IMPACT

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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

Our rating for this key question remains requires improvement. People’s care records contained inaccurate and contradictory statements about their communication needs and abilities. Although staff received training and supervision, we identified concerns in relation to the regularity of supervision and the scope and effectiveness of the training provided. People’s care records did not demonstrate effective communication and collaboration with external teams and professionals involved in people’s care. Staff had not always been provided with clear information and guidance on their role in supporting people with long-term health conditions. People’s rights under the Mental Capacity Act (2005) were not fully understood or protected. People and their relatives confirmed they were involved in the initial assessment of their care needs and were able to readily contact management about any changes in these. They felt the care and support provided addressed what was important to them.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us they were involved in the assessment of their needs when their care started and had opportunities to discuss any changes in need with staff and management, although this may not be as part of a formal review meeting. They felt their care needs were understood by staff and management and were satisfied with the overall outcomes of the care provided. One person said, “Yes, I am happy with my care.” Another person told us, “I am happy with my carers and the company.”

Staff were able to tell us about people’s basic care needs, including the support provided with different aspects of their personal care. They also spoke about people’s individual communication needs. For example, 1 staff member told us, “[Person] is non-verbal, but if [person] is not well, [they] would cry. [Person] shows signs of happiness - [they] will laugh, but if [person] is not showing those signs, [they] could be tired.”

People’s care needs were assessed with them and, where appropriate, their relatives before their care started. However, we did not see any evidence of structured care review meetings. In addition, the risk assessments and care plans we looked at had passed their stated review date. People’s risk assessments did not include any evidence that people and their relatives had been involved in these assessments. People’s care records contained inaccurate and contradictory statements about their communication needs and abilities. For example, 1 person’s ‘Capacity, cognition and communication’ risk assessment stated, inaccurately, ‘[Person] has no capacity, cognition and cannot communicate.’ However, their care plan referred to their non-verbal communication, explaining they made ‘sound which those who know [them] can interpret’.

People and their relatives told us the care staff delivered reflected what was important to them. One relative spoke about the support staff gave their family member with washing, continence care, taking their medicines and preparing meals. Another relative described how staff helped their family member to prepare for bed each night. People and their relatives did not raise any concerns in relation to support from staff with nutrition and hydration.

Staff did not raise any concerns in relation to the training or wider support they received from management to stay up-to-date with the legislation, good practice and required standards associated with their roles. However, we found some staff lacked awareness in relation to their safeguarding and whistleblowing responsibilities.

The provider had processes in place designed to help staff remain up to date with legislation and good practice, such as the provision of a range of mandatory training and discussing important topics during staff meetings. However, we found staff training provision did not always reflect people’s individual needs, and so how to meet these in line with current best practice. In addition, staff had not always received supervision in line with the provider’s policy.

People and their relatives did not raise any concerns in relation to how staff worked and shared information with community health and social care professionals and teams when people accessed different services.

Staff told us they had the information they needed about people’s individual needs to deliver their care. They also spoke positively about the sense of teamwork within the service. The nominated individual spoke about their liaison with occupational therapists in relation to people’s care equipment. The registered manager spoke about how they worked with people’s GPs, pharmacists and social workers to ensure their care needs were met.

We did not speak with any external health and social care professionals as part of this assessment.

People’s care records we looked at contained very limited information about the health and social care professionals, teams and services involved in their care or how staff worked and shared information with these. This did not fully promote joined-up care and effective working between teams.

People and their relatives were satisfied with the support they received from staff in relation to their health needs. One relative explained how staff supported their family member to complete physical exercises, following a medical event. People’s relatives confirmed staff responded to significant changes or deterioration in their family members’ health. One relative said, “They [staff] notice things and they alert us to it. There was [medical issue affecting person] and they alerted us to the fact [person] was finding it difficult to stand and we had to take [person] to the hospital. It is good [person] has had this level of support that we may not notice sometimes.”

Staff felt they had the information they needed to meet people’s needs and they did not raise any concerns in relation to supporting people with their health needs. The registered manager described how they would support people to see their GP, by helping them to make appointments or arrange a home visit.

People’s care records did not always include clear information about their long-term health conditions or the role of staff in monitoring and supporting them to manage these. For example, 1 person staff supported had epilepsy. Staff had not been provided with clear information and guidance on the type of seizures they had, their typical duration, potential triggers for seizures, or signs to look out for that may indicate they were going to have a seizure. In addition, staff training records indicated staff had not received awareness training in relation to people’s known long-term health conditions, such as epilepsy and diabetes.

People and their relatives were satisfied with the outcomes of the care they received, which met their expectations. They did not raise any concerns in relation to inconsistencies in the care delivered and also felt able to speak to staff and management in the event that changes were needed to their care.

Staff did not raise any concerns about the outcomes people experienced from their care. They spoke positively about the overall service provided.

People and their relatives were invited to complete periodic feedback surveys, to ensure the outcomes of their care were positive and their expectations were being met. The provider analysed this feedback. However, the provider’s broader approaches to monitoring and driving improvement in people’s care were not effective. They had not enabled the provider to identify the shortfalls in quality and safety we found during this assessment, and the preceding inspection, including concerns around the management and assessment of risk. In addition, people’s care records did not focus on their skills, strengths and goals, but rather their need for support.

People and their relatives felt their needs and wishes were taken into account when their care was planned and delivered. They spoke about their involvement in the initial assessment of their needs before their care started, and felt able to contact staff and management to discuss any changes in how they wanted to be supported.

Staff told us they had received training in relation to the Mental Capacity Act (MCA) 2005. One staff member said, “I did take training and it is about the individual making decision[s]. If they can't, someone else makes it for them.” However, we found some staff lacked awareness in relation to the role of power of attorney and the legal authority a person can be given to make decisions on their behalf. In addition, the management team did not demonstrate a clear awareness of people’s rights under the MCA. For example, the registered manager informed us they relied on other community professionals, such as social workers, to conduct mental capacity assessments. This did not reflect the potential that any staff member caring for a person may be required to assess their capacity to make day-to-day decisions.

The provider’s systems and processes still had not ensured people’s rights under the Mental Capacity Act (MCA) 2005 were fully and consistently protected. There was no evidence of decision-specific mental capacity assessments in the service users’ care records we looked at to demonstrate how their ability to make a particular decision about their care had been assessed. In addition, there was no evidence of any best-interests meetings or decision-making in the service users’ care records we looked at to confirm any decisions made on behalf of that person had been made in their best interests. Service users’ care records contained inaccurate and contradictory information and guidance for staff on their ability to communicate their needs and wishes, and to make decisions for themselves. These statements did not reflect the principles underpinning the MCA, including the need for assessments of capacity to be decision-specific. In addition, some service users’ care records contained contradictory information on whether their relatives had power of attorney, and so legal power to make decisions on their behalf.