A & A Services West Midlands

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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

Our rating for this key question has remained the same and effective is still rated as requires improvement. Improvements had been made to assessments and care plans; however further work was needed to consider people’s health needs. Whilst staff understood how to seek consent, documentation about people’s consent to their care was not in place. Staff understood information about people’s needs relating to personal care but needed to have increased knowledge around health needs.

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 their relatives told us they were involved in the process of assessing their care needs and developing their care plans.

Staff told us the completed assessment and care plan was shared with them to help guide how they supported people. They told us they used an electronic recording system to document the care people received. Leaders told us the assessment and care plans needed to be updated to make improvements, but this had not yet commenced.

Assessments and care plans were not up to date. One person had stopped receiving support with medicines, but their care plan still referred to staff having to support them. This placed them at risk of receiving medicines that they did not require. Care plans did not consistently give guidance to staff on how to meet people’s needs. One person had assessed needs relating to being short of breath, however there was no guidance for staff on how to support the person if this happened.

People told us they had the support they needed with meals and drinks from staff. One relative told us, “Yes, the staff will give [person’s name] lunch. Heat it up. Yes, they get enough drinks.”

Leaders told us they were in the process of developing their systems to enhance assessment and care planning to incorporate more information. Staff told us they were able to support people with their meals and drinks where care plans required people to have support as some people were supported by their family members.

The assessment and care planning process did not fully consider people’s needs and put evidence-based care plans in place. Where assessments identified specific needs, this did not always result in a plan of care for meeting those needs. Needs identified with no plan of care included, diabetes, epilepsy and being registered blind. This meant there was no guidance for staff on how to support people to meet their needs.

Relatives told us the staff working with people communicated well together. One relative told us, “Yes, during the handover they will share information. I don’t know about sharing information with other agencies though.”

Leaders said they had regular meetings to share information about people’s care. The meetings discussed any incidents and changes to people’s needs and included all the management team. Staff told us they did not communicate with other agencies about people’s care. One staff member said, “If I need to communicate with other agencies, I would go through the office team to do this.” Another staff member said, “If a Doctor or District Nurse is coming out they use their own folder, they will report back to the office team and then the office team will tell us any updates or changes.”

Partners told us the provider was working alongside a quality improvement team to support with making improvements to the service.

Care records showed where people had engagement with other agencies this was documented in their care records.

Relatives told us they felt able to seek support for people’s health needs. One relative said, “Yes, I am here, and I can access the GP. They have been very supportive. They understand his health needs”

Leaders told us people’s health needs were assessed and documented in their needs assessment. Staff were asked about people’s health needs and were unable to give us any detail about what needs people had or how they were supported to manage their health conditions.

The providers care planning system did not create plans to meet people’s health needs. Where people had a diagnosis of a specific health condition there was no guidance for staff on what to look out for if people’s health needs changed or how to support people to maintain their health. People had diagnosed health conditions such as hypertension, osteoarthritis, psoriasis, diabetes and epilepsy which meant they were at risk of these health conditions deteriorating.

Relatives told us people’s lives had improved since using the service. One relative told us, “[Person’s name] life has improved they are more sociable. They look forward to seeing them. Communication is good, comments in the folder, like he looks well”

Leaders told us peoples care needs were monitored through annual reviews and they had quality assurance processes in place to check on the outcomes people achieved. Staff told us they believed the support people received from them helped to improve their quality of life.

Processes in place to monitor peoples care and treatment were not consistently effective in ensuring up to date information was available for staff. Despite annual reviews taking place, care plans had not been updated to remove out of date information and guidance for staff. For example, 1 care plan had conflicting information about whether a person could prepare their own food and drinks.

Relatives told us staff always asked for verbal consent before they supported people. However, they confirmed people had not been asked to sign any documents to consent to their care plan.

Leaders confirmed there was no documentation in place to allow people to consent to their care and support plans or indicate their involvement in their care and support planning. The provider told us this was going to be introduced as part of a review of the care planning system. Staff confirmed they sought verbal consent from people before helping them with their care. One staff member told us, “We ask when we arrive, if they are not in the mood, we will not carry out our usual routine and will respect wishes.”

There was no effective process in place to record people’s ability to consent or their actual consent to care. Care records did not evidence people had been involved in consenting to their assessment and delivery of care. There was no system in place to check if people had capacity to consent to their care or seek consent from those with legal authority to make decisions within the requirements of the Mental Capacity Act.