Bateleur HC 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.

This is the first assessment for this service. This key question has been rated 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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. However, we found guidance available to staff within some care records was occasionally limited. Although this had not impacted on the delivery of effective care, it increased the risk that staff may not always have sufficient information to provide consistent support. The registered manager took immediate action to address these findings and implemented improvements to record keeping.

People spoke positively about how staff met their individual needs and were confident in the care they received. They told us they were involved in reviews of their care packages and that changes to their needs were responded to appropriately. One person said, “We review the care plan together, any changes needed are arranged.”

The provider had systems and oversight processes in place to identify changes in people’s health, care and support needs. Changes in circumstances acted as an additional trigger for reviewing care packages and, where required, seeking advice and support from external health and social care professionals to ensure people continued to receive appropriate care.

Care records demonstrated that people’s individual communication needs had been assessed and planned for. Staff were provided with guidance on how to support people to communicate effectively, which in some cases included assistance with reading and understanding mail and other correspondence.

Staff understood the importance of adapting their communication approaches to meet people’s individual needs. They gave examples of how they supported people effectively. One staff member said, “I meet people's different communication needs by considering each person's individual needs. I speak clearly and respectfully, give sufficient time to respond, listen carefully and use simple language where appropriate.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. However, we identified the provider was not consistently following the National Institute for Health and Care Excellence (NICE) CG139 in relation to catheter care provided in the community. Staff had received training in catheter care and were knowledgeable, the shortfall was in relation to care plan and risk assessment guidance. This was discussed with the registered manager who agreed to review their care records and practice.

Some people required care and support with preparing meals and drinks, and with eating and drinking. One person required daily support with meal planning, shopping and cooking. Guidance for staff included supporting and respecting people's choices while encouraging healthy eating and promoting independence. Staff had completed food hygiene training and were aware of people's specific dietary needs and preferences.

The provider had a range of policies and procedures in place which were up to date and reflected current legislation and recognised best practice guidance.

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 spoke positively about how staff worked with external professionals, where necessary, to meet their care and support needs. For example, staff worked closely with GPs, district nurses and other healthcare professionals and followed professional guidance to help ensure people's needs were met safely and effectively.

The provider's electronic care recording system enabled staff to record and share handovers effectively, supporting continuity and consistency of care.

Staff had developed positive working relationships with external professionals and maintained effective lines of communication. This enabled information to be shared appropriately, supported positive outcomes for people and helped ensure a consistent approach to their care and support.

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 told us they were confident care staff would contact healthcare professionals when needed. A relative also told us staff kept them informed about their family member's needs and any changes in their health or wellbeing. One person said, “I’m confident they [staff] would get the GP if I was ill. They stayed extra time for me when I was not well and phoned 111.”

Staff told us they would promptly seek advice from healthcare professionals and escalate concerns whenever they identified changes in a person's health, wellbeing or support needs. They demonstrated an understanding of the procedures for contacting relevant professionals and ensuring people received timely support.

The provider's monitoring systems enabled staff to identify and respond appropriately to any deterioration in a person's health or wellbeing. For example, through reviewing daily records and incident reports, staff identified an increase in one person's emotional support needs and associated risks. This prompted contact with the person's multidisciplinary team, and a review of their care and support arrangements was undertaken.

The provider routinely monitored people’s care and treatment to continuously improve it. However, they were unable to consistently ensure that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. We found the provider’s process that reviewed people's care packages, required strengthening. Information recorded was not always sufficiently detailed and did not consistently demonstrate the outcomes of the discussion or any actions agreed. We discussed this with the registered manager, who acknowledged this as an area for improvement.

Care plans were generally outcome focused. However, people's desired outcomes were not always clearly recorded or sufficiently detailed. This meant it was not always possible to determine whether people had achieved their goals or whether care and support had been effective in helping them achieve the outcomes that were important to them. The registered manager recognised the need to strengthen the recording of outcomes within care plans to better demonstrate people's progress and the impact of the support provided.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. However, some shortfalls were identified.

The Mental Capacity Act 2005 (MCA) provides a legal framework to protect and empower people aged 16 and over who may lack the mental capacity to make specific decisions for themselves. The Act sets out the principles of assessing capacity, supporting people to make decisions wherever possible, and making decisions in a person's best interests when they lack capacity.

The registered manager had not consistently recorded whether people had the mental capacity to consent to their care and support. In addition, where people's mental health conditions indicated they may experience fluctuations in their capacity to make decisions, this had not always been considered within care planning or risk assessments. The registered manager confirmed they had not completed any MCA assessments or best interest decision records, instead relying on assessments completed by external professionals. This meant the provider could not always demonstrate they had appropriately considered their responsibilities under the MCA in relation to the care and support they were providing.

We discussed this with the registered manager and reminded them of their responsibilities under the legislation. The registered manager acknowledged the shortfalls identified and agreed to review current arrangements, training needs to ensure the requirements of the MCA were consistently understood and applied in practice.