Expectation Care 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 requires improvement.
This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.
 

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 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.
People’s needs were not comprehensively assessed. Some care plans were incomplete or out of date.
One person’s care plan ‘About me’ section detailed that they had a brain condition and bone disease. However, these conditions were not recorded in the medical history section or in a care plan or risk assessment. Therefore, there was no information about how these conditions affected them.
Another person’s care plan recorded a diagnosis of vascular dementia. However, there was no information about how this condition affected them.
However, people and their relatives were aware of their care plan and said that they were involved in the care planning process. People’s communication needs were clearly documented in care plans with guidance for staff on how to effectively engage with them and involve them in their care.
 

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 care, treatment and support was not always delivered in line with relevant legislation, national standards and evidence-based good practice guidance. For example, in relation to delegated healthcare tasks and administering medication.
One person’s care plan included contradictory information regarding their nutrition and hydration needs and it wasn’t clear whether they required a modified diet. The care plan stated a referral had been made to Speech and Language Therapy (SALT) a year ago however no further updates were recorded.
However, people felt staff were competent and trained and knew what they were doing. One relative told us, “They are good, they understand the care [family member] needs, and they have reported anything if necessary to the care company and the doctor’s surgery. They also inform me and I can talk to the surgery too.”
People told us staff supported them with eating and drinking and were always asked what their choices were.
 

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.
Input and guidance from other services was not clearly documented in care plans. There was a lack of information that actions were followed up on, for example referrals to external healthcare services. Staff meeting minutes included inaccurate and out of date information about people’s circumstances and people’s care records were not always updated.
However, people and their relatives told us staff liaised with health services for example the GP. Staff felt that there was effective communication and coordination within their own staff team to enable them to plan and deliver people’s care and support. One staff member said “We do partnership working, if the district nurse (DN) has to come and change a patch the DN takes care of that, they replace the catheter, GP comes to visit their home as well, there is cooperation. The service has access to GP connect to share information.”
 

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.

One person’s care plan stated that a decision had been made for the person to remain in bed due to their mobility risks. However, there was no evidence of working with the person to understand and manage the risks. No risk assessment was in place that balanced the needs and safety of the person with their rights and preferences.
However, people told us that staff provided support, whilst encouraging them to maintain their independence. People told us how they managed their own health needs including speaking to district nurses and GP. They said that when required care staff would liaise with health professionals on their behalf.
 

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and
consistent, or that they met both clinical expectations and the expectations of people themselves.
Due to the lack of information in care plans relating to people’s physical and mental health needs, the service could not effectively monitor the risks relating to the health, safety
and welfare of people. For example, unclear information about 1 person’s nutritional needs meant it was unclear if staff were meeting their clinical expectations and if appropriate referrals had been made.

However, we had feedback about people achieving positive outcomes with support from staff. One relative told us how 1 carer went above and beyond to support their family member when they were not eating.
 

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.
The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.
Where people were considered not to be able to safely make choices, the provider did not always complete mental capacity assessments to confirm this. For example, for people who refused support with personal care.
One person was prescribed medication to manage anxiety. However, the care plan did not set out the person-centred approach staff should use to try to reduce distress and agitation before deciding to administer the medication.
One person’s care plan consent form had not been signed for several years and their relative was not aware there had been a review in this time. One person had appointed a relative to act as Power of Attorney; however, the care plan did not record this.
However, people told us that staff sought consent before providing care and staff we spoke with had a good understanding of the mental capacity act and consent. One staff member told us, “We support people to make own decisions, be person centred, take them through the process of them making a decision for themselves.”