Hales Group Limited - Norfolk

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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.At our last assessment we did not rate this key question at this assessment we rated this key question as 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 the legal regulation in relation to consent.

This service scored 38 (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. Communication between people using the service, staff and the office staff was poor, so we could not be assured people’s care and treatment was effective. A lack of effective communication and planning was our main concern resulting in people being dissatisfied with the service and staff feeling stressed and burnt out. Not all records were up to date and did not provide concise information. Not everyone using the service had a consistent care worker or care provided at the same time of the day meaning care was delivered in a hap hazard way. Assessments were completed electronically and staff had access to peoples care plans and previous care notes on an electronic app. However, some staff reported concerns using the electronic app and at times were unable to get a signal so could not upload peoples care notes contemporaneously, meaning timely information was not always available on the location of care staff, duration of visits or what care had been provided.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

We identified issues with the digital care records systems and found information was not always being recorded correctly which made it difficult to ascertain how the provider was following legislation and current evidence-based good practice and standards. We found evidence staff were not reading important updates or providing care in line with best practice. People with a diagnosis of diabetes were being supported without an appropriate diabetes care plan or risk assessment in place. Some care plans did not identify to care staff, that the person they were supporting had diabetes.

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. Assessments were in place and care plans developed to assist staff in meeting people’s care needs. However, there were not robust processes in place to assess and review people’s needs over time or assess staff competencies in meeting those needs. Staff raised concern about constant changes to their rotas at short notice and people using the service referred to ‘strangers’ coming into their home. Records were not always being completed thoroughly and contemporaneous and the escalation and management of risk was poor.

Staff did not feel supported by all of their leaders and not all leaders have a good overview of staff needs. Staff told us that the regional manager and recruiter of the branch supported them and praised their approach towards them. Staff also told us the regional manager is not always at the service.

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.

We were not assured people’s care plans were up to date or followed. People did not always receive continuity of care which potentially left them vulnerable. For example, we saw people refusing assistance with meal preparation because staff arrived too early or too late and some calls were close together which did not ensure adequate spacing between meals or medicines meaning meals and medicines were not given. Staff were rushed across their day and said if they were falling behind for example because of a medical emergency then their calls were not covered. This resulted in them regularly call cutting. This means that the actual visit duration completed by care staff was significantly less than the planned duration time. Daily care notes failed to show how staff were delivering all the planned care in a person, centred way. People reported poor experiences of care which did not enhance their health and well-being. For example, 1 person told us, “A lot [of care workers] don’t know about my ‘condition’. They just clean and go. One carer had me in tears. They didn’t talk to me and looked irritated with me. He (care worker) said I looked like a child.”

Despite this, people told us carers did sometimes follow up on seeking healthcare. A relative said, “They (care workers) will tell me to contact the doctor and did so once or twice.”

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.

Oversight of people’s care was poor. Management did not regularly enter people’s home to assess the care they were being given or their satisfaction with the care provided. This would have ensured staff practices and competencies were regularly assessed in the workplace. Management had remote access to people’s care records which meant there was regular oversight, but office staff were often tasked with providing care reducing their ability to audit records and staff did not always have reliable information or guidance to refer to.

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

Information sharing and governance was poor. From the records we reviewed we were not assured that the provider always worked in line with the principles of the Mental Capacity Act 2005. People and their families did not always feel they were appropriately consulted, and records were not sufficiently robust. For example, we saw lasting power of attorney was in place for 1 person, but the service had not seen any original documentation in relation to this person so could not be assured that the relative had the authority to act in their best interests. Other care plans had information about people living with dementia and stated they did not have full capacity to consent to all aspects of their own care and treatment. However, records did not give a clear overview of what decisions people could make or what decisions they might need support with to ensure the decision was in their best interests. There was also contradicting information in care plans so we could not clearly see if people could or could not make their own decisions. Decision specific mental capacity assessments (MCAs) were not consistently in place.

Care coordinators told us they used an MCA toolkit as part of the preadmission assessment process if a person lacks capacity and this was included in people’s care plan.