Total Care Norfolk

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 were assessed to ensure the service could meet them. The provider ensured assessments by the local authority, where available, formed the basis of relevant care plans. Staff worked in line with healthcare professionals’ advice to ensure people’s needs were met. Although the provider assessed people’s initial needs and documented major changes to people’s care, people told us they had not all been offered a planned review of their care. Most people told us they were routinely asked for their consent. However, some staff’s level of English language was found to be a barrier to establishing consent.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were involved in drawing up their initial care plan and told us they were confident any significant changes in their care were reflected in their care plan,although scheduled reviews of plans were not in place for all. People had been able to ensure what was important to them was captured in their initial care plan. One person told us, 'I discussed my needs. A lady came from the office and we discussed it.' One person's plan needed more detail around a particular situation which could place them and potentially staff, at risk. We fed this back to the provider.

Staff told us they knew people well and understood their current needs. They felt information was clear enough for them to be able to support people safely from the start. However,one staff member said that changes are not always reflected quickly on the care plans.

The provider worked in partnership with the local authority and private clients in assessing people’s needs and devising care plans designed to meet them. Care plans reflected people's needs and checking the care plan was part of the observations of care carried out on staff to assess their practice. It was not clear how often care plans should be reviewed and this varied. Records were not electronic which meant updates had to be recorded in the paper files in people's homes which one staff member commented on negatively. However, other staff said important changes would be communicated to them directly.

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.

People told us staff liaised with other health and social care professionals should this be required. One person received support with their exercise programme drawn up by a physiotherapist. Where people had moved from another service, they told us this had been well managed and their needs and information had been captured in their new care plan.

The provider told us they work well with other health and social care professionals and aim to share key information appropriately to benefit people who use the service. Staff told us the systems for communication with other care providers and the community health teams worked well. However, we found some staff lacked the confidence to make decisions to involve other professionals and relied on the registered manager to take this forward.

The local authority quality monitoring team had worked with the service to bring about improvements. It was clear that initiatives had been put in place following this period and improvements were evident in certain areas, although some still required further work.

Care records were detailed and contained information for staff to refer to and share with other health and social care professionals as needed.

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.

People told us they had not been offered the opportunity to review their care plan, although major changes were documented. The provider carried out an annual survey to gauge people’s opinions. The one we viewed dated from 2020 but no action was documented in response to some issues raised. For example, one question asked if staff seemed knowledgeable about care plans and 8 people responded ‘mostly’ but this was not investigated further. In response to a question about being involved in developing care plans 2 people had responded this rarely happened but no action was evident.

Staff told us they relied on care plans being updated to reflect people's current needs. One staff member told us they audited daily notes as no senior staff were available to do this. They said they did not have additional time to carry out this monitoring task which meant it was often delayed. The provider told us they were aware of this and were in the process of appointing more senior staff to ensure tasks like this were carried out more routinely in future.

Daily notes documenting staff visits to people were reviewed. This was designed to ensure care and support was monitored. However, there were not enough senior staff to carry this out in a timely way which meant the registered manager and provider did not always have an accurate overview.

Some people felt there was a language barrier in place with some staff for whom English was not their first language. They told us this impacted on their ability to seek and gain consent. People’s care records documented consent on issues such as who they were happy to have provide personal care for them and people told us their choices were respected.

Staff were aware they needed to ensure they asked people's consent before providing care. Staff had received online training relating to people’s capacity to consent to care and on the Mental Capacity Act 2005, but their understanding was not always good. This meant their was a risk people’s rights would not be protected.

Although staff received training relating to consent, the provider was not proactive in ensuring staff were clear about all aspects of consent. Records detailing observations of staff practice noted a failure to gain consent to provide care in two cases but it was not clear if this was followed up by the provider.