Belong at Home Domiciliary Care Agency - Wigan & Southport

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

This service scored 75 (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 was exceptional at making 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’s medical conditions were documented in detail within their care records. For instance, for a person who had been diagnosed with vascular dementia, there was detail on when the condition was diagnosed, their capacity to understand, the impact the condition had had and the support which was required. This was consistently updated when changes to their condition occurred.

When people lacked capacity to make decisions, their care plan referred to them by their preferred name and care plans for people with full mental capacity were written in the first person to indicate they had been predominantly written by them.

People’s risk assessments and care records were person centred and detailed. For example, a person’s personal care record provided a detailed explanation of how the person’s catheter required positioning due to their preference.

People’s emergency risk assessments were personalised and clearly described the key risks for the person and key contacts relevant to the person.

The provider ensured there were regular reviews of care taking place and leaders were responsible for completing regular reviews of people’s care plans and risk assessments which were reviewed as part of governance and quality assurance checks. We saw evidence of care plans and risk assessments being updated in quick succession following a change in presentation.

The provider had considered the key risks for people and had put contingency plans in place. For a person, on time sensitive medication, it was arranged that if staff were running late, they would phone their relative to ensure they could adjust the timing of the medication.

People’s care notes were accurate, detailed and respectful and concise. In addition to care notes, staff also completed a set of observations at every visit, which included notes on the person’s fluid intake, their physical and mental health, their overall mood and toilet visits. The observations section acted as prompts for staff to ensure detailed recording and provided valuable information for all involved in the person’s care.

People told us staff had an excellent understanding of their needs relating to their protected equality characteristics, social and cultural needs, and their values and beliefs.

The provider had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The provider had systems and processes in place which allowed leaders to review the care hours which were planned and what had been delivered on a weekly basis. The registered manager had clear oversight of this and explained how appropriate action would be taken if people were not getting the time allocated, which they had paid for.

The provider was aware of the funding arrangements for each person supported and this was documented clearly within their care record.

The provider had good links with services locally such as community healthcare matrons, and had admiral nurses employed by the service which meant care was joined up and flexible.

People receiving homecare were not excluded and had access to all the activities and amenities that people from the provider’s ‘villages’ had. This allowed them to be part of their local communities.

People told us they received care from the same staff members. The registered manager expressed to us how important it was to ensure people were matched up appropriately with the correct staff members. They explained how ongoing reviews and discussions were held with people to ensure they felt the match was appropriate and if not, this would be changed.

Leaders understood when people’s needs changed, and when they did, they responded effectively. For one person, whose behaviour became more aggressive as their condition deteriorated, the leaders increased staffing levels from 1 to 2. The provider also ensured they had conversations with their family about whether homecare was still an appropriate option for the person, or whether 24-hour care such as a care home environment would better suit them and their needs.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People and relatives had access to their care records. The information was mainly accurate, up-to-date and provided in a way they could understand.

People were provided with clear and transparent information in the form of a Belong at Home brochure. The provider had recently produced this in audio, CD format, braille and large print and were due to be introduced next month. The provider had also ordered easy read versions of documents for people with cognitive impairment or literacy needs.

People’s individual needs to have information in an accessible way were identified, recorded, highlighted and shared. These needs were met and reviewed to support their care and treatment in line with the Accessible Information Standard. The registered manager said, the provider would accommodate people’s wishes whether that meant sending letters instead of emails or printing care plans and risk assessments, instead of them being accessible electronically.

The provider was able to evidence how staff go the extra mile to ensure communication barriers are recognised and attempted to be resolved. For example, a staff member introduced communication cards to a person to communicate her needs and often prompted memories by using photographs or books.

Leaders told us that although the service did not currently provide care to anyone whose first language was not English or who had difficulties hearing, they would respond in the best interests of anyone’s needs who they had assessed and ensure they received access to equitable care.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

The provider had a complaints log, which evidenced 1 complaint had been received in the last 12 months. The complaint was not indicative of poor care and was resolved swiftly by leaders. Learning from the complaint was consolidated with staff.

