Baobab Care UK Limited

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate.

This meant services were not planned or delivered in ways that met people’s needs.

The service was in breach of legal regulation in relation to person centred care.

This service scored 32 (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 were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

We found records did not always provide staff with detailed guidance about people’s individual needs. More work was required on improving support plans to make them more person centred, easier to read key information, particularly in relation to positive behaviour support plans. Improvements were required to fully involve people and their relatives in the planning of care and support. Some relatives told us they had not been asked for their feedback or been invited to care reviews. Some told us how they had concerns in relation to the service and care provided but did not feel listened to. Three relatives told us how they had raised concerns in relation to the support provided but their concerns had not been responded to.

The registered manager, who carried out assessments and wrote support plans and risk assessments, had not received appropriate training and support to be able to complete person centred support plans. They were provided with guidance of where to seek such training. The provider had not had oversight of the quality of the care plans and risk assessments or identified the need for additional training.

Some people’s care records lacked detail. This included where people’s support plans did not include information in relation to known health conditions, smoking risks and the associated fire risks. When we spoke to the provider about this, they told us they would improve the guidance for staff to refer to.

We were told some people were subject to restrictive practice as they required 1:1 or 2:1 support. We found that not all people had their own keys to be able to secure their own rooms when leaving and front doors were locked. This meant that not all people were free to come and go as they chose and this had not been factored into their support plans or risk assessments.

Most people told us that care was responsive to their needs, but some felt improvements were required.

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity.

The provider failed to ensure support plans were detailed and reflective of all people’s known health conditions and support needs. This posed a risk when people were moving between services, such as during hospital admissions, where clear, accurate information may be needed, including when the ambulance service attend and needed important medical information.

We saw that care records required significant improvements, to ensure they were more robust and reflective of what support took place. For example, for 1 person who was at known risk of damaging their skin, these were not clearly or routinely recorded and there were no support plans with clear guidance for staff to follow.

The provider’s training matrix indicated just 17 of their 83 staff had received up to date training to support people with mental health conditions. At the time of the assessment the service supported people with diagnosed mental health conditions. This meant we could not be assured staff had the appropriate skills and knowledge to support people safely.

Records demonstrated that overall people received the same staff which provided a continuity of care and meant that people and staff built good, supportive relationships where trust was developed. Some relatives told us they felt the service needed to improve how they worked with them when they were required to do so.

The provider did ensure all staff were suitably trained to communicate effectively and consistently provide accurate and up-to-date information in formats that were tailored to individual needs.

Since 2016 all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard. The Accessible Information Standard tells organisations what they have to do to help ensure people with a disability or sensory loss, and in some circumstances, their carers, get information in a way they can understand it. It also says that people should get the support they need in relation to communication.

We found that the provider did not always meet the Accessible Information Standard. People's communication needs were not always assessed or met to enable effective communication between staff and people using the service.

The provider failed to ensure staff had clear information about people's communication needs. Records relating to people’s communication needs and preferences lacked detail. For example, 1 person whose first language is not English they did not have a support plan available in their preferred language. In addition, we found they did not have a clear and effective communication plan. We could not be assured the provider had taken all possible actions to enable effective communication between the person and staff.

We were told and observed that some people had flash cards to aid communication where barriers had been identified.

The provider supported people who had significant hearing impairments and their preferred method of communication was via sign language however, they had not provided staff with such training. This meant opportunities to improve how staff were easily able to communicate effectively were missed.

Relatives told us that staff knew people well and understood what they wanted by people’s communication styles and body language.

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result.

The provider had a complaints policy and the registered manager told us they did not keep a record of complaints. However, the provider later shared a copy of the complaints received. This demonstrated a lack of robust systems to record all complaints received and demonstrate that complaints had been responded to in a timely way. In addition, we were unable to see how they would drive changes and improvements to prevent re occurrences as there was no analysis, learning or actions plans in place.

Feedback was not routinely sought from people or relatives nor were they consistently involved in reviews of care needs. This meant we could not be assured people’s feedback and views were listened to or acted upon.

People and their relatives told us they knew how to make complaints telling us they would call the registered manager or provider. Complaints could also be raised electronically however, some relatives told us how often these would not be responded so they had stopped complaining. This demonstrated a failure of the providers systems and processes to gather and respond appropriately to complaints.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

People were supported to access healthcare professionals, attend appointments and request emergency healthcare as needed. This included support from GP’s, mental health teams, opticians and other healthcare professionals.

Where people lacked capacity, the registered manager and provider were unable to evidence a consistent approach when assessing people’s ability to make decisions about their care. This meant opportunities could be missed to support people, enabling them to have a say in their care and treatment. We found this to be the case when people were moved between supported living locations without following the MCA legal framework.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

The provider failed to recognise the inequalities people they supported may face. These inequalities and people’s needs were not always considered. Although people were supported to participate in the community, others had not been supported with barriers they faced. For example, people living with a physical disability were not fully supported to address and remove barriers. This included a lack of steps taken to make everyday enjoyment of getting out of bed more accessible and improving their quality of life.

Some people were supported to access the community and participate in hobbies and interests and were positive about the staff. However, we were told by 3 relatives that they felt support and encouragement to build confidence and independence in the community needed to be improved. This meant we could not be assured that all people experienced the same life experiences and positive outcomes in their daily living.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

At the time of the assessment the registered manager told us they were not supporting anyone on the end-of-life pathway. However, we were told they planned to support people at this stage of their journeys. Just 1 staff member had received end of life training. This would place people at risk of not having all their needs and wishes met at such an important time in their journey.

For people using the service whose support plans we looked at there was no evidence of advanced care planning for when they approached the end of life. Some people using the service were supported by loved ones, but others were not. There were no records to demonstrate people, or their relatives/advocates had indicated they did not wish to discuss their end-of-life journey. There was no record of when this lack of information should be revisited with the person or their loved ones. This meant if end of life support was needed unexpectedly, something which was important to that person may not be actioned. The service supports people who have learning disabilities, autistic people and those living with poor mental health. We know from studies that people with a learning disability and autistic people often have poorer physical and mental health than other people and may face barriers to accessing health and care to keep them healthy.