ILS24Health Care Limited

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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

We found breaches of the regulations in relation to assessing people’s needs, evidence based treatment and the need for consent. Best practice guidelines in respect of people’s care were not always followed which increased the risk of poor outcomes for people.

Relatives told us they were involved in discussions about people’s needs and care along with the person where they were able. People’s care plans contained information on their wishes and preferences but people’s individual needs, risks and the care were not properly assessed or care planned to enable staff to support then effectively.

Where people required aspects of their health and wellbeing to be monitored, records were not always completed accurately or consistently by staff, to enable their progress to be monitored. Staff were undertaking basic clinical tasks not appropriately delegated to them, by a health care professional registered with CQC for clinical care. Staff were not adequately trained or supervised in the completion of these tasks in accordance with guidance issued by the Nursing and Midwifery Council (NMC).

People relatives told us their loved one had a regular staff team who worked well together. However, effective team working or contact with external teams or other health and social care professionals in support of people’s needs was not evidenced.

People’s relatives told us staff sought their consent prior to providing support. People’s records confirmed this. Where there were concerns about a person’s ability to understand and consent to specific decisions. their consent was not obtained in accordance with the Mental Capacity Act 2005 (MCA).

The provider did not have adequate processes in place to assess and monitor people’s care in order to ensure care was safe, effective and in accordance with recognised standards or relevant legislation

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’s relatives told us that they had been involved in discussions about their needs and care, along with the person where they were able. They confirmed the person had a copy of their care plan in their own home.

Staff told us they had access to people’s care plans via a paper-based care plan in the person’s own home and electronically by using the provider’s homecare app on their mobile phone. They said people’s care plans contained information on their needs, risks and care.

We found however, staff did not always have accurate, sufficient or up to date information on people’s needs and risks to support them effectively.

We asked the provider and registered manager about the shortfalls in people’s care plans and the lack of adequate risk assessments in place to guide safe and effective care. The provider and registered manager did not demonstrate an awareness of, or an understanding of these shortfalls or how to adequately assess people’s needs and risks. For example, with regards to moving and handling; skin integrity; nutrition; falls etc.

The processes in place to guide staff in the delivery of safe care and treatment were not robust.

The provider’s processes failed to identify the lack of sufficient detail about people’s needs and risks in their care plans. The audits and processes in place had not identified and addressed that suitable risk assessments and management plans specific to individual people were not in place. They had failed to ensure up to date and appropriate guidance from other health care professionals was obtained and care plans updated so staff had the right information to deliver some of the support tasks expected of them. For example, some people required medicines to be delivered in a specific way yet care plans did not accurately reflect the professional advice on how to do this from the pharmacist.

The processes in place to ensure people received the care they needed were not robust. For example, where daily monitoring was required, this was not always completed accurately or consistently by staff, to enable people’s progress to be monitored. For example, fluid input and output charts, repositioning, and bowel records, showed gaps and inconsistencies suggesting people were not in receipt of the care they needed. There was little evidence the provider and registered manager routinely reviewed these records to ensure people’s needs were being met and their health and welfare protected.

People’s relatives were not asked to provide any feedback on whether the care they received was evidence based. People relatives told us they felt their needs, or the needs of their loved one were met by the service.

The provider and registered manager were unable to explain why staff were undertaking clinical tasks not appropriately delegated or supervised by a health professional registered with CQC to provide such tasks.

They were unable to explain why the service was providing aspects of clinical care for which, as a service provider they were not registered or legally authorised to provide by CQC.

The provider and registered manager during our discussions failed to demonstrate they had a clear understanding of the concerns identified with people’s safe care and treatment, medicines or their failure to deliver evidence based care in line with legislation and best practice and the NMC’s scheme of delegation.

The processes in place to ensure care was delivered in accordance with best practice, were not robust. The provider did not have any adequate audit or quality assurance process in place to assess and monitor the delivery of care to ensure it followed recognised standards and relevant legislation.

For example, the delivery of basic clinical tasks by care staff did not adhere to the Nursing and midwifery code of practice or scheme of delegation which provides a safety framework to support the safe delegation of basic clinical tasks to care workers working in the community or other settings. The provider and registered manager had not paid due regard to this scheme in order to ensure the clinical tasks completed by staff were safely delegated to the by a qualified health care professional with robust oversight of this support.

