Cedar Oak Healthcare Services Ltd

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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.

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.

The service was in breach of legal regulation in relation to person-centred care.

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.

The provider did not ensure people’s care and treatment was effective because they did not consistently assess, review or involve people in their health, care, wellbeing and communication needs.

The provider told us basic information was available to staff before support started, with full care plans expected within a week. However, we found not all people receiving support had comprehensive care plans in place, including people receiving end of life care and those with complex physical and mental health needs. This meant people were at risk of receiving care that did not meet their needs.

Where care plans were in place, these were often overly complex, using clinical language that was difficult for staff to understand and follow. This increased the risk of inconsistent or unsafe care.

Following our on-site visit, the provider submitted information to show these concerns were being addressed; however, these improvements had not been embedded at the time of the assessment.

The provider did not always plan and deliver people’s care and treatment with them, including what was important to them.

Best practice tools to monitor people’s wellbeing in areas including nutrition and hydration, skin integrity and pain management were not used. Although no one reported any specific concerns in relation to this, this presented a risk that health concerns may not be identified in a timely manner. These risks were partially mitigated by the involvement of health care professionals as part people’s individual care packages.

The provider told us they would look at additional training in these areas and review if the electronic system used would support the use of these tools, however these improvements had not been implemented at the time of the assessment.

The provider did not always work effectively across teams and services to support people’s care. They did not always share their assessment of people’s needs when people moved between different services. Which meant there was a risk people’s care was not fully aligned to their needs when they returned home.

The lack of comprehensive information relating to people’s care needs meant staff were not always fully aware of people’s needs prior to supporting them. Some people and relatives told us the assessment information was completed by the hospital prior to their discharge. This meant that information provided was not specific to people’s needs in their own home environment.

In other areas, the service demonstrated positive partnership working. Hospital discharge information was reviewed for concerns and relatives told us they were informed of changes, such as hospital admissions. One relative said, “They make me aware of everything.”

The provider did not always support people to manage their health and wellbeing in a way that enabled them to 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.

Records showed that staff supported people with nutrition, hydration and pressure area care where required. Relatives told us people were appropriately supported with their nutrition, and people said their choices were respected. Staff worked alongside health professionals to monitor risks such as malnutrition and pressure damage. However, we found limited evidence that these areas were consistently monitored, meaning changes in people’s health may not always be identified or responded to in a timely way.

For example, weight monitoring was not recorded, and gaps in care records relating to what people had eaten and how they had been repositioned meant it was not always clear how health risks were being monitored and managed over time.

The provider did not always routinely monitor people’s care and treatment to ensure it improved over time or achieved positive and consistent outcomes.

People’s preferred outcomes were not always recorded or followed. One person’s care plan highlighted the need for social interaction, developing relationships and providing support to increase their independence and self-esteem. Despite this, we found the person's daily care notes were functional and only reflected the physical care the person had been supported with.

Two other relatives told us their family members enjoyed going out. One relative reflected that staff would sometimes support their relative to take a short walk, which they enjoyed and was important to them. However, not all staff were happy to do this, and this was not recorded in the person's care plan. A second person who received live-in care was unable to go out as this required the use of their car, but no driver was available. The service had not explored how the person's wishes could be accommodated.

For other people, we found records confirmed staff supported people in the areas required, and relatives told us the approach of staff meant a lot to their family member. One relative told us, “[Relative] needs companionship and they are communicating with [them]. It is great to see that [relative] has someone to talk to and help with [their] exercises.”

The provider did not always ensure people’s rights around consent were upheld and did not always follow the principles of the Mental Capacity Act 2005.

The provider told us relatives were able to access the electronic system used to review their family members' care notes. Some relatives felt reassured by having this access. However, there was no system in place to ensure people had given their consent to this. No capacity assessments had been completed for people who may not have the capacity to consent to the information being shared. The provider told us they did not believe this was required, as if relatives were sharing information with the service, they felt this meant they were managing the person’s care. A number of people’s care plans stated they lacked capacity, although there was no information to indicate how this had been assessed or what specific decision it related to. This demonstrated a lack of understanding regarding the principles of the MCA and meant people’s rights may not be being upheld.Following our assessment the provider forwarded evidence that systems in relation to consent were being urgently reviewed.

In other areas, people and relatives told us that staff always asked people for their agreement prior to supporting them with their care. One person told us, “We have a good routine now, but they communicate well and check with me at each stage.”