Unite Highland Care

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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 identified a breach of the legal regulations in relation to consent. The provider did not robustly assess or re-assess people when their needs changed. Staff did not have all of the information they required to safely support people with their complex needs. The provider and staff’s understanding around consent and capacity was poor and people lived with unnecessary restrictions.

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's needs had not been fully assessed before their package of care began. We asked a relative whether an assessment of their loved one’s needs had been carried out. They said, “They were supposed to carry on from the original lot so I don’t know.” Another relative said, “I have no book here to look though from their company but from previous companies I do. I hope it’s all on their tablets (electronic device staff used for information). The manager came out he wrote down all the hoisting but my set up is slightly different at home. I don’t know if they have on their tablets of what (loved one) needs.”

The registered managers assessment of needs was poor and the information they provided staff to support people was contradictory or missing. People’s care and support plans were not holistic, or strength based. There was no focus on goals, aspirations or supporting people to reach their full potential. The registered manager had not carried out regular reviews of people’s care plans or carried out thorough assessments of people’s health and support needs. For example, one person’s care plan stated they enjoyed engaging in therapeutic activities with other people. There was no information about what these ‘therapeutic activities’ were to ensure staff could support the person to maximise their engagement and enjoyment.

There were ineffective systems to assess and update information relating to people’s needs. People’s assessments were not up to date and had not been reviewed when people’s needs changed. When people returned from hospital, had been unwell or their medicine changed, care plans and guidance was not updated or implemented. Risk assessments were not reviewed and updated following incidents. For example, a person’s daily notes stated, ‘(Person) was observed on bed trying to stand up. Staff explained to them that they couldn’t stand up on their own without help. (Person) then stop struggling with staff.’ There was no further information about what ‘struggling with staff meant’ or how staff had responded in an appropriate way. The incident was not recorded by the registered manager as an incident and no re-assessment of the person’s needs was completed. There was no information in the person’s care plan to inform staff this was a known risk.

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 had not been empowered or included to make decisions about their care and support. We asked a relative if staff sought their loved one’s consent before providing care. They said, “No, they just do it, and (person) just lays there like that.” People were subject to constant surveillance within their homes. The provider did not demonstrate people's capacity to consent to constant surveillance had been assessed, or that best interest decisions had been undertaken. For people who had capacity there was no evidence they had consented to the constant surveillance. Some people were smokers. Staff told us they kept people's cigarettes and lighters and gave people cigarettes intermittently to stop people 'smoking all their cigarettes at once.' However, no capacity assessments or best interests had been completed for people who lacked capacity to consent to this. For people who had capacity, there was no evidence that they had been consulted and consented to their cigarettes and lighters being withheld. Staff did not regularly review this restriction to consider if this was the least restrictive option for the person.

The provider and staffs understanding around consent and capacity was poor and people lived with unnecessary restrictions. We asked if people had capacity or not and the provider and staff did not seem sure and gave inconsistent answers. Staff told us people had capacity, but they restricted them in certain aspects of their lives. For example, in one person's home all the knives were kept in the 'staff room' which was locked. A staff member told us it was for ‘people's safety’ we asked if there was a known risk associated with knives or if there had been any incidents and they said no. There was no risk assessment in place, and the restriction to remove the knives from the kitchen had not been regularly re -assessed to ensure it was the least restrictive option for people.

Consent and capacity was poorly managed. The provider and staff had a poor understanding of capacity and consent to care and treatment. There was no evidence mental capacity assessments had been completed or consent to care and restrictions had been agreed with people. People had restrictions placed on them which had not been considered if least restrictive and some people with capacity were being restricted with no reason as to why. For example, 2 people the provider told us had capacity had to be 'escorted/supervised' when out and were not allowed to go out alone. Another person, staff told us had capacity was 'redirected' back to bed when they wanted to get up. There was no information to demonstrate people had agreed to this. All supported living houses had CCTV but there was no evidence capacity or consent had been assessed or obtained.