People and relatives told us it was easy to share feedback and ideas or raise complaints about their or their loved one’s care, treatment and support. Although they had not felt the need to do so, they felt they would be treated with compassion by leaders if they did.

People using the service were involved in decisions about their care. The provider ensured there were regular care reviews being completed with people and/or their relatives. The reviews were detailed and covered whether they felt the level of support met their or their loved one’s needs, reviewed risk assessments and care plans, whether they felt any additional training was required to meet the person’s needs and any further comments. From the reviews, we could see how the leaders worked collaboratively with people and their relatives, ensuring they were respectful but always ensuring the best interests of the person were at the centre of the conversation.

Whilst reviewing a care record, we observed that a concern had been raised with the registered manager regarding a staff member. This concern was investigated swiftly by the registered manager, who completed a thorough review of all relevant documentation and appropriate action was taken.

A person told us about a concern they had raised with the provider about a support worker. They said this was quickly addressed and the provider changed who was allocated to the person. Since then, they have been extremely happy with the care and described the carer as being “one of my friends.”

The provider made sure that people could access the care, support and treatment they needed when they needed it.

The provider ensured people could access support when they needed it. Staff almost always completed their calls on time and as arranged. Staff almost always stayed for the duration which had been planned for.

People’s care and support was timely and in line with best practice. The provider made reasonable adjustments for disabled people including addressing communication barriers.

The provider ensured there was access for people with dementia to attend a monthly meeting in a Belong Village café. The meeting was hosted by a Belong Admiral Nurse, in conjunction with the village experience team, who helped facilitate opportunities for verbal and non – verbal communication, through music, art, exercise and dance. Admiral nurses discussed concerns, gave information about the diagnosis of dementia and were able to signpost further.

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.

Leaders and staff were alert to discrimination and inequality which could disadvantage different groups of people using their services. The registered manager told us how the people they supported mainly had a diagnosis of dementia and the importance of staff recognising the distinct differences in people with this diagnosis instead of treating everyone the same. They mentioned how there were various types of dementia, various stages and how it could affect people in different ways and thus the importance of seeing the person as an individual and not underestimating them.

People felt empowered by the provider to give feedback on their care which took into consideration their rights to equality and their human rights.

The people accessing homecare, were able to access the provider’s ‘villages’ for several activities and were included socially. The provider had a commitment to ensuring these areas were equipped for children to attend. Highchairs and baby changing facilities were integrated into the provider’s ‘villages’ to ensure peoples loved one’s including grandchildren could attend and be part of their lives. This demonstrated how the provider was committed to experiences being equitable for those in homecare and those with diagnoses such as dementia.

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.

Staff were trained in the foundations of palliative and end of life care. The service regularly linked in with the local hospice who delivered face to face training.

Staff worked closely with people who were on end-of-life care. We were provided with a recent example of a care plan, risk assessments and daily notes of a person who had recently passed away. The person’s care plan clearly reflected their end of life wishes, including their preferred environment and emotional needs, which staff upheld. Staff ensured the person remained comfortable and provided care in line with their wishes, such as playing music and ensuring their favourite television shows and sport were showing. Staff communicated well with family members, ensuring they were informed and supported throughout.

The provider was able to evidence excellent feedback from professionals about the end of life care they provided. For example, a district nurse stated: “Each and every member of the team has gone above and beyond in ensuring this [person] could remain at home and pass away peacefully as [they] had wished. This [person] was able to have a peaceful and dignified death due to the outstanding care provided from the care team.”

When people wanted to express their wishes about cardiopulmonary resuscitation, they were supported to do so and were able to change their mind if they wished. People’s care records clearly indicated whether they had a DNACPR (Do not attempt cardiovascular pulmonary resuscitation) order in place and if they did, where this was located.

The provider, as part of their initial assessments with people, ensured they considered information about them as individuals including their preferences and history. The provider demonstrated how people had been supported to achieve outcomes, goals and aspirations including riding a horse, driving a sports car and attending sporting events. However, the provider would benefit from these being documented and tracked better in the care planning system. The provider was developing their outcomes section on their electronic system.