Quality Homecare

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s needs were met through good organisation and delivery.

This service scored 68 (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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.People were supported in a person-centred way with their needs and wishes respected by staff. In most cases people were supported by the same, small group of care staff who then got to know them well. Staff were then aware of people’s preferred routines and schedules and the way they preferred to receive the support needed. A staff member told us, “I like to keep the same group. I can see if they are unwell, I get to know them well.” Another said, “I know how they like to be addressed.” This person-centred approach was also reflected in care plans which set out people’s social and medical history along with their own short- and longer-term goals. There was a lot of detail provided and a clear view on what a successful outcome for people would look like. There was also a section called, ‘who to contact when.’ This was helpful and enabled people to get the right contacts there to help and support them in a variety of different circumstances.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. Some people lived with complex health and social care needs. The service worked well with other professionals to support people with these needs. For example, some people required then use of PEG tubes, some lived with catheters and others had learning disabilities. Staff had received appropriate training to support people with their individual needs and care plans provided clear instruction for them. For example, people who lived with learning disabilities had clear guidance for staff about changes in people’s presentations, things that caused increased anxiety and techniques that would provide comfort in calming people. Relatives provided support to staff along with professionals for example, social workers, community mental health teams GP’s. The best outcomes for people were achieved by this working collaboration and understanding of people’s needs. A person told us, “My overall care needs are met by a number of different providers. Most of the time it works well, a lot of good will, good management and a clear idea of my needs.” A professional said, “They are aware when a client needs extra support and professional input to ensure they remain safe and well cared for and appear to have a good awareness of the community teams and services in which they have access too.”

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Feedback from people and relatives about communications with the service was mixed. Some told us they received the information they needed, but others said there were delays and discrepancies. People received rotas in advance of care call times and names of staff scheduled to attend. Some people told us that they did not always get the same people attending and often not the people named on the rota. Comments from people included, “The communication from the service could be improved” and “I do not always know which carer will be attending, as it tends to vary each visit.” Some people lived with communication needs that meant they could not always communicate verbally with staff. Some tools were available to staff to help with this including picture representations and the use of Makaton. Makaton is a language program using speech, signs and symbols to assist with communication.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result. The registered manager caried out annual written surveys with people to seek feedback about the service. Several people we spoke with had not yet been with the service for 12 months and so had not had this opportunity. People told us however that they were able to feedback any concerns or issues either directly to their care staff or by contacting the office. We received mixed feedback from people about the service they received when they raised issues with the office. One person said, “I requested that staff attend after a certain time on a particular day due to a regular family visit. It worked for a couple of weeks and then just reverted to what it was before.” Another told us, “The office does not always keep me updated about any changes, I generally receive information from the carers instead.” Other people told us that issues raised were generally responded to but that it often took a long time. The service had a complaints policy in place and complaints had been dealt with and responded to in a timely way in accordance with service policy. People and their loved ones told us they were confident if they raised a complaint that it would be dealt with. Everyone told us they had access to the complaints policy and procedure.

The provider made sure that people could access the care, support and treatment they needed when they needed it. The positive working relationship developed between the service and statutory health and social care partners ensured that people received the most appropriate care and support and achieved positive results. People and their relatives told us that referrals were made to, for example, GP’s, occupational therapists and social workers as needs arose. Professionals confirmed these working arrangements with one telling us, “They refer to us as needed, in a timely way. We carry out joint visits where needed and when we request it.” Another told us, “They will advocate on behalf of clients to ensure they have access to widespread healthcare and community services. They are responsive to clients’ needs particularly in relation to use of equipment and following of moving and handling plans.” Within care plans there were lists of key professional contacts to call as and when specific additional support was needed.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. People were supported with kindness and understanding and every effort was made to accommodate their preferred routines, likes, dislikes and any social events or outings they had. As far as possible the service adjusted care call times to fit around people’s social and family commitments. Although this was not always possible, every effort was made. People’s culture and religious observance was respected with efforts made to acknowledge significant days in people’s calendars. A staff member told us, “We are supportive of people and know that some like to pray at certain times of the day.” People with complex needs were given more allotted time for their care calls to make sure the support was not rushed and needs were met.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. People were given the opportunity at the pre-assessment stage and during subsequent reviews of their care, to discuss and make advanced decisions about their future care needs. Not everyone was prepared to make these choices and this was respected. People’s decisions were recorded in Recommended Summary Plan for Emergency Care and Treatment (RESPECT) forms and these were kept within care plans along with details of who to contact when people were approaching the end of their lives. Similarly, most people had consented to the completion of, Do Not Attempt Cardiopulmonary Resuscitation form (DNACPR). These documents assisted healthcare professionals to support people’s wishes in the future. Staff had all completed training in end-of-life support and most had experience of supporting people at this important time in their lives. Training included a session with the local palliative care team. Staff were able to tell us about the important aspects of care at this time with one saying, “Use their preferred names, sometimes use endearments like, ‘lovely.’ Make sure they are treated with respect and dignity and are comfortable.”