Geocare Services Limited

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 assessment we rated this key 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 service remained in breach of legal regulation in relation to people’s consent.

This service scored 33 (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.

We received mixed feedback from people and their relatives about the effectiveness of the care provided. One relative told us, “The carers are often rushed and don’t always pay attention to detail. I as relative shouldn’t always be telling the carers what to do”. However, another relative told us, “The regular carers know what my relative likes and needs and cover all his duties. The carers are usually on hand to do extra if needed”.

Care plans did not always contain evidence to show people’s needs had been effectively assessed. For example, 1 person’s care records included a Diabetes care plan which identified symptoms of hypoglycaemia and hyperglycaemia. However, there was no information to guide staff on the actions required if these symptoms occurred, including escalation processes or how to provide appropriate support. Staff routinely involved in the person’s care were unable to describe the necessary actions in response to these risks. This meant the provider failed to ensure the person’s needs associated with Diabetes were effectively assessed and managed, placing the person at risk of harm, including potentially serious and life-threatening complications associated with both hypoglycaemic and hyperglycaemic episodes.

Although people were aware that care plans were in place, they were not always involved in developing or reviewing them. This limited opportunities for people to contribute to their care and ensured plans were not consistently reflective of their current needs or preferences.

The provider did not always plan and deliver people’s care and treatment around evidence based good practice and national guidance.

While reference was made to nationally recognised tools to assess risks associated with malnutrition and skin deterioration, recorded scores were not supported by detailed guidance. For example, where a person had a pressure ulcer, a nationally recognised assessment had been completed and a score recorded; however, there was limited detail about the person's specific risks, how the score had been determined, or the actions required to mitigate identified risks. This meant it was not always clear how assessments were being used to inform and guide care delivery.

Care plans and risk assessments did not always provide staff with sufficient information, based on best practice and national guidance, to support people’s specific healthcare needs. For example, where a person had a catheter in place, there was no care plan or risk assessment to guide staff on how to provide safe catheter care, monitor for potential complications, or respond to concerns. This meant staff did not have clear written guidance to support the person's assessed needs consistently and safely.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Some staff were unable to demonstrate a clear understanding of when and how to escalate concerns. For example, in relation to catheter care we spoke to staff who were unable to clearly describe what actions they would take and which health professionals they would contact if concerns arose including if the catheter site became sore or if there were signs of complications. This indicated a lack of knowledge and understanding in relation to safe catheter care and monitoring. However, some staff described care plans as a source of guidance and felt confident to escalate concerns to health professionals.Records did not always contain sufficient or robust information to support safe and effective care delivery. For example, lack of detail for pressure care, catheter care, wound care, diabetes management.This demonstrated that systems were not effective in ensuring staff, teams and services worked together to deliver safe, coordinated care, placing people at risk of harm.However, the provider told us they had systems in place to ensure coordinated and joined-up care, using information from local authority support plans, their own observations, and discussions with people and relatives to inform care planning. Electronic care records were used to share information with staff, alongside paper copies held in people’s homes.

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.

Systems were ineffective in ensuring care plans and risk assessments accurately reflected people’s health and wellbeing needs. As a result, staff did not always have sufficient information to support people effectively. Records showed that people required support with nutrition and hydration; however, care plans lacked detailed guidance on people’s individual needs relating to their nutrition and hydration and associated risks. This meant there was insufficient guidance for staff to manage people’s nutrition and hydration effectively, placing them at risk of harm, including dehydration, inadequate nutritional intake, weight loss, and deterioration in their health and wellbeing.

Staff demonstrated some awareness of people’s nutritional and hydration needs in practice, such as preparing meals in the absence of relatives. However, staff also told us they sometimes identified needs during visits that were not reflected in care plans, highlighting a lack of accurate and up-to-date information to support consistent, effective care.

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.

Care plans did not demonstrate that people’s health and wellbeing were routinely monitored, and staff did not always have access to up-to-date or sufficiently detailed information to support safe care. While staff understood some people’s day-to-day needs, they were not consistently aware of individual risks or how to respond to changing needs appropriately.

Records did not provide clear guidance to monitor and manage identified risks. For example, pressure care assessments lacked sufficient detail to guide staff in preventing and managing skin damage. In addition, people at risk of choking were not always supported by appropriate assessments, such as Speech and Language Therapy (SALT) input, and care plans did not contain clear instructions to ensure safe eating and drinking. Where people required support with catheter care, there were no systems in place to monitor this health need to ensure people had positive outcomes. People’s urine output was not being consistently recorded or monitored to ensure any concerns could be identified quickly and acted upon. This meant the provider failed to ensure risks to people’s health were effectively assessed, monitored and mitigated.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.There was insufficient evidence to demonstrate how people’s mental capacity was assessed, how decisions were made in their best interests, or how consent was sought and recorded in line with the Mental Capacity Act 2005. Records did not clearly show how consent was considered, particularly in more complex situations where capacity may have been in question.Documentation reviewed did not specify the decision being assessed, who was involved, or the outcome of any mental capacity assessments. This limited assurance that assessments were decision-specific and undertaken in line with legal requirements.

There was also a lack of clarity regarding consent, as documentation included signed consent forms by relatives without clear evidence of appropriate legal authority, such as a valid Lasting Power of Attorney. This meant the provider could not demonstrate that consent to care and treatment was obtained and recorded lawfully.

Staff told us they sought consent in day-to-day care, for example before providing personal care. However, this was not supported by robust systems and records to demonstrate consent was consistently obtained and managed in line with legal requirements.