Archived: East Anglia Domiciliary Care Branch

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 aviation evidence. At our last assessment we rated this question requires improvement. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.The provider was previously in breach of legal regulations in relation to safe care and treatment, person centred care, dignity and respect and consent. Improvements were not found at this assessment, and the provider remained in breach of these regulations. Additionally, the provider was in breach of regulations relating to meeting people’s nutritional needs and consent.

This service scored 29 (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 was effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them or their relatives. Care plan reviews had not been taking place. A lot of care plans were overdue for review and there was little evidence of involvement of people or their relatives. Some relatives said they had annual reviews. However, there was little evidence of these being reflected in the records. We identified a lack of people’s needs being assessed to ensure appropriate measures were put in place. We identified people who had high cholesterol, epilepsy, and catheter care whose needs had not properly assessed and appropriate measures put in place. Tools such as Malnutrition Universal Screening Tools (MUST) were not being completed routinely for people who had concerns on their nutritional intake to ensure appropriate measures were being put in place and referrals made as needed.

The provider did not plan and deliver care and treatment referencing and following legislation and current evidence-based good practice and standards. We found the provider was not taking into consideration best practice guidance about epilepsy or medicines management. The Mental Capacity Act 2005 was not being followed in respect of ensuring people’s consent was sought, relevant best interest decision made and ensuring care was provided in least restrictive way. CQC’s Right Care, Right Support and Right Culture was not being followed in relation to positive behaviour support.

There had been constant change in some of the homes, with times of heavy reliance on agency staff. New staff had been recruited and some of the service leads were new to the role and had not been in post long. How well teams worked together, depended on some of these factors. Some staff raised concerns about how well their team were working together with some staff falling out and lacking basic knowledge of how to care for people. In other homes, especially in those with established teams, staff told us how supported they felt and how well they worked together to support people and meet their needs. Measures were being in place by the locality manager to help support staff including meetings with the service leads to help improve networking, communication, learning and consistency in the way the homes were run.

The provider did not always support people to manage their health and wellbeing, so people could not 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. We found the guidance in care plans lacked details in this area or was non-existent. When there was a need that people should be encouraged to eat healthy, there was no guidance as to what that was for that person. Relatives had raised concerns and complaints regarding what people were eating. Two people had become pre-diabetic. However, some staff said it was people’s choice and there was little evidence of encouragement.

People’s wellbeing was not always being supported. There were no positive behaviour support plans being completed to help people and staff did not have training in this approach. This meant staff could make assumptions about the way people behaved. One person’s records said they had no mental health issues, but they did burst into tears when they could not get their own way. It suggested they should be reminded, ‘ladies do not do that’ and if there was an issue they should speak to staff. However, they had very limited verbal vocabulary, and their learning difficulty impacted on their ability to communicate their wishes and feelings, so it was difficult to see how they could verbalise this in a way staff could understand.

The provider did not engage people to look at their life ahead. They did not identify their skills, life experience and strengths to look at their life choices, goals, ambitions and outcomes so these could be planned. Care plan reviews were not taking place to ensure the plans in place were complete and accurate. There was little goal setting or independence planning. The examples we found were not always completed. One person had a goal from January 2024 to go shopping with staff to choose the weeks food shopping. It identified actions to complete. The outcome was some of the goal was achieved. They had written a list, but staff needed to prompt them to go to the supermarket. Another person’s goal was to buy some new shoes which they needed staff support with, dated August 2024. The outcome was they were currently not working on it but were looking through a catalogue and would come back to it later. This meant people’s outcomes from their life were not going to improve due to lack of identifying goals and planning for them to be achieved.

Consent was not always obtained or recorded in line with relevant guidance and legislation. Where people lacked the capacity to make specific decisions about their care and the restrictions in place, the provider had not obtained written evidence as required to show legal processes had been followed. Some people had their name added to their care plan to show they had consented without their capacity being assessed, even though their records showed they lacked capacity in other areas. For one person, their records had been updated after they had given consent. They had consented on 29 January 2024 and the records were dated 24 December 2024, which showed they had not consented to the changes. We found in some cases there were capacity assessments completed to show people lacked capacity to make a specific decision without a decision made in their best interests. In other cases, we found a decision recorded as being made in someone’s best interest without their capacity being assessed to show they lacked it to make the decision. This showed a lack of understanding and implementation of the legislation, Mental Capacity Act 2005. Some staff spoken to did not have a good understanding of capacity in relation to such things as vaccinations and who could make decisions if the person lacked capacity.