Archived: Sapphire Support Services Limited

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

People were not always involved in planning and reviewing their care and did not always receive the best possible outcome. There was no culture of improvement embedded into practice.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they had not always felt involved in the assessment of their care needs and preferences, although improvements were now taking place and staff had recently been asking them about their care. One person told us their care plan was very out of date and staff were working with them to update their care plan. Relatives told us there had been limited discussion with them about their family members’ needs, wishes and preferences.

The manager was unable to provide us with evidence of how some people’s care needs and preferences had been assessed and kept under regular review. They acknowledged that improvements were needed to care planning and risk assessment processes, and they were in the process of reviewing people’s care plans and risk assessments.

Health and social care professionals told us people’s care plans and risk assessments lacked detail and were not kept under regular review. They said communication with the service was not always good.

The provider had processes in place designed to enable them to assess and meet people’s individual needs, but these were not implemented effectively, and did not ensure people were consistently involved in these assessments. Reviews of care plans and risk assessments were not robust or consistent and did not ensure the information and guidance for staff to refer to, on meeting people’s needs was accurate, up-to-date, complete or effective. Some people were experiencing significant changes in their health needs and accurate records of this were not always kept. This placed people at an increased risk of harm. We requested a number of records pertaining to the provider’s initial assessment of people’s needs and were told these were not available. For example, we were not able to see the initial assessment records for 3 of the 4 people whose care records we looked at and assess the extent to which these were comprehensive and person-centred.

People told us staff were involving them more in planning their care. People told us staff helped them shop for food items and some people had help from staff to prepare meals.

Not all staff we spoke with had sufficient understanding of people’s current care and support needs. There was a lack of care planning and risk management regarding supporting people to access healthy eating options, and the importance of this with improving people’s health and wellbeing. The manager told us they had identified this and were starting to explore with people how they could be supported to access healthy eating options. For example, staff had started to support one person to buy fresh food items and prepare meals.

Records indicated poor monitoring and recording in relation to meeting people’s nutrition and hydration needs. People’s care records were not clear about potential risks in relation to nutrition and hydration.

People told us they were able to access healthcare professionals when they needed to.

Staff were not able to tell us how information was shared effectively with other teams and services.

Health and social care professionals told us people’s care plans and risk assessments lacked detail, were not personalised and there was missing information in peoples care records. Some professionals told us communication with the service was not always effective, although improvements had been made since the new manager was in post.

Staff did not always have access to the accurate, up-to-date and complete information they needed about people’s needs and risks to deliver people’s care. For example, not all known risks had been assessed or clear information and guidance made available to staff on meeting these. In addition, where people’s health needs had changed, these changes had not always been clearly documented. Limited information was available about how staff worked with other services to ensure people benefitted from coordinated care, and we received some negative feedback from external professionals on their communication with the service. For example, one person’s care plans and risk assessments made no reference to the regular input they were receiving from the community nurse team.

People told us they attended medical appointments when they needed to. Some people told us they needed help from staff to do this, and this support was provided.

The manager and staff were not always able to tell us how people had been supported to manage their own health care and wellbeing, or how their associated needs and preferences were discussed and reviewed with them. The manager told us they were in the process of reviewing whether people’s health care needs were being met and follow-up appointments were taking place where appropriate. As part of this, they were updating people’s care records in relation to their health needs and seeking clarification from the relevant health care professionals so care records were accurate, up-to-date or complete.

The local authority informed us about the recent reviews they had completed on people’s care. They had identified the need for improvements in care and outcomes for people, including the need for clearer information about risk and for greater personalisation of care plans.

The provider did not have effective oversight of how people were supported to manage their health and wellbeing. Some people were experiencing significant changes in their health needs, and accurate records of this were not always kept. There was limited information available about people’s co-ordinated care including how professionals were working together to ensure people’s needs were appropriately assessed and understood.

People we spoke with had not always felt their views and suggestions about their care, and how this might be improved, had always been listened to. However, they said things were now improving at the service and staff were now asking them about their care and what they want to do and achieve. One person told us, “It wasn’t very good before, you would ask for something and nothing happened. I think now the manager is very good and they listen, and things are starting to improve.”

The manager and staff were not always able to tell us how people’s care had been monitored, and how people had been supported to achieve skills, strengths and goals.

People’s care had not been monitored effectively to ensure they experienced positive and consistent outcomes. Care records were not accurate, up-to-date or complete. The manager and told us that improvements were being made and there was evidence of some improvements at the time of our assessment.

People we spoke with had not always felt their views and wishes were taken into account in the planning or delivery of their care. This included decisions made about the management of people’s medicines, and the degree to which they were supported to manage aspects of this independently. Relatives told us they had limited involvement with their family member’s care. However, people told us they were supported by staff to make most day-to-day decisions about their care. People told us staff asked for their consent before providing care.

Staff we spoke with had some understanding of people's rights under the Mental Capacity Act (MCA) and told us they encouraged people to make everyday decisions. This included decisions about what people wanted to do, how they spent their time, and what to eat and drink. However, people’s consent to care and treatment, and guidance on people’s mental capacity, had not always been documented in their care plans. This limited staff’s insight into what decisions people were able to make for themselves and where they needed support, including staff support with their medicines and finances.

The provider's processes for assessing and documenting people's consent to care were not effective. People’s rights under the Mental Capacity Act 2005 were not fully supported or always understood by staff. This included a lack of clarity and robust recording in relation to people’s capacity and support needs regarding medicines management and managing their personal finances. There was limited evidence of discussions with people about their views and wishes for their care or their involvement in decisions made in relation to their care. The manager told us they were aware of the process to follow to ensure any decisions made on people’s behalf were made in their best interests and were taking steps to implement the provider’s MCA policy and to make the relevant improvements.