Quality Homecare

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 71 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. A pre-assessment process was in place for new people wanting to use the service. The same process was carried out when a person returned from hospital or other extended period of time away from using the service. On receipt of care notes from the local authority or hospital, home visits take place. These are thorough face to face meetings with people and where possible, relatives or advocates. Care plans and risk assessments are then completed, care staff are introduced to people and there will be a follow up call within the first month to check that the support provided is working. There then follow annual reviews that take place with people and their loved ones. These reviews occurred more frequently if there was an incident, illness or other change in people’s circumstances. People told us they were involved in these processes. Comments from people and relatives included, “I was actively involved in the development of my care plan” and “I have a very keen interest in making sure that my care package is safe. I’ve got a direct line to the care managers and recently was given access to their new care reporting system. I am involved in planning and reviews.”

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 and current evidence-based good practice and standards. Staff knew people well and were able to notice any changes in their moods, presentation and health. Staff worked with people to help achieve the best outcomes for them. Advice and support were sought from professionals who contributed to people’s support in specialist areas. These included district nurses and occupational therapists. Staff told us they were confident to call in other professionals for support when needed. The service worked hard to accommodate people health appointments and care call times were adjusted to fit around people’s other commitments wherever this was possible. Using their mobile phone applications to record care call details, information was quickly updated and shared with their colleagues so the latest updates relating to people’s needs were known.

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. Positive professional relationships had been formed with other professionals which resulted in people receiving the best care and support and beneficial outcomes. Timely referrals were made when making appointments for people or seeking expert advice. Professionals told us that the working relationship resulted in smooth transitions and people getting the right support. A professional said, “I have had some very positive experiences of joint working with carers and care assessors. Thinking about the cases I have joint worked, I have been impressed by the responsive communication e.g. via email and phone.” Another added, “I have been impressed by the attitude of the staff I have had contact with.” The service worked closely with local hospices, helping to support people towards the end of their lives. Care plans had details of these professionals’ conversations and in some cases care packages had been increased because of advice sought. A relative commented, “They work alongside the OT, DN and doctors and as a result we have a good relationship with the GP and pharmacy.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.Some people were supported to meet their nutrition and hydration needs. Most people and relatives told us that staff were helpful and understood people’s choices and food preferences. Some however told us that some staff appeared to lack the basic skills needed to prepare food. This issue was discussed with the registered manager who had identified this concern and had started some additional training for all staff, however this remained a concern for some people. Staff were trained in food hygiene and diabetes. A member of staff told us, “I prepare meals. I have a diabetic client and work with the community nurse re support, diet controlled not injections.” Some received training in the management of percutaneous endoscopic gastrostomy (PEG) tube. PEGs were used by some people who were unable to eat and drink orally.

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. Differences in people’s presentation and general health were identified by staff who knew them well and knew when things were not right. Where there was a clear need for intervention to monitor people’s health then staff would record details in the care notes and notify managers. If for example, staff noticed that people were not eating or drinking as much as usual they would contact managers and request food, fluid and weight charts be used to monitor. Similarly, if there were early indications of skin pressure damage, community nurses would be called in to assess. In some care plans we saw photographs relating to identified pressure sores. Although these had been identified and addressed there were no additional photographs to show the improvements. This was discussed with the registered manager who immediately put a system in place to follow up photographic records so the complete picture could be seen.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. People’s ability to understand questions and to consent to care and support were recorded as part of the initial pre-assessment process. Staff received training in mental capacity and the importance of making decisions in people’s best interests. Staff were aware of the importance of gaining consent from people, one telling us, “Consent is important. I have one person who is reluctant. I must talk them through and gently approach them but understand I can’t carry on if point blank refusal. As long as you explain yourself.” Mental capacity assessments were completed by trained professionals and decisions made with people and their relatives in their best interests. If staff noticed any change in people’s ability to make decisions, they would immediately report to a manager, and a new assessment would be completed. People and their loved ones confirmed that people were given opportunities to make their own decisions. One person said, “They never touch me without asking first.’ A relative added, “Carers always ask permission and use their initiative.”