PentaCare (West Kent)

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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.
 

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider assessed and reviewed people's health, care, wellbeing and communication needs with them. We reviewed care records relating to people with a diverse range of needs, including dementia, stroke rehabilitation, complex physical health conditions, oxygen therapy, pressure care needs, continence support, mobility difficulties and autism. Initial assessments were detailed and person centred and considered people's strengths, abilities, preferences and desired outcomes. Care assessments were holistic and demonstrated people and, where appropriate, their relatives were involved in assessment and review processes.
One person's assessment following a life-changing injury contained detailed information regarding communication, mobility, catheter care, eating and drinking, rehabilitation goals and maintaining independence. The assessment explained what support was required and what tasks the person preferred to complete independently.
Staff consistently described care plans as detailed, person-centred and easy to follow in practice. One member of staff told us, "The care plans are brilliant... it gives a breakdown of what the person likes and how they want things done."
Review systems included an initial telephone review, a face-to-face review, six-monthly reviews and welfare checks which identified changes in needs and ensured care records remained current and reflective of people's circumstances. People told us they had been involved in developing and reviewing their care plans and felt their views were listened to.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.
Care records demonstrated specialist advice and recommendations from occupational therapists, district nurses and other healthcare professionals had been incorporated into support planning. Staff received training relevant to the needs of people they supported, including specialist training in areas such as PEG feeding, dysphagia, stroke care, autism, positive behaviour support and end-of-life care. Care records included condition-specific information and guidance to support staff in delivering safe and appropriate care.
We saw examples where professional recommendations relating to mobility, transfers and equipment use had been reflected within care plans and regularly reviewed. People told us assessments had involved relevant professionals when required to ensure care was delivered safely and effectively.
People described the service involving healthcare professionals where needed. One person told us, “When they came to assess me initially they even asked a professional to come in to ensure I was transferring safely.” Care records demonstrated recommendations from occupational therapists and other professionals informed care planning and risk management arrangements.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.
The provider had systems in place to support communication between staff and office teams, including care note reviews, communication forms, daily office updates and information sharing processes. Records showed information was shared and acted upon when people's needs changed. Service reviews ensured concerns were escalated and referrals made when appropriate.
People described good communication between staff supporting them and told us staff were aware of changes in their wellbeing and circumstances. The provider also demonstrated a cautious approach to accepting new packages of care to ensure assessments could be completed safely and support arrangements were appropriate.
One person told us, “Their communication is brilliant amongst the staff. If I'm not very well on the morning call, the evening staff always ask how I am.” This demonstrated information was shared appropriately between staff to support continuity of care. Records showed staff worked with healthcare professionals and family members when people's needs changed.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.
Care records included clear information regarding health conditions, risks, symptoms to monitor and actions staff should take should concerns arise. One person's oxygen support plan provided staff with clear instructions regarding signs of deterioration, oxygen safety, escalation procedures and emergency response arrangements. Records demonstrated people were supported with mobility, nutrition, hydration, skin integrity, pressure care and emotional wellbeing. Ongoing monitoring of people's wellbeing helped identify changes in health and ensured action was taken when concerns arose. Examples included referrals to professionals, follow-up with families and changes to care planning. Staff described supporting people with exercises, mobility goals and rehabilitation-focused care where appropriate. People described staff encouraging healthy eating, hydration and maintaining mobility, and some spoke positively about improvements in confidence, wellbeing and independence following support from staff. The provider's wound monitoring systems provided additional oversight of people with skin integrity concerns to ensure appropriate action and monitoring took place
People described staff actively supporting their health and wellbeing. One person told us, “They both nag me about my fluid intake all of the time. They know it's important for me to drink plenty of water.” Another said, “They even cook me very nutritious meals and make recipe suggestions.” Care plan records and daily notes demonstrated staff supported people with nutrition, hydration, mobility, skin integrity and preventative healthcare.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. Leaders were able to demonstrate how information gathered through reviews and ongoing monitoring was used to adapt care and support and improve outcomes for people.
People described positive outcomes from the support they received. One person told us, “They are trying to build my confidence in walking again following an accident.” Another said, “It has changed my mood. I feel fitter. I feel happier and more in control of my life.” These comments reflected the wider evidence reviewed, which demonstrated a clear focus on supporting people to achieve outcomes which were important to them and adapting support when their needs or goals changed.
We saw an example where the provider worked with a person and their family to achieve an outcome that was particularly important to them. The provider was originally approached to support one person at home following their spouse's admission to a care home after a prolonged period in hospital. During assessment and review discussions, leaders explored the wider family circumstances and identified that the person's spouse wished to return home but required substantial support to do so safely. Rather than limiting their involvement to the original package of care, the provider worked with the couple, their family and healthcare professionals to explore how the person's wish to return home could be achieved safely.
This included completing capacity assessments, introducing the proposed live-in carer before discharge and carefully planning the transition home. As a result, the person was able to leave residential care and return home to live with their spouse. Relative feedback described the outcome as life-changing and explained the provider had "given my (loved one) their quality of life back where they belong, at home." This demonstrated a focus on achieving meaningful outcomes and improving people's quality of life, independence and family relationships rather than simply meeting immediate care needs.
Reviews and wellbeing monitoring explored more than physical health needs and included consideration of emotional wellbeing, social participation, independence and quality of life. Care planning was outcomes-focused and reflected what was important to people, their goals and the support required to achieve them. Reviews, welfare checks and governance systems were used to monitor progress, identify changes and ensure care remained effective.
We saw multiple examples where review processes resulted in meaningful changes to care delivery and improved outcomes for people. For example, following changes in mobility and deterioration after falls, care plans were reviewed and updated to reflect new moving and handling requirements, revised equipment needs and professional recommendations.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.
Care records demonstrated consent was discussed as part of assessment processes and people's wishes and decisions were recorded and respected. We reviewed examples where people had declined aspects of care and these decisions had been reflected within support planning. People’s ability to make decisions was assessed where required and records demonstrated consideration of people's ability to understand, retain, weigh up and communicate decisions regarding their care. Assessments were detailed and decision-specific and reflected the principles of the Mental Capacity Act 2005.
Care records also demonstrated that diagnoses such as dementia did not automatically result in assumptions about people's capacity and that people continued to be supported to make decisions about their lives wherever possible.
People told us staff sought their consent before providing care and respected their choices. One person explained, “They always ask for my consent, even down to changing my night bag.” Care records demonstrated detailed consideration of consent, capacity and decision-making and showed people's choices were respected.