Midlands Care Direct

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 newly registered service. This key question has been ratedRequires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. However, records did not consistently demonstrate how care and support had been formally reviewed or how decisions and actions arising from reviews had been recorded. The registered manager acknowledged that record keeping was an area requiring improvement.

Feedback from the person and discussions with the registered manager demonstrated a person-centred approach to care planning and review. However, improvements were needed to ensure records provided a clear audit trail of reviews undertaken and any changes made to the person's care and support arrangements.

The person who used the service confirmed the registered manager had developed their care plans with them. Additionally, they told us they had regular contact with the registered manager, including face-to-face visits and discussions about their ongoing care and support. They said, “I don’t think I have a copy of my care plan, but I've been through it with the manager. I've attended meetings with the manager, my social worker and CPN [nurse], we talk about my support and if I'm happy with everything. I think everything is all going well. Yes, I've signed documents to say I agree with everything.”

The registered manager told us of their person-centred approach to care planning. They said, “We take time to understand a person’s preferences, strengths, aspirations, cultural needs, communication requirements and desired outcomes. Ensuring these are reflected within their care and support plan. Care plans are developed collaboratively, encouraging the person to make informed choices about how they wish to receive support and to identify what is important to them.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The registered manager told us how they ensured their service was based on best practice and current legislation. They said, “We keep up to date by monitoring guidance from the CQC (Care Quality Commission), National Institute for Health and Care Excellence (NICE), Skills for Care, (is a workforce development and planning body for adult social care in England) and other relevant professional bodies. We regularly review our policies, provide ongoing staff training, attend provider forums and implement learning from audits, incidents and inspections to ensure our practice reflects current standards.”

The provider’s policies reflected current legislation and best practice guidance.

Staff supported and monitored the person’s nutritional, and hydration needs to support their health and wellbeing.

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.

The staff team worked well together to ensure care and support was consistent. Communication procedures, monitoring and oversight by the registered manager were fundamental in ensuring the person received effective care and support.

Staff confirmed how well they worked together and were supported by the registered manager. A staff member said, “The staff team work really well together and there's clear communication and management support. Staff are all on the same page and want to do the best. We've increased the frequency of staff meetings, and this is going well. We have staff meetings and specific meetings to discuss individual tenants as and when we need to and this is supportive.”

Information such as ‘grab sheets’ were in place, to share important information with others such as ambulance crew and hospital staff to support consistency and continuity in care.

Care records confirmed there was a multidisciplinary approach to care delivery. Staff worked collaboratively with health and social care professionals, sharing relevant information and seeking advice when required. This helped to ensure care remained coordinated, consistent and responsive to the person's changing needs, whilst supporting positive outcomes and promoting their wellbeing.

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. Whilst staff supported the person with their health needs including attending health appointments, improvements were required in record keeping.

Records did not always clearly demonstrate the outcomes of appointments, any advice received from healthcare professionals, or the actions staff needed to take to support the person's ongoing health needs. This meant there was not always a clear audit trail to evidence how health information had been considered, communicated and incorporated into the person's care and support. We discussed this with the registered manager who agreed to review and improve their systems and processes in relation to record keeping.

Despite this, the person told us staff supported them to access healthcare services when required and records confirmed staff worked closely with relevant health and social care professionals. This helped to ensure the person's health needs were monitored and supported in a timely manner.

Staff had received training in mental health awareness and demonstrated a good understanding of the person’s mental health needs and the impact this had at times on their emotional needs, wellbeing and safety. A staff member said, “During times of emotional distress it’s important to remain calm and polite and respond by keeping a safe distance and try to deescalate using communication, reasoning and explanation. This usually works, but sometimes it's about recognising the time for space, allowing time before approaching and talking about the issue that's concerning them.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. The registered manager maintained regular contact with the person and held frequent discussions regarding their care and support, as detailed elsewhere in this report. However, records did not consistently reflect these interactions, and there was a lack of documented evidence to demonstrate the ongoing monitoring and discussions that had taken place.

The person 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, including the registered manager, worked with them to promote their safety, wellbeing and independence. They told us they felt listened to and involved in decisions about their care and support, and that staff responded appropriately to their changing needs.

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 (MCA) is a law in England and Wales that protects and empowers people aged 16+ who may lack the ability to make certain decisions for themselves. It sets out clear principles for assessing capacity, making decisions in someone’s best interests, and supporting people to be as involved as possible.

We identified the registered manger was not fully meeting the MCA requirements. For example, the registered manager told us and records confirmed, the person lacked mental capacity with regard to their medicines and finances. In addition, the person’s mental capacity could fluctuate at times when they were mental unwell and or as a result of their lifestyle choices. However, an MCA assessment and best interest decision had not been completed as required, and their fluctuating capacity not planned for. We suggested to the registered manager they would benefit from refresher training to update their knowledge. The registered manager agreed to do this and to complete MCA assessments where required. They also confirmed they would consider the person’s fluctuating capacity and actions required of staff during these times.

The person who used the service told us staff involved them in decisions about their care and support. They said, “The staff are a good group of people, when I have questions they can't answer, they call the manager for me who will talk to me or come and see me. They treat me right, they listen to me.”