Initial Care Services South East 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 a breach of legal regulations in relation to the need for consent. The provider did not always follow the Mental Capacity Act 2005 Code of Practice. They did not ensure people’s mental capacity was adequately assessed in relation to specific decisions and that they supported people to fully engage in mental capacity assessment processes. People were at risk of their rights not always being upheld and their unwise decisions not being respected due the provider not considering the possible restrictive nature of some support strategies in place. The provider’s systems and processes did not fully consider national best practice guidance on supporting people with a learning disability and autistic people, for example around assessing their needs, wishes and experiences of living with a learning disability and how these were to be addressed in their care to promote their independence and rights.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

While the people we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. People could not be assured their needs had been appropriately assessed and understood by staff. People had not been involved in a meaningful review of their support.

The registered manager told us they assessed people’s needs and gathered information from people, people’s representatives, social services and other professionals as needed before starting to support people. However, people’s care plans did not always accurately reflect all needs and risks assessed in their social services’ care plans. Staff did not have all the right information to support people effectively.

The provider’s systems and processes did not consider national best practice guidance on supporting people with learning disability and autistic people. For example, around assessing their needs, wishes and experiences of living with a learning disability and how these were to be addressed in their care to promote their independence and rights. For example, although care plans were written partly in an easy read format, there was a lack of robust assessment of how people’s learning disability affected their communication and what support staff could provide when people became distressed. People’s care plans did not address all risks and health needs identified in their local authority care plans.

While the people we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. People did not receive care that was in line with evidence based good practice and standards. For example, staff and the provider did not have awareness of best practice guidance in relation to supporting people with a learning disability and autistic people living in the community. The provider had not ensured people’s care plans provided guidance to staff on how to support them to be as well as possible, physically, mentally or emotionally.

The registered manager was not aware of guidance and best practice standards in relation to supporting people with learning disability and autistic people. For example, they were not aware of and how to apply guidance such as ‘Right support, right care and right culture’ or ‘STOMP’ (Stopping the overmedication of people with a learning disability, autism or both), although some of the provider’s policies referred to these. Staff supporting people did not have full understanding of learning disability, although they completed a relevant online training course in line with the national guidance.

The provider lacked the awareness and understanding of specific guidance and best practice standards in relation to supporting people with a learning disability and autistic people. This put people at risk of not receiving care meeting their specific needs, as the provider was registered as a specialist service supporting people with a learning disability and autistic people.

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 the people we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. For example, the provider did not work in line with the Mental Capacity Act 2005 and associated Code of practice. People’s capacity to make specific decisions in relation to their care and treatment was not always effectively assessed. People could not be assured their rights were upheld. The registered manager lacked understanding about people's rights.

The registered manager could not explain how they adhered to Mental Capacity Act 2005 Code of practice when assessing people’s capacity. They were not able to explain how they ensured people were supported when making unwise decisions or how they would recognise possibly restrictive practices when planning and reviewing people’s support. Staff told us they had training around mental capacity and they asked people for their choices when supporting them. Staff said, “I communicate with [person] every day. I ask for choices, they tell me what they need.”

The provider failed to ensure people’s mental capacity was adequately assessed in relation to specific decisions and that they supported people to fully engage in mental capacity assessment process. For example, mental capacity assessments lacked detail on how the person’s capacity was assessed, and care plans did not correlate with these assessments. People were at risk of their rights not always being upheld and their unwise decisions not being respected. The provider did not always consider the possible restrictive nature of the support strategies proposed in their care plans and those the registered manager told us were in use at the time of the assessment. This was a breach of regulations in relation to the need for consent.