Totus Care Ltd

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 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.

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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People's needs were assessed; however, assessment and care planning records were not always accurate or consistent. We found discrepancies between care plans and other documentation relating to people's needs. For example, one person's assessed needs in relation to epilepsy did not align with the guidance provided by a healthcare professional. When discussed, the manager was unable to confirm which document reflected the person's current needs and support requirements. This created a risk that staff may not have access to accurate information to guide safe and effective care.

Relatives told us that they, and the people receiving care, were involved in assessing needs and planning support as much as possible. One relative said, “It’s difficult (to involve) [person] because they like what they like. They have a tendency of turning things down. There are ways of encouraging them to take part in things.” Another relative said, “[Person] wasn’t involved in the assessment process, but he wouldn’t be able to be.” There was limited documented evidence to demonstrate how people and their relatives had contributed to assessments, reviews or decisions about care. As a result, the provider could not consistently evidence that assessments were person-centred and reflected the views, preferences and wishes of the people receiving support.

We did not identify evidence that people had come to harm because of the issues found. However, inaccuracies and inconsistencies within assessment documentation meant the provider could not be assured that staff always had access to clear, up-to-date information about people's needs, or that people and their representatives were fully involved in the assessment process.

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

Whilst we did not see evidence that people's day-to-day care was affected, some care plans did not evidence that best practice guidance had been considered. For example, one person's care plans did not reflect guidance from health professionals on managing their condition. There was no evidence that this had caused harm to people.

Where people had specific nutrition and hydration requirements, these were clearly documented within their care plans. Care plans provided staff with detailed information about dietary preferences, nutritional risks, fluid intake needs, and any support required with eating and drinking. Staff demonstrated awareness of these needs and monitored people appropriately to ensure they maintained adequate nutrition and hydration, helping to promote positive health outcomes 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.

People benefited from coordinated care and support because staff, teams and external professionals worked together effectively. Feedback from relatives and staff was consistently positive and indicated that the service maintained good communication with relatives and informal carers, ensuring they were involved in discussions about people's care and wellbeing where appropriate.

Records demonstrated that the service worked collaboratively with a range of professionals and agencies to support positive outcomes for people. There was evidence of regular liaison with social workers, healthcare professionals and solicitors when required. Information was shared appropriately to ensure people received joined-up care and that decisions were made in their best interests. This collaborative approach helped to ensure people's needs were understood, reviewed and responded to in a timely manner.

One staff member told us, “We get updates about people’s needs verbally, via email, in team meetings and by care plans being regularly updated.”

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.

People were supported to maintain and improve their health and wellbeing through encouragement to make healthy lifestyle choices. We saw evidence that people were supported to remain active and participate in activities that promoted their physical and emotional wellbeing, in line with their preferences and abilities.

Staff encouraged people to make informed choices about their nutritional intake and supported them to follow healthy eating practices where appropriate. One staff member told us about one person’s tendency to make nutritionally poor choices around their food and described how they support them to make healthy decisions. Care records demonstrated that people's health needs were monitored, and support was provided to help them maintain a balanced diet and healthy lifestyle. This person-centred approach promoted independence, wellbeing and positive health outcomes for people using the service.

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.

People’s care plans contained identified goals and expected outcomes for the care package. However, the provider could not demonstrate that people, or where appropriate their relatives and representatives, had been meaningfully involved in setting these goals or reviewing progress towards them.

Records reviewed showed that goals were documented within care plans, but there was limited evidence to confirm that these had been developed following discussion with the person receiving care. Team meeting minutes indicated that staff were contributing to and identifying goals; however, there was no clear evidence that people were actively involved in determining what outcomes were important to them or what they wished to achieve through their care and support.

The provider shared only one example of a care plan review. This record focused primarily on checking and updating documentation rather than evaluating the effectiveness of the care package. There was insufficient evidence to demonstrate that reviews considered whether identified outcomes had been achieved, whether goals remained relevant, or whether people were satisfied with the care and support they were receiving. However, one relative told us, “They review the care regularly. We meet often to make sure everything’s ok.”

As a result, the provider could not demonstrate robust systems for monitoring outcomes, measuring the effectiveness of care, or ensuring people’s views informed the ongoing development of their support. This meant opportunities to review progress, identify changes in need, and improve people’s experiences and outcomes may not always have been fully recognised.

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 provider had systems in place to assess people’s capacity to consent to their care and treatment where there were concerns about their ability to make decisions. However, mental capacity assessments (MCAs) reviewed were not completed in line with the principles of the Mental Capacity Act 2005 (MCA).

Records did not demonstrate how staff had reached their conclusions when applying the two-stage test of capacity. For example, one assessment relating to a person's ability to consent to their care package consisted only of ‘yes’ or ‘no’ answers being circled, with no explanation of how the person’s understanding, retention, weighing of information, or ability to communicate a decision had been assessed. This meant there was insufficient evidence to show that decision-specific and time-specific assessments had been carried out appropriately.

We also found inconsistencies between different mental capacity assessments completed for the same person. These conflicting findings had not been explained or explored, making it difficult to be assured that capacity was being consistently and accurately assessed.

In addition, records showed that in some cases relatives had provided consent for homely remedies to be administered despite not holding a valid Lasting Power of Attorney (LPA) for health and welfare, nor having any other legal authority to make decisions on the person’s behalf. This indicated that staff did not always have a clear understanding of who could lawfully make decisions for people who lacked capacity. One relative told us, “They always ask [person] for consent, but they do run it past [relative].” The relative who made this comment confirmed they did not have lasting power of attorney for the person receiving support so did not have the legal powers to consent on the person’s behalf.

These issues meant the provider could not demonstrate that consent was always sought and recorded in accordance with relevant legislation and guidance, or that people’s rights were consistently protected when decisions about their care and treatment were made.