Archived: Initial Care Services South East Limited

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• 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.

The rating for the Effective key question was previously Requires Improvement. At this assessment the rating has remained Requirements Improvement. However, the quality statements we assessed: Assessing needs and Consent to care and treatment were scored at Inadequate.

The service was in breach of legal regulation in relation to the need for consent. The provider did not always follow the Mental Capacity Act 2005 Code of Practice.

This service scored 50 (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.

At our last inspection, we found that the registered manager could not demonstrate how they assessed people’s needs and worked with other professionals as part of their care planning. At this inspection we found the same concerns. Although the registered manager completed reviews of the care plans, they did not identify that the care plans did not fully assess people’s needs and did not implement any meaningful changes to the care plans.

Care plans had not been created with people, or in a meaningful format that people could understand. Where English was not a person’s first language, care plans had not been translated to their first language.

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.

At our last inspection we found the registered manager did not understand or follow national guidance or best practice. At this inspection we found similar concerns. The registered manager was not able to explain how to use the clinical tools (for example, MUST.) The MUST tool is the Malnutrition Universal Screening Tool, a validated screening tool developed to identify adults at risk of malnutrition, who are malnourished, or obese. We asked the registered manager how they used statutory guidance including RSRCRC, and they were unable to demonstrate their knowledge, understanding and implementation of RSRCRC. This guidance ensures people have access to care that promotes independence, choice and human rights. There was no evidence that this guidance had been considered as part of care planning or supporting people to be independent.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

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

At our last inspection we found that the registered manager did not work in line with the Mental Capacity Act 2005 (MCA) and associated code of practice. People’s ability to make specific decisions relating to their care and treatment was not effectively assessed. At this inspection we found this had not improved. People’s care records did not contain any information to inform staff of people’s capacity to make decisions. The provider told us one person’s capacity fluctuated; however, they had not assessed the person’s capacity to make specific decisions, and in some cases had sought the person’s consent, and in others sought consent from family. There was a risk that decisions were not being made in line with the MCA. In relation to one specific decision we asked the registered manager why the person had consented, if their capacity had not been assessed and they told us, “Sometimes they want to sign, so we allow them to sign because they like to sign. We don’t want to deprive them because they like writing.” This demonstrated the registered manager continued to lack understanding about the MCA.