Centred Healthcare

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.

This is the first assessment for this service. This key question has been rated 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 54 (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. For example, when an assessment was required to ensure safe moving and handling this was not completed or discussed with the person.

However, people had initial assessments which included consideration of their physical, mental health, sensory, social and communication needs. Assessments focused on people’s strengths and staff had a good understanding of people’s needs. Staff completed clear, detailed daily records to support reviews of people’s needs.
 

There was no evidence that people and their carers were always informed of what current good practice looked like in relation to their assessed needs and involved in how this may impact their care and support. For example, the equipment required to safely support someone with transferring.
However, the provider planned people’s care and treatment with them, including what was important and mattered to them.
People told us that staff knew what they are doing and seemed confident and competent when supporting them. Daily records provided evidence of staff supporting people well with complex physical and mental health needs.
 

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.
Staff had not been proactive in working with other services when multidisciplinary involvement was required for 1 person, and there was a lack of evidence that actions were followed up on as needed. The absence of clear accountability and coordinated care across teams led to risks being poorly managed, potentially compromising safety. Following our feedback, action was being taken to address this.
 

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

We saw evidence that staff had worked with a person to gradually reduce their care and support following a person-centred review of their needs. Daily records evidenced that staff were flexible to ensure that people’s well-being was prioritised. For example, moving calls to ensure people could attend activities and appointments. Records were viewed of supportive and interested discussions staff had with people about the activities they enjoyed in the community, their exercise routines and diets.
 

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.
Clinical monitoring tools were in place for known or emerging healthcare needs for 1 person, including food and fluid monitoring. However, there was a lack of evidence as to why these were in place, who was monitoring them and that action had been taken to address concerns and improve outcomes.
 

One staff member was not familiar with the Mental Capacity Act 2005 when we spoke to them. However, peoples’ rights and decisions around consent were understood and respected by staff and the service. One staff member told us, “Staff allow client to have a choice, options, these are the options, you have a voice too, you go ahead and let me know.”
People told us that staff would seek their consent before completing a task and they were in control of their care and support.
However, where there was reason to doubt 1 person’s mental capacity relating to safe moving and handling decisions, there was no evidence that a mental capacity assessment had been completed. The service had not identified this gap or escalated the concerns to the relevant agencies.

When a care plan was reviewed it was not always re-signed by the person. Therefore, we viewed care plans that had not been signed for several years to confirm the person had read and consented to the content.