unable to demonstrate all staff had received supervisions. This meant they had not always been provided with an opportunity to discuss any concerns they may have about people’s care or how it could be improved. There was no evidence to demonstrate staff received annual appraisals and staff confirmed this.

Where incidents had occurred and these had been analysed there was a lack of evidence to demonstrate the required actions had been acted upon and completed. This meant we could not be assured that lessons learnt were taken from these to help drive better outcomes for people. For example, where medicines errors had occurred there had been no actions taken to prevent a repeat of the incident.

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

The provider was not compliant with the Mental Capacity Act (MCA) 2005. Relatives or representatives told us that the provider had not consistently involved those who had the legal authority in making decisions on people’s behalf. This meant we could not be assured decisions were being made on their behalf appropriately.

We were told and saw that people who lacked capacity were moved between supported living locations without the legally required involvement of the person and their legally appointed representative. They were not adhering to current requirements in relation to the MCA, deprivation of liberty and best interest decisions. We were concerned in both the registered manager’s and providers lack of application of the MCA although they told us they knew what the correct process was. This demonstrated a lack of regard to gain consent prior to the provider making the decision to move people from location to location.

There was a lack of recorded evidence that people using the service consented to their care and the sharing of information on their behalf.

The provider’s training matrix indicated that just 25 out of the 83 staff had received training in relation to consent, MCA and deprivation of liberty. However, most staff members we spoke with could tell us what applying the MCA meant for the care of people using the service.

Most the people and relatives we spoke with told us that staff gained consent prior to supporting them but 1 said that at times staff just entered their room without speaking.