Quality & Compassion 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 requires improvement. At this assessment the rating has remained 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 1 legal regulation in relation to consent.

This service scored 54 (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 told us their needs were assessed before they began receiving care and support from the service. People had care plans in place however, these were not always reflective of their current needs. For instance, some people’s care notes indicated they were supported to move from bed with equipment, however, their care plans informed staff should not use the same equipment.

People who had skin integrity concerns did not have clear care plans for staff to follow. People we spoke with could not always remember if care plans had been reviewed.

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

The provider did not routinely ensure they followed best practice guidance for supporting people with diabetes or epilepsy. For instance, there was not always clear guidance for staff on how to support people with epilepsy or how they would identify the person was having a seizure. Information relating to people’s individual diabetic needs was not recorded to ensure staff had the information required to recognise when a person was hypoglycaemic or hyperglycaemic (Blood sugars being too high or too low)

However, staff told us they received training in key areas such as diabetes and modified diets as examples. One member of staff told us, “I have supported service users with dysphagia, which is difficulty in swallowing, the company organised a training.”

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.

Systems were in place to share information with staff. One member of staff told us, “When working double-up calls, carers also work together closely by communicating effectively throughout the visit. Staff support one another, discuss any concerns identified during care, and ensure that tasks are completed safely, appropriately, and according to the client’s care plan.” Other staff comments included “I feel there is good teamwork and communication within the service” and “Staff and teams work together by communicating, handing over properly, management updating when there are any changes and doing follow ups on concerns.”
 

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 and their relatives gave us positive feedback about how the care staff supported them with their health. One person told us staff had called an ambulance when they were taken unwell. Another person told us, “I will ask them to call the GP or district nurse, and they do that for me.”

Staff told us they looked out for any changes in people’s needs and reported this to the office. One member of staff told us, “I understand people’s healthcare concerns by reading care plans, handovers, and observing changes in their wellbeing. If I notice deterioration, I will report to the office immediately so that action can be taken quickly.”
 

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.

We found care plans did not always guide staff on how to support people with complex needs. We found the provider was unable to demonstrate care plan reviews occurred. However, the registered manager told us care plan reviews regularly occurred. People and relatives could not always be certain reviews had occurred. Comments included, “I don't know when they do it” and “I can’t remember it has been a while”. However, other comments included, “They did a phone call review, I think it was last month, and “We have had 2 a year.” We have discussed this with the provider to ensure review of care plans are carried out with people and relevant people.

The provider did not work within the guidance of The Mental Capacity Act 2005 (MCA).
The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any decisions made on their behalf must be in their best interests and as least restrictive as possible.

Legal consent for the care and treatment delivered was not consistently in place. The provider had failed to adhere to the MCA. Mental capacity assessments were incomplete and did not follow best practice guidance. People who had restrictions in place such as lap belts and bed rails did not have clear mental capacity assessments which were decision specific regarding those restrictions.

Mental capacity assessments did not routinely have a clear outcome recorded. Where outcomes were recorded, the assessments did not ensure decisions were made in people’s best interests. The provider failed to ensure people were supported in line with the MCA and associated code of practice. This had the potential to reduce people’s human rights.