Care Outlook (West Wickham)

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 inspection we rated this key question good. At this inspection 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.

We found the provider to be in breach of 1 legal regulation relating to Consent.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Assessments of people’s needs were carried out prior to joining the service to ensure their care needs could be met. However, re- assessments were not always carried out when people returned home after a hospital admission. This assessment would help the provider to assess whether there had been a change in people’s needs in the first instance before care is delivered. The re-assessment would also establish whether there were any shortfalls in the person’s current needs and how these could be mitigated to prevent future hospital visits and for relevant risk assessments and care plans to be updated as required.

People told us they were included in discussions about their needs and care when they initially started receiving support.

The provider did not always maintain records demonstrating that they involved people and/or their relatives in planning and delivering their care and treatment, including what was important and mattered to them.This meant people’s changing needs were not always identified and documented.

Clinically recognised tools to enable a structured approach to the assessment and monitoring of risk, were not used appropriately in respect of health conditions, such as skin integrity and behaviours that cause distress. For example, we reviewed 2 repositioning charts, which helped to ensure that individuals were being moved into different positions regularly to prevent, or support the healing of, pressure ulcers. Both repositioning charts identified that people were not being repositioned regularly, in line with their care needs.

People’s care plans did not always include all relevant information about their specific health conditions and how they impacted them as individuals. This included dementia, stroke, asthma, rheumatoid and osteoarthritis. Care plans contained some general information about certain conditions, but there was limited or no guidance for staff on how to support people with these conditions appropriately and safely.

Following the inspection, the provider sent us updated risk assessments and risk management plans. We will check that these have been. implemented for other people using the service at our next inspection.’

The provider did not always work well across teams to support people. Staff did not always adhere to the visit times scheduled to ensure people’s time critical medicines were administered when they should have been and to ensure care was consistent and joined up.

The provider had not taken effective action to address poor record keeping or the irregularities of visits to improve the co-ordination of some people’s care.

Some people’s care was delivered by a variety of different staff. This meant staff often supported them without understanding their needs, risks, or routine. People and their relatives told us communication between staff could be variable. One person told us, “I seem to get lots of different [carers], so it means that I must explain to each different carer what they need to do, and it becomes very waring. I have to do this quite often. I think this has an impact on my care; there is room for improvement.” A relative told us, “[Person] has 4 calls a day and has limited mobility so needs a stand aid and should have 2 carers at each call, but that doesn’t always happen.”

Other relatives said, “The regular carers that [person] has got to know are pretty good, but they need holidays and days off” and “As long as [person] has an experienced carer it is not a problem with transferring [person]” and “Overall, yes I am happy with the care [person] receives.” One person said, “I’m happy with the care I’m getting.”

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives or, where possible, reduce their future needs for care and support.

People’s needs and risks were not always assessed in relation to their mental health needs and how this impacted them in the delivery of the regulated activity of personal care. For example, 1 person’s care plan stated, ‘My mental health care team will be involved in regular reviews to adjust my care plan as needed.’ However, care records did not always document when this meeting with the mental health care team took place, the outcome of the mental health team’s involvement and if any changes needed to be made to the person’s care plan and risk assessments.

For people living with mental health conditions and behaviours that caused distress, there were no positive behaviour care plans being completed to help people and staff did not have training in this approach. For example, for one person had a very specific and complex mental health condition, we asked staff about this condition and how they supported the person. One staff member said, “Yes person has a mental disorder, they just talk to their self, but I don’t know the name of the condition.” and “I do not note behaviours anywhere.” We asked staff about another person’s specific mental health condition, how it impacted the person and the positive behaviour strategies they use to support the person. A staff member said, “I don’t know about this condition, except [person] gets frustrated. I don’t know what positive behaviour strategies is, I just keep asking [person] what they want.” This meant staff could make assumptions about the way people behaved, instead of understanding the condition and how it impacted the person as an individual.

People had enough to eat and drink. we saw information about people's nutritional needs and there was detailed information about people’s nutritional risk and how staff could support people to consider more healthy options to help promote and maintain their health and wellbeing.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, nor that they met health care expectations. This was because people’s care needs were not consistently monitored. For example, repositioning charts were not consistently monitored. Behavioural charts to record behaviours were not used to understand monitor and identify repeat behaviours, themes, trends or factors that could trigger or reinforce acute behavioural incidents. This meant the provider could not be assured that people were monitored and supported safely in line with their care requirements.

There was limited evidence of people’s and their relatives’ involvement in care plan reviews. Therefore, the provider did not have effective oversight of people’s needs, and staff did not always have up to date guidance to refer to. Although the provider completed feedback telephone monitoring and surveys for people using the service, there was no evidence this information was used to improve the care delivered.

The provider was not working within the principles of the Mental Capacity Act 2005 (MCA). The manager and staff did not have a clear understanding of the MCA and when it should be applied. The 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 make particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty.

It was not always clear from care records whether or not people had capacity to make decisions. Assessments of people's capacity to make specific decisions, for example in relation to their personal care, had not always been completed. Records showed that ‘consent to care’ forms had been signed by people, although they did not have the mental capacity to understand or make complex decisions. For example, 1 person who had been deemed not to have capacity to make complex decisions, had signed a ‘consent to care’ form. Another person had been deemed to have capacity, although they did not have ability to understand new or complex information. A mental capacity assessment for them had not been carried out. This meant the provider could not be assured that people fully understood the information in the forms they had signed.

We saw from records that ‘Best Interest’ meetings were not always attended by relatives, healthcare professionals and others involved in the person's care.

Staff told us they sought consent from people before offering them support.