Hazelcare Head Office

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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.

This is the first assessment for this service type of supported living. 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.

We found improvements were needed to ensure people’s health needs were fully assessed and mental capacity assessments and best interest decisions were clearly documented for people where required.
 

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.
People’s care plans provided an assessment of their needs and gave some information about people’s health, wellbeing and communication needs. However, some areas of people’s care had not been recently reviewed and did not reflect their current needs. For example, 1 person’s care plan recorded they had a wet room and completed their personal care independently. The person had a shower they were not currently able to use and required support with personal care due to reduced mobility. Care plans did not always clearly record the support people needed to manage their health conditions, such as diabetes or epilepsy.
The provider told us people were regularly asked for their feedback about their care and support, their comments recorded in their care plans, which were then updated. However, we did not find this had always been completed with people.

People and relatives had different experiences of being involved in reviews of people’s care and care plans. People’s comments included “They’ve been changing it, every year they sit you down and go through it with you” and “Saw my care plan when I first moved in not since”. Relatives told us, “They are really good at that, I have a copy of the care plan” and “We have not had a care review in 3 years.”
 

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.
Some people’s care plans required more detail to ensure staff had clear guidance on how to support people with their health conditions. For example, where people had epilepsy, more information was needed to ensure any seizures people had were monitored and recorded.
People’s weight was not being routinely recorded despite some people’s care plans stating they should be monitored for weight changes. This meant changes in people’s weight which may be of concern may not be identified. However, 1 person told us they had lost weight and their relative told us, “They had a dietician referral, [staff] are really good with their diet, they have lost weight.” The provider told us written weight records were in place for 1 person however these were not shared with us.

People had eating and drinking care plans which recorded their preferences and any support they needed to maintain their nutrition and hydration. Staff assisted some people to prepare meals and drinks as part of their support. People told us they were supported to make their own choices about food and drink. Staff told us they encouraged people to make healthy choices where possible and recorded people’s choices in their care notes.
Where people had been identified as at risk of constipation, care plans recorded the systems used to monitor this and actions to take if there were concerns.
Staff completed specific training relevant to people’s care and support needs, such as learning disability, autism, and mental health training. Staff inductions covered specific information about the people they would be supporting.
 

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.
Staff attended team meetings which provided opportunities to discuss people’s care and support. Daily handovers were also held to share information. Staff were kept updated about people’s needs. One staff member told us, “Any changes are shared through handovers, care plan updates, and communication from management so staff can provide the right support.”
People’s care files contained emergency admission packs, which gave an overview of people’s support needs. They contained information which could be shared with healthcare services.
We heard mixed views from professionals regarding how the service shared information across services, depending on the specific supported living service. A health and social care professional said of 1 service, “Health needs were identified early, and appropriate referrals were made without delay” but for another service, “Communication can be slow, and obtaining information from the provider is often difficult. This can impact multi-agency working.”
 

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.

Care plans explained people’s mental health support needs and actions staff should take if their mental health deteriorated. However, there was limited information about some people’s physical health conditions within their care plans, for example where people had skin conditions or diabetes. This meant staff did not always have enough guidance about associated risks, required monitoring, and any support measures necessary to ensure any concerns were identified and escalated.

Although we found people regularly had access to their GP, appropriate referrals had not always made in a timely manner. For example, where staff had identified a person’s mobility needs had increased a request for an occupational health referral was not made until we raised this with the provider.

Some people told us they managed their health appointments independently, where others needed more or full staff support. People were satisfied with the support they received from staff with their health appointments. Comments included, “I have a list of my appointments in my wallet. Staff have got a copy in case it gets lost” and “Staff arrange my doctors’ appointments. Once a week, my bandages are changed.” Staff recorded the outcomes of people’s health appointments in their care notes.
 

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.
People’s care records were not regularly and effectively monitored and reviewed by the provider. Provider audits had not identified the areas we found where there was a lack of relevant information in people’s care plans about health conditions and changes in needs such as a deterioration in mobility. People’s care plans recorded the outcomes they wanted to be supported to achieve and gave information on how staff should support them to achieve these outcomes. However, records did not show how people had been involved in reviews of their care. This meant it was not always clear if the provider monitored people’s outcomes or if they continued to meet people’s expectations.
People using the service told us they were happy with the care and support they received. They spoke positively about the support provided and were complimentary about how staff worked with them.
 

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.
MCA and best interest processes had not always been followed or reviewed. Decision-specific mental capacity assessments and best interest decisions were not always in place for people identified as lacking capacity.
Some records contained conflicting information about people’s capacity to manage specific areas of their care. For example, 1 person’s medicines risk assessment recorded they lacked capacity in relation to their medicines but also stated they managed their medicines independently. The person had a mental capacity assessment which stated they had capacity to manage their own medicines, however this had not recently been reviewed.
The provider had not regularly reviewed consent forms in people's care records. Records showed that some people assessed as lacking capacity in specific areas had their name signed on consent forms, with no clear evidence of how consent had been obtained or that they understood what they were consenting to.
Staff were aware of the need to seek people’s consent before providing any care. Comments included, “I always ask for consent before offering support.” and “I explain what I am doing, ask for consent, and encourage the person to do as much as they can independently.”