Archived: Exclusive Care Services

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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

Staff failed to complete a comprehensive assessment of each person’s physical and mental health, either on admission or soon after. Care plans did not reflect a good understanding of people’s needs. There were ineffective systems to ensure people’s capacity was assessed and staff had a poor understanding of The Mental Capacity Act (2005). We found a breach of the legal regulations in relation to safe care and treatment.

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 people and relatives we spoke with expressed concerns with assessment processes, our assessment found care did not meet the expected standards. A relative said information they had shared with the provider during the initial assessment about their loved one’s needs had not been effectively assessed and shared with staff. When the staff member came to support the relatives loved one, they showed a lack of knowledge about their needs and asked questions that were inappropriate about the person had they been given information about them before attending their call. Another relative said the provider had called them to say they needed to re-assess their loved ones needs but they did not show up at the arranged time.

Staff did not have a good understanding of people's assessed needs. One person's care plan said they had allergies, a staff member said, “they have no allergies.” We asked another staff member about a person's needs and they said, “I haven't checked his plan.” Another staff member said a child did not use any communication aides or Makaton (Makaton is a language programme combining signs, symbols and speech to help people communicate). Their care plan stated they did use this. Staff told us some people used different types of communication. Staff tried to implement guidance to inform staff how best to communicate with the people they supported, for example with signs and pictures, however this was not complete or in place for every person who needed this support. Staff told us people’s care plans were not up to date, and they were not routinely reviewed due to workload. Office staff were aware of people’s needs changing, however this was not documented, for example when someone’s dementia needs increased, their care plan was not updated to reflect this.

There was ineffective systems to assess and update people’s needs. People’s assessments were not up to date, and had not been reviewed when people’s needs changed. Risk assessments were not reviewed and updated following incidents. For example, when people became distressed, there was no review of their risk assessment to ensure it was reflective of their current needs, and informed staff how best to support them to reduce their distress. People’s needs had not been fully assessed prior to the care package starting. For example, new packages of care were started, despite staff not having the relevant training in place. One person had a catheter, however there was no guidance or assessment in place to inform staff how to support them. Other people had risk assessment templates within their care plans which were yet to be completed. The registered manager had not ensured care plans were reviewed regularly and updated. For example, 1 person’s care plans had not been updated since October 2022. Senior staff had a matrix detailing what care plans and risk assessments were outstanding, however there was no delegation by the registered manager to prioritise completing these assessments. People’s care plans contained information which was contradictory. For example 1 person's care plan detailed they were allergic to certain medicines, however within the medicine risk assessment this was not documented. The provider could not be assured the guidance in place was accurate. People’s communication needs were not always assessed prior to starting care packages. Some people used other forms of communication, including Makaton. There was no information about which signs people used, or any adaptations they may have.

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.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

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.

While some people and relatives we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. One relative complained that prior to the package of care starting staff did not engage with them or complete a visit to discuss the support their loved one needed. They said, “With the issues we've already had with timings and medications, today has just added to my anxieties about the abilities and professionalism of your company. This all could of easily of been avoided if someone had done a home visit or taken the time to explain how things are set up before the care package started! “

Feedback from staff was mixed in relation to capacity. Some staff had a poor understanding of capacity and consent. A staff member said, “No, I didn’t have training in mental capacity.” The staff member did not know what this was. Despite some staff being able to tell us how they asked people for consent whilst they supported them with their care needs, we were not assured people’s consent was consistently sought by staff to ensure people were always involved in decisions around their care and treatment.

There were ineffective systems to ensure that capacity was assessed. Care plans for some people were inconsistent regarding capacity and consent. For example, 1 person’s care plan stated they lacked capacity regarding personal care, however the care plan also stated that they declined support with oral care. There was no guidance for staff to inform them when or how to share concerns if the person declined oral care. Staff failed to gain consent before entering a person’s home who was in hospital. A staff member was due to complete a spot check at the person’s home, and had not been notified that the person had gone into hospital. The staff did not consider seeking consent from the person, or next of kin, before entering their home and attempting to complete a medicines review. Senior staff had a matrix to inform them of information missing from people’s care plans. This evidenced that capacity assessments had not always been completed. When people did not have capacity, it was not clear how decisions would be made, and who should be included.