Daily Comfort Healthcare Ltd

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.

This is the first assessment for this service. This key question has been rated good.
This meant people’s outcomes were consistently good, and people’s feedback confirmed this.
 

This service scored 62 (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.
The provider completed initial assessments of people’s needs prior to care packages commencing. Assessments incorporated information from people and professionals; to help ensure they reflected the care required. The provider identified where there may be risk to people, but there was not sufficient information available to staff in people’s care plans on how to manage these. For example, where people were at risk of pressure ulcers, there was no risk management plan in place. Care plans contained limited information about people’s history, cultural, religious and spiritual needs to enable staff to understand what was important to people.
Although some reviews of care had happened, and senior staff followed up with people about their care, it was not always clear when or if reviews were taking place. People and relatives we spoke with confirmed this. One person who said they hadn’t had a review told us, “I’d like a review very much.” Whilst a relative said, “But we haven’t had any formal reviews.” Reviews of care help to ensure care plans and assessments are up to date and reflective of people’s needs.
 

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. However, they did not always follow legislation and current evidence-based good practice and standards.
Although the provider had worked with people to plan and deliver their care, there was no evidence the provider had followed NICE guidance in risk assessing pressure ulcers for people where a risk had been identified. The provider had not used recommended tools such as the Braden scale or Waterlow score when assessing pressure ulcer risk. There was also no evidence of the use of a SaLT assessment where a person was at risk of choking. A relative told us, “I don’t know if there’s a risk assessment for pressure care, I haven’t actually seen their care plan or how they record what they do and see.” This meant people were at risk of poor care where current evidence-based good practice was not followed.
The registered manager told us they involved professionals such as district nurses, and their details were in people’s care plans. However, these did not contain the detailed information required to guide staff in people’s care.
 

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.
People’s care plans included where other stakeholders had input into their care, such as GP or district nurses. Staff were also trained on more specialised care from external professionals. For example, where staff supported people using a percutaneous endoscopic gastrostomy (PEG) they were trained by a nurse specialising in this, who also gave support to the service. This helped to ensure staff were competent in the use of equipment or monitoring of people’s wellbeing. The registered manager included information for staff during induction on how to talk with other professionals to better work together.
 

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.
People’s healthcare needs were identified in their care plans. This included the level of support they needed to maintain good health. Senior staff told us they monitored daily logs of care to help recognise when people’s needs were changing and whether care needed adjusting. The registered manager also said they rely on staff alerting them to changes in people’s healthcare needs. The service could also communicate with staff via the electronic care planning system, which meant updates and key messages could be shared in real time. Where people had specific health conditions, staff had training in line with these conditions. This helped to ensure they had a good understanding of how to effectively manage them. Staff we received feedback from confirmed they were knowledgeable in conditions such as diabetes.
 

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.
People’s care plans identified specific goals and outcomes related to their care. However, the lack of comprehensive risk management information made it difficult for the provider to evaluate the care people received to determine if it was effective in reducing risk and meeting people’s needs. It was also unclear when or if the provider had carried out regular reviews with people to help ensure preferred outcomes of care were relevant, agreed by all parties and being met.
The registered manager told us they had equipment and were planning to do vital checks on people, such as oxygen levels in the future, once staff had been trained.
 

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.
There were policies and procedures in place to ensure valid consent to care was obtained. People told us staff sought their consent before delivering care. Staff had a good knowledge around Mental Capacity Act 2005 (MCA) and how to practically apply this in their everyday roles. The provider sought consent during the initial assessment, documenting verbal consent where people were unable to sign. Where a person lacked capacity, the provider obtained consent from either the power of attorney or through a best interest decision meeting. This helped to ensure the provider was following the correct procedures around gaining consent to care.