JHN Healthcare 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

This assessment considered the following three quality statements: Assessing needs; Supporting people to live healthier lives; Consent. We found areas of concern in relation to consent. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. Though the assessment of these areas indicated areas of concern since the last inspection, our rating for the key question remains good. People told us staff sought their consent before providing care and support. However, we found a breach of the legal regulation in relation to consent. The service had failed to ensure people's rights were upheld within the principles of the Mental Capacity Act 2005. People’s needs were assessed before they started to use the service. Whilst people told us staff knew them well and understood their specific needs, we found some information was missing from care plans. This was discussed with the management team who took prompt action to ensure records were complete and provided staff with clear guidance on how to support people. Staff supported people to manage their health and wellbeing and to enable them to live healthier lives.

This service scored 71 (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 relatives confirmed their needs were assessed by a member of the management team prior to the service starting and they were involved in these assessments. A person told us, “A care plan was completed by agency with me and my [relative]. The supervisor also visits at least fortnightly to check on care staff and make sure everything is ok.” Another person said, “I get on with the carers, mostly all of them are easy to get along with. It has got to the stage now where I can have a good laugh with them.” Relatives confirmed they were informed about changes in people’s needs and would request support from healthcare and social care professionals if required.

Staff told us they were provided with information about people and their care needs. They felt confident any changes were reflected in the care plan and communicated in a timely manner. Staff demonstrated an understanding of people’s specific needs and described how they adapted their approach to best support each person.

People’s needs were assessed prior to care starting. This helped to ensure appropriate levels of staff with the required skills would be available to provide the care required. People, relatives and health and social care professionals were involved in assessments, if appropriate. Information gathered during assessments was used to create plans of care and support. However, on review of these care plans, people's needs, including aspects of their life which were important to them, their abilities and how people should be supported in line with their needs, wishes and preferences had not been documented. This meant we could not be assured staff were provided with detailed person-centred information to keep people safe and meet their specific needs in line with their choices and wishes. Although the above shortfalls in relation to the quality of the care plans was identified, people and relatives confirmed that staff knew them well and understood and met their specific needs. Additionally, regular checks of staff practice were completed to help ensure people received effective care. Following the site visit on 16 January 2024, the inspector was provided with updated care plans and risk assessments for people. These records demonstrated improvements had been made.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

All people and most relatives felt well supported by staff to manage their health and well being and enable them to live healthier lives.

Staff described a high continuity of care and said they were alert to changes in people’s health or wellbeing. Staff told us they had good support via the on-call system and from external healthcare professionals. They felt confident any changes were reflected in the care plan and communicated in a timely manner.

Processes in place did not fully assure us people were supported to manage their health and wellbeing so they could maximise their independence, choice and control. This was due to the lack of specific and detailed risk assessments and the lack of information in people’s care records in relation to their individual needs and abilities. Following the site visit on 16 January 2024, the inspector was provided with updated care plans and risk assessments for people. These records demonstrated improvements had been made.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

Staff sought consent from people before providing care or support. This was confirmed by both people and staff. People’s comments included, “The staff definitely respect my independence and choice”, “They [staff] always ask me before doing anything and check I’m happy” and, “Yes, they [staff] get my agreement before doing anything, they won’t just do something without asking.”

Staff described how they supported people to make choices and decisions in relation to their care and treatment. Where people refused support, staff told us they would respect this and alert their supervisor. The management team told us information on people's capacity had been provided by health/social care colleagues. They were unable to describe what was meant by phrasing used in records, including ‘Variable’ and ‘No capacity.’ The management team confirmed they has not completed any capacity assessments directly for any of the people they supported. This demonstrated a lack of understanding in relation to the roles and responsibilities held by the management team in relation to Mental Capacity Act 2005.

Processes in place to ensure people’s rights around consent were considered in line with the Mental Capacity Act 2005 (MCA) were not robust. 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 Act requires that, 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 made on their behalf must be in their best interests and as least restrictive as possible. The management team was aware when people lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and be as least restrictive as possible. However, on review of people’s records in relation to this, we identified in a person’s care plan their mental capacity was described as ‘variable’ and another person’s capacity as ‘No capacity.’ No other information was available, indicating people's capacity had not been appropriately assessed. The management team told us there were families who had Lasting Power of Attorney (LPA) to make decisions for people around health and overall welfare. However, they had not always asked for evidence these LPAs. This meant there was a risk families would be making decisions for people where they may not have had the legal authority to do so. The failure to ensure people's rights are upheld within the principles of the Mental Capacity Act 2005 is a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.