Bramble Home Care LTD - Cinderford

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

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.

his meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Care plans did not evidence people’s physical, health, wellbeing and communication needs had always been fully assessed. Information was not always accurate, complete and contemporaneous. Care plans did not always show consideration to the needs of unpaid carers. Care plans did not always evidence individuals and their relatives were involved. For example, in one person’s care plan instructions were for staff to contact relatives in the event of any concerns, however it did not specify the person lived with their spouse, who could also be informed of any concerns. In another individual’s care records it stated a person needed to use mobility equipment but did not specify what equipment was needed. It also did not specify how the person did their shopping or if they needed support with oral care. Staff told us, “Sometimes the care plans aren't always on the system when we are visiting a new client.”

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 individuals well and knew their preferences and care needs. People were very complimentary of how well staff knew them and supported them. Individuals told us, “The staff I have, I cannot criticize. They’re so lovely, they pick up on all my problems. I had a skin infection recently and the staff member noticed it. I think they generally understand me and the way everything affects me. I have a very detailed plan” and “When my regular staff member comes in, they’ll always ask - how are you? And will always doublecheck everything. [They] are a very curious chap. It’s really nice.” However, information in care plans did not always consider national legislation and evidence-based good practice. For example, where people had specific healthcare needs, they did not reflect relevant guidelines. Staff told us, “The medicines will be listed but not always what we need to do for the person so we must call the office or talk to the person to ask them what they would like help with.”

The service 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.

External professionals told us they had positive experiences with the service. Professionals told us they felt information was clear and sufficiently up to date, and professionals could understand people’s assessed needs when reviewing care plans or records. One professional told us, “I find staff to be enthusiastic and not only ask relevant questions regarding medical needs but also request more information about different resources available which they could then adapt to better deliver care and support for people they support.”

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.

Staff were trained to identify and prevent health concerns within their first aid training. The service also delivered training on specific health conditions such as stoma care and diabetes. Training was a combination of face-to-face sessions and e-learning. The service had a training room on-site; however, most staff would attend training at the provider’s other office in a nearby town. The manager told us they had recently recruited a new training manager who would deliver training at this location.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Care records did not always evidence people’s health and wellbeing were routinely monitored. Care plans did not always emphasise or include details around agreed outcomes. For example, one person was prescribed cream for dry skin, however their care record only documented creams to be applied to their feet and did not include a body map. This showed the care plan had not been updated when the cream for dry skin was prescribed. Another person’s care record did not include agreed outcomes or details of their goals. However, improvements were being rolled out but not embedded by the end of the assessment.

The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Staff told us, although they asked for consent, they felt care plans lacked sufficient details. When we reviewed people’s daily notes, we could not find evidence staff were consistently recording they asked for consent. Staff told us, "We always ask permission before doing anything - we get consent” and “We have on-call and they will always answer. We have a lot of information about medicines, but not always about anything else… my clients are very consistent, and they know me, the families know me, I just stick to what they've already said what they want.” Managers told us people were able to consent in a variety of ways, although they agreed staff needed to improve their recording of this.