Records maintained in respect of any basic clinical tasks completed by staff did not show evidence based, best practice guidelines were followed in the provision of this support. People's experience of medicines did not follow good practice guidelines issued by the Royal Pharmaceutical Society, NICE or CQC. People’s capacity to make decisions was not assessed and planned for in accordance with the Mental Capacity Act.

People relatives told us their loved one had a regular staff team who worked well together.

Effective team working or contact with external teams or other health and social care professionals in support of people’s needs was not evidenced. This meant it was difficult to tell if people’s experience of care across services was effective and support appropriately by the service.

Staff enjoyed working at the service and felt they worked well together as a team.

The registered manager was unable to explain what working arrangements were in place to ensure delegated clinical tasks were completed safely in partnership with NHS providers. The provider and registered manager could not explain why staff had not completed training for some of these clinical tasks with the NHS’s preferred training provider. This did not show the service worked effectively in partnership with other agencies.

Partners gave no feedback on how staff worked together. NHS and Local Authority commissioning partners advised they were unaware of the working arrangements in place with the provider to ensure delegated clinical tasks were monitored and completed safely and effectively under the direction of a health care professional. The registered manager could also not explain how the delegation of basic clinical care was monitored by a regulated health care professional.

Staff meetings took place, but not all staff attended these meetings to ensure they were kept up to date and informed about any changes to the service or people’s care.

The processes in place to ensure staff worked well with external partners were not clear or effective. Records showed little ongoing involvement, discussion or reviews of people’s care by external partners. It was unclear how referrals to other services were made and who held responsibility for this aspect of service delivery.

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.

One relative told us how the the person looked forwarded to seeing staff, who they got on well with and this has improved their overall wellbeing.

We found however people did not always experience the care they needed to keep them safe and well. This increased the risk of poor outcomes. People’s care records showed gaps in the care received and agreed to.

The registered manager was unable to explain the inconsistencies in the care people received. They told us spot checks on the delivery of people’s care were undertaken and we could see some evidence of this. We saw the registered manager met regularly with the person and their relatives to ensure they were satisfied with the care being provided.

The provider and registered manager was however, unable to describe what systems and processes were in place to monitor the provision of people’s care on a day to day basis. There was no evidence people’s daily care records and charts were reviewed by the provider and registered manager to ensure the care provided was effective and in accordance with their care plan.

The provider’s processes to monitor people’s care and drive up improvements were necessary, were not effective.

There was no effective process followed by the provider and registered manager to gain a clear understanding of how the care provided contributed to the achievement of positive outcomes. There were no robust processes in place to enable the provider and registered manager to be assured staff were not providing support with tasks outside of their skills and experience.

The processes in place had not identified some people’s care was not being provided in accordance with their care plan. There was no process in place to routinely review records relating to people’s day to day care to monitor whether staff were following people’s care plans.

Relatives told us staff sought the person’s consent before support was provided. People’s daily records confirmed this.

We found however the principles of the Mental Capacity Act (MCA) 2005 had not been fully adopted by the service in respect of people’s care which increased the risk of people experiencing inappropriate support with specific decision making and consent.

Staff told us they had completed training in the MCA. The provider’s training matrix reflected this. During discussions, staff members demonstrated an understanding of the need to seek and respect people’s decision to consent or refuse care.

During discussions with the provider and the registered manager we were not assured they had a sufficient understanding of MCA legislation and their legal responsibility to protect people legal right to consent to their care.

At the last inspection, there was a lack of robust processes in place to ensure people’s capacity to consent to decisions about their care were made appropriately in line with the MCA. This included a lack of active and reliable processes in place to ensure best interest decision making took place where the person’s capacity to consent was impaired.

At this assessment, no adequate improvements to the provider’s systems and processes had been made. This meant people’s rights under the Mental Capacity Act (MCA) 2005 were still not fully or consistently protected.

The provider’s audits and processes to drive up improvements in this area failed to be effective in addressing the organisational lack of understanding of the MCA and its implementation.