East Anglia Domiciliary Care Branch

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’s needs had not all been assessed, and plans put in place to guide staff to ensure people received the care they required. When guidance was in place for staff this was not always being followed which put people at risk of harm. Health care professionals were not always involved in assessments of people’s needs. This was a breach of Regulation 12. Some people did communicate their needs, emotions and distress, and staff did not always manage this in a positive way that protected their dignity. Positive behaviour plans in place used labels and negative language to describe how people expressed themselves. This was a breach of Regulation 10. People and their relatives were not involved in assessments around their care, meaning their contribution could be missed. People were not put at the heart of every decision relating to them, therefore, their rights were not protected due to staff not understanding the principles of the Mental Capacity Act (2005). Records around mental capacity and best interests were poor or non-existent. There was a culture of doing the right thing by people for the right reasons. However, we found it did not give people the opportunity to experience decision making and truly supporting people to understand their options. This was a breach of Regulation 11.

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.

Relatives we spoke to had not been involved in reviews of people’s care plans and risk assessment to ensure their needs were being meet. However, some had been involved in meetings with social workers involved with the person’s care. The assessments which were in place did not always mean the people received the most effective care. One person who was cared for in bed should have had their position changed every 2 hours. However, this was not taking place and there was no skin integrity plan. This put the person at risk of their skin breaking down resulting in pressure areas.

Staff did not always ensure guidance was received when assessments took place. On visiting a home, we saw a person using a walking frame to help aid their walking. Staff were supporting this person in different ways with the frame. This had been privately purchased and had not been assessed by an occupational therapist. When asked staff said an occupational therapist had visited but there had been no follow-up and staff had not chased this for their recommendations. This put the person at risk of falls or injuring themselves if the equipment was not suitable or used incorrectly.

Health care professionals were not involved regularly with all people to ensure their needs were assessed to receive the care the required. One person who suffered from epilepsy had not been reviewed by the epilepsy nurse since November 2022, even though they should have been reviewed every 6 months. Another person was observed to be bolting and cramming food into their mouth. Staff had cut their food into bite size pieces to help. However, there was no clear rationale or guidance from any health care professionals for this.

Care plans and risk assessments lacked detail and, in the majority of cases, were out of date. This showed people’s needs had not fully been assessed and appropriate plans but in place to meet all their health, care, wellbeing and communication needs. There was a lack of systems to ensure people and their relatives were consulted as part of the assessment process. For one person in a summary in their records it stated there should be a bowel monitoring chart, but with no further details. There was no care plan or risk assessment in place to give further details as to why, what staff should look out for or what action they should take. However, in their hospital passport it stated when they should seek advice from the GP. We found some bowel monitoring charts had been completed. From this guidance, we found 3 incidences when the GP should have been contacted, which had not happened.

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.

People and their relatives were not regularly consulted about their care. There was a lack of understanding about people’s mental capacity and the process if this was lacking. Decisions were made with little or no consultation and, if a person lacked capacity, the provider did not complete mental capacity assessment and make best interest decisions. In January 2024 one of the homes became flooded. As a temporary measure 2 people were moved into another person’s home. In May 2024 they were still there. There were no mental capacity assessments completed or best interest decisions made during this time. The move had impacted on all 3 people involved.

Mental capacity assessments had not always been completed by staff. Following safeguarding concerns service leads told us they had been given training on MCA so they could complete assessments for people. However, this had not been started yet due to capacity issues.

The provider was not working in accordance with the Mental Capacity Act 2005 and associated code of practice to ensure people’s rights were being meet. There was a lack of details and copies of lasting power of attorney (LPA) for people who had these in place. This is important so staff know who can legally make decisions on behalf of people. It was identified in one person’s care plan they had a significant learning disability, and this impacted on their decision-making capabilities. However, there were no mental capacity assessments or best interests in place. Their care plan stated their relative had a LPA in place for health, but stated they did not know if there was one in for finances. No attempt had been made to verify this or secure a copy.