Dimensions Warrington Domiciliary Care Office

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 newly registered 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 67 (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 was effective by assessing and reviewing their health and care needs with them.

For example, in some instances, there was no record of people’s health history, which could have supported the development of care plans and assessing needs. This was fed back to the provider so necessary improvements could be made.

However, people, families and professionals were involved in assessments and reviewing the needs of people. People’s communication needs were clearly documented and detailed. We observed staff members using a range of different communication techniques to engage with people, such as picture cards and objects of reference.

Staff were able to tell us about people needs and clearly knew people well. We found this knowledge aligned with information provided in care plans.

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.

For example, where appropriate, Positive Behaviour Support plans (PBS) were in place for people. The aim of these was to implement proactive strategies and person-centred approaches to reduce distress and create supportive environments. These plans were developed in collaboration with a specialist PBS team within the organisation. Staff received training in the PBS framework, which applies evidence-based strategies to improve quality of life by promoting positive behaviours and reducing the need for restrictive practice.

Competency assessments were in place to review staff knowledge of individuals’ PBS plans.

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.

Staff reported teams worked well together and supported one another. Comments included, “The team working with [Person] are brilliant,” and, “We support each other as a team.”

Staff worked effectively with other professionals, including district nurses and speech and language therapists. Professionals provided positive feedback about the staff teams’ collaboration and communication. One professional commented, “The support team know people they support really well, and they have a consistent approach. They always engage with us and make us feel welcome on visits.”

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 the need for future care and support.

For example, in collaboration with relevant professionals, a high calorie, healthy diet plan was developed for a person at risk of malnutrition. As a result, the person reached a healthy weight and improved health outcomes.

Family members shared examples of activities and lifestyles that had been encouraged to help their relatives lead healthier lives. One family member commented, “The best thing is that they are supporting my relative to lead their best life.”,

However, we did identify some gaps and inconsistencies in bowel monitoring and food monitoring for some people. We raised this with the registered manager, who provided assurances that these shortfalls had been identified and appropriately addressed with staff.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured outcomes were positive and consistent, and they met both clinical and people’s individual expectations. Staff supported people to achieve their goals by breaking them down into realistic, achievable steps.

Annual reviews were held with people, their families, professionals, and staff to ensure the support provided was tailored to each person’s needs, preferences, and goals, leading to positive outcomes. These reviews helped identify what was working well, what needed to change, and how goals and outcomes could be refined.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. We did find improvements were required in the recording and documentation of mental capacity assessments and best interest decisions. Some records were inconsistent or had not been reviewed.

Our observations confirmed staff were following the principles of the Mental Capacity Act (MCA). Staff had received training on the MCA, were not applying unnecessary restrictions, and could clearly explain decisions made in people’s best interests. We found for one person who was non-verbal, staff explained how they gained consent through recognising specific body language signals, which were also documented in the person’s care plan.

There was evidence that, where appropriate, consent had been obtained for specific decisions. The provider demonstrated adherence to policy by notifying the local authority of existing restrictions to support Court of Protection and Deprivation of Liberty Safeguards (DoLS) applications.