Optimal Care Plus

We reviewed all 8 quality statements under this key question; learning culture, safe systems, pathways and transitions, safeguarding, involving people to manage risk, safe environments, safe and effective staffing, infection prevention and control and medicines optimisation. At this assessment although we found concerns about safety were listened to, investigated and reported to the relevant authority where required, the provider had not always notified the Care Quality Commission when incidents occurred at the service. The provider submitted the relevant statutory notifications retrospectively after our onsite assessment visit. Information was shared with staff to learn from and make improvements to the quality of service people received through staff meetings. Improvements were needed to ensure all areas of the recruitment process were followed. We found the verification process for identification documents such as passport, driving licence had not been followed, and gaps in staff employment history had not always been obtained despite prompts to explore this area during the interview process. The provider addressed our concerns immediately after the assessment. There were enough suitably trained staff to meet people’s needs. People’s medicines where required were being managed and administered by trained staff whose competencies were regularly undertaken. There were effective infection prevention and control measures in place.

We reviewed all 6 quality statements under this key question: 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 and consent to care and treatment.

We found people were involved in their care and their consent to receive care, was sought by staff and the management team. Where people could not consent to care, people had a representative who was the agreed decision maker for more complex affairs. People had their needs assessed before care commenced and expressed how they wished their care to be delivered. People were supported to have their nutrition and hydration needs met where required. There were effective approaches to monitor people’s care and treatment and their outcomes.

We reviewed all 5 quality statements under this key question: kindness, compassion and dignity, treating people as individuals, independence, choice and control, responding to people’s immediate needs and workforce wellbeing and enablement.

Staff respected people’s privacy and dignity and encouraged people to remain independent. People were supported by a caring staff group who respected their choices and preferences. Staff felt supported by their leaders and colleagues and felt able to contribute to decision making.

We reviewed all 7 quality statements under this key question: person-centred care, care provision, integration and continuity, providing information, listening to and involving people, equity in access, equity in experience and outcomes and planning for the future.

People were supported to make decisions about their own care and support. Staff treated people as individuals, providing a person-centred approach. People had access to external health care professionals to ensure their health needs were met. Where possible, staff supported people to plan and document their end of life wishes.

We reviewed 7 quality statements under this key question: shared direction and culture, capable, compassionate, and inclusive leaders, freedom to speak up, workforce equality, diversity and inclusion, governance, management and sustainability, partnerships and communities and learning, improvement and innovation.

Staff were clear about their responsibilities and roles and felt supported by the registered manager and management team. Staff spoke positively about the leadership and culture of the service and felt able to speak up confident that the registered manager would actively listen and address any issues. The provider had quality assurance systems and processes in place to monitor the overall quality of the service, however we found in relation to staff recruitment processes these could be further improved. We did not find these improvement needs affected the safety and quality of people’s care and any future risks were mitigated by the actions taken by the registered manager during this assessment. The provider was actively involved in seeking out best practice guidance from different sources to drive improvements across the service.