OASIS West London Office

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

We assessed 6 quality statements in the effective key question and identified 1 breach of regulations in relation to consent to care and treatment. Staff were not knowledgeable about the principles of the Mental Capacity Act (MCA). The provider did not have evidence of following the MCA in relation to people who lacked capacity. However, people and relatives told us they were involved in care planning and reviews. Staff worked well with the local authority and health care professionals. Feedback from the local authority was very positive about the provider.

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.

People and families told us they were involved in the care planning process. A care needs assessment was carried out before the person started using the service. One family member said, “The carer visited [my relative] in hospital to get to know them. Once my [relative] got home, I think the manager, or the supervisor visited them and asked questions regarding their care needs. They asked about hazards, they didn’t look around they just asked questions.”

The registered manager and care coordinators explained that before beginning a service to a person they would first carry out a care needs assessment. This would determine what support was needed to meet the person’s needs. Staff described what support they would provide to people. For example, one staff member told us they would always check with the person to make sure they understood how they wanted to be supported. Staff told us they read people’s care plans and care notes and felt there was enough information in care plans to support them to meet people's needs.

People had been assessed for their care needs by the funding authority and then this assessment was shared with the provider. This assessment was used by the care coordinators to set a range of care tasks for the support people needed and develop the initial care plan. However, at the time of the inspection some potential risks that had been identified through the assessments and recorded in the care plans were not fully assessed and plans were not always in place for staff to effectively monitor people’s health or wellbeing needs. For example, in one person’s assessment, it indicated that the person had some communication needs, but the care plan stated there were no communication needs .

People’s care plans lacked details for staff to monitor health issues effectively. In care plans sampled some key information was missing. For example, if a person needed support to follow a healthy balanced nutritional diet. There were no details for staff to know what this would entail. The provider supported people with a learning disability and mental health needs. Whilst the care plans identified the condition people lived with, the care plans had little to no information as to how this impacted people.

The registered manager told us they worked with health care professionals. We saw evidence of this in people’s care notes. For example, if a person had a GP appointment this was recorded in the person’s care records. The registered manager told us they followed evidence based best practice. In one care plan we saw a reference to the speech and language team (SALT) assessment which had recommended to use a thickener in drinks due to risks around choking.

The provider did not always use best practice guidance, For example, the provider supported people with a learning disability, but had not provided staff with the latest nationally recognised training in this area. The quality assurance framework did not include monitoring compliance with national standards and evidence-based practices. However, we saw 2 examples of care plans which did reference best practice.

We had some mixed feedback about staff working with other services. Some people told us staff worked well and would contact health care professionals if required. However, some people had experienced a lack of actions and communication between the agency and the local authority when they had raised a concern.

The care coordinator we spoke with on the day of the inspection had very good knowledge of people and what other professionals were involved in their care. For example, they knew if a District Nurse was visiting a person to administer daily treatment, however this information was not always recorded on care plans.

We asked the local authority for feedback about the agency. Overall, they told us they worked well with the agency. The local authority told us the agency had made a steady improvement following our last inspection of the service. The local authority was satisfied with the progress the agency was making towards their service improvement plan. Each visit was recorded and shared with CQC.

The provider had good communication avenues developed with the funding authorities, people they supported as well as family members. Evidence of communication records were seen attached to people’s care plans.

Most people and families we spoke with told us they had access to health care professionals for example the GP. We had mixed feedback from relatives about the support people received with health care. One relative told us, “They [staff] call me if they think she needs to see a professional.” Another relative told us, “My [family member] has complained about her feet being painful for some time. As they are attending to her personal needs, I can’t understand why they haven’t raised the issue with other professionals to investigate. It took me ages to get someone to see her about the issue.”

The registered manager informed us that staff supported people to live a healthy life. In one example a person accepted additional support about their diet when staff pointed out some of the effects a poor diet may have on a person's health. Also, a referral was made for the person to see a nutritionist to offer advice on diet and exercises. However, some care plans and risk assessments we sampled did not have enough information in them for staff to identify early signs of health deterioration. Records were not clear on when to seek medical advice or treatment. In one example, a person had pressure ulcers, the care plan did not show if the staff had sought medical advice in a timely manner. This meant the person may have suffered harm as a result.

The provider did not have an effective system in place to ensure that people’s health and well-being was monitored. Care notes were not in enough detail about what support was provided. The lack of details in care records meant staff may not always be able to identify when people needed support and who to call or how to seek support for medical interventions. This could put people at risk of harm.

Outcomes were set for people in their care plans. Examples of outcomes for people were independent living, cleanliness, skin breakdown prevention, oral health promotion, emotional well-being, social participation, health issue management. Plans detailing how these outcomes were to be achieved were not in place and outcomes were not measured, therefore it was hard to establish based on care records if people achieved positive outcomes.

Staff were not recording in daily notes the reasons when set tasks were not completed. This made it difficult to establish if people refused, did it independently or maybe family members supported them. When care reviews were completed, this information should be considered when evaluating outcomes, this would be difficult if not recorded. The registered manager acknowledged that staff were not always recording details of care that had been delivered. They explained that this had improved over the last few months but there was some noncompliance in this area. This was being monitored by the management team.

None of the care plans we reviewed showed evidence of outcomes being monitored or progression towards goals. Checks and quality assurance processes did not identify changes in the person’s condition or their care needs. Overall, this meant people’s goals or expectations may not have been met. Staff were not always aware about people’s goals and how to achieve them.

People told us that staff asked their permission before supporting them with care. One relative said, “The carers are polite when they are supporting with their personal needs.” Another relative told us, “They greet them, and they tell them what they are doing. They ask if there is anything else they need.” Relatives also told us that staff would contact them if the person refused the requested support. This was recorded in care notes.

Care plans were signed by people who received the support they needed from staff. However, one person’s care plan detailed that they lacked capacity to make important decisions. There was no mental capacity assessment in place. The person had signed their care plan, but it was unclear if they understood what they were consenting to. There was no evidence that a best interest meeting had taken place. Most care staff we spoke with did not understand the principles of the Mental Capacity Act (MCA) or how to apply them in practice. We gave feedback to the registered manager about this and they said that staff had training in this topic, and this was discussed in team meetings.

The process for obtaining consent to care from people was not clear. Mental Capacity Assessments were not completed in line with the Act. For example, in one assessment there was no record of what decision was being assessed. There was no best interest decision record. A best interest decision needs to be specific and if possible, with input from the person’s representative or health and social care professional to ensure the least restrictive practices are in place when supporting people.