Totus Care Ltd

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

This meant people’s needs were not always met.

This service scored 61 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People's care plans contained information about their needs and preferences; however, the quality and level of detail within records were inconsistent. While some care plans provided sufficient information to support staff in delivering personalised care, others were brief and lacked the detail necessary to ensure support was consistently tailored to the individual.

Where care plans were more detailed, they contained information about people's preferences, routines and the support they required, helping staff to provide care in a way that reflected their individual needs. However, this was not consistent across all records reviewed. Some care plans lacked detailed information about how people wished to receive support, what was important to them, and how staff should respond to their specific needs and circumstances.

We also found examples where staff demonstrated a good understanding of people's individual needs that was not reflected within care records. This included information about behaviours and support strategies that staff could describe but which had not been documented in care plans. This increased the risk of inconsistent care being provided, particularly by new or unfamiliar staff who may rely on written guidance to understand how best to support people.

The inconsistent quality of care planning reduced assurance that people's care and support was always planned and delivered in a fully person-centred way. While there was evidence that staff knew people well and sought to provide individualised support, records did not consistently contain the level of information required to demonstrate this.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

People received care and support that was delivered consistently and in line with their assessed needs. Records demonstrated that care plans contained information to guide staff in providing ongoing support and there was evidence that care delivery was monitored to help ensure continuity of care.

Staff demonstrated a good understanding of the people they supported and were able to describe their needs, preferences and routines. This helped to promote a consistent approach to care delivery and ensured people received support from staff who knew them well.

Where changes in people's needs were identified, information was communicated amongst staff to help maintain continuity of care. There was no evidence of people experiencing unnecessary disruption to their care or support, and no concerns were identified regarding how care was coordinated or delivered.

Overall, people experienced continuity in their care and support, and there was no evidence of gaps in care provision or failures in care coordination.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People's care plans included information about their communication needs and the reasonable adjustments required to support effective communication. Records contained guidance for staff on how to communicate with people in ways that met their individual needs, helping to promote understanding and engagement.

However, we did not see evidence that people's care plans, assessments or other key information about their care and support had been shared with them in formats that met their communication needs. As a result, the provider could not demonstrate that people had access to information about their care in a way they could understand. This limited assurance that people were fully involved in assessing their needs, reviewing their care, or providing informed feedback about the support they received.

Whilst staff had considered people's communication needs within care planning, the lack of evidence that care-related information was provided in an accessible format meant people's involvement in decisions about their care may not have been fully supported.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

The provider sought feedback from relatives and, where possible, involved people in decisions about their care and support. Relatives we spoke with told us that people were involved as much as they could be and were enabled to express their views and preferences regarding the support they received.

However, there was limited evidence within care records to demonstrate how people had been involved in assessing their needs, planning their care, setting goals, or reviewing the effectiveness of their support. Whilst staff and relatives described efforts to involve people in decisions, this was not consistently reflected in care planning documentation.

We found limited evidence that people had participated in formal reviews of their care packages or that their views had been routinely sought and recorded. Where reviews had taken place, records focused primarily on the documentation rather than capturing the person's experience of care, whether the support continued to meet their needs, or whether they wished to make any changes.

The lack of recorded evidence reduced assurance that people were consistently involved in decisions about their care and support, or that their feedback was routinely used to shape and improve the service they received.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

People were supported to access care and support based on their individual needs, and no concerns were identified regarding equitable access to services. Care plans reflected people's assessed needs and there was no evidence that people experienced barriers to receiving the support they required.

Records demonstrated that people's communication needs and preferences had been considered, enabling staff to make reasonable adjustments to support engagement and participation. Staff were knowledgeable about the people they supported and understood how to adapt their approach to meet individual needs.

There was no evidence of discrimination, exclusion or unequal access to care and support. People appeared to receive services that were responsive to their needs and circumstances, and we found no indication that any individual or group was disadvantaged in accessing the support available.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

People experienced care and support that was focused on meeting their individual needs and promoting positive outcomes. We found no evidence that people were treated unfairly or experienced inequalities in the care and support they received.

Care plans reflected people's assessed needs and preferences, and staff demonstrated an understanding of the individuals they supported. People were supported in line with their circumstances and requirements, helping to ensure they had opportunities to achieve outcomes that were meaningful to them.

There was no evidence that any person or group experienced poorer outcomes as a result of protected characteristics, communication needs, disability, health conditions or other individual circumstances. Staff were able to describe how they adapted their approach to meet people's needs and support their wellbeing.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People's care records showed that consideration had been given to end of life planning where appropriate. Records documented people's wishes and preferences relating to end of life care, including instances where people had chosen not to discuss these matters. This demonstrated that staff recognised the importance of respecting people's choices regarding future care.

However, there was limited evidence that people had been supported to consider and plan for other aspects of their future. Care plans focused primarily on day-to-day care needs and routine support tasks, with little information about people's longer-term goals, aspirations or what they wanted to achieve in their lives. The provider was unable to demonstrate how people were supported to identify meaningful outcomes, develop skills, increase independence or pursue opportunities that were important to them.

Records did not consistently show that people had been involved in discussions about their hopes, ambitions or future plans, nor how care and support arrangements were designed to help them work towards these. This meant there was limited evidence that care was being planned with a clear focus on achieving personally meaningful outcomes beyond meeting immediate needs.

The lack of emphasis on people's aspirations and future opportunities was not consistent with the principles of Right Care, Right Support, Right Culture, CQC’s guidance on supporting people with learning disabilities and autistic people, which promote person-centred support that enables people to live fulfilling lives, achieve their goals and maximise their independence. As a result, there was insufficient assurance that people were being fully supported to plan for and work towards the future they wanted.