Independence at home Limited

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• 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.

This is the first assessment for this service. This key question has been rated good: This meant people’s needs were met through good organisation and delivery.

This service scored 64 (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 were effectively at the centre of their care and treatment choices.

Care plans and risk assessments did not always provide person-centred information about people’s needs. Where information was documented in care records, it did not always contain sufficient guidance to ensure people’s individualised needs could be met. Although they were reviewed with people and relatives, care plans and risk assessments were not effectively reviewed to ensure they remained current and reflected people’s changing needs and preferences.

Staff were able to tell us ways in which they demonstrated an awareness of the individualised support they provided people. For example, 1 staff member described how the people they supported, ‘’Are the boss,’’ and how they worked differently depending on the needs and preferences of who they are working with. This was supported by people and relative’s feedback.

The provider sought the views of people and relatives on occasions regarding the care people received through satisfaction telephone calls and visits.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

While leaders used systems and processes to ensure people’s care was regularly reviewed, these processes were not always effective in ensuring people’s care records provided accurate information. This meant staff did not always have guidance relating to people’s needs to ensure they achieved positive outcomes.

Safety event records which detailed incidents of risk and harm were not always appropriately analysed to support understanding and learning. This meant there was a risk of incidents reoccurring. Events were also not always reported to CQC and the local authority. Reporting these incidents would have enabled greater joined-up working and greater understanding and learning. The provider’s failure to always report notifiable safety events to external partners meant people were at risk of their risks and needs not being known and investigated.

Staff were able to tell us their awareness of people’s health needs and how they supported people to meet these needs in consultation with external healthcare professionals, such as physiotherapists and nurses.

People and their relatives told us staff worked closely with families and external health professionals when this was required.

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

Care plans and risk assessments documented how people chose to communicate where they had communication needs. Staff were able to tell us about different people’s communication needs and how they used a variety of communication methods to aid people’s understanding, such as picture boards.

People and relatives told us how staff adapted their communication with people based on their communication needs, with 1 relative telling us, “It takes time to fully understand how [my relative] communicates. Quicker than I expected, the staff have got to know how [my relative] communicates and I’ve been impressed by this.”

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.

Most people and relatives told us they were involved in care planning processes, and how they were provided with regular opportunities in which they could raise matters with the provider, such as via people satisfaction surveys.

People and relatives told us staff and leaders kept them informed about changes, with 1 relative saying, “I’m kept up-to-date of what’s going on; they’re good in that way.”

A complaints procedure was in place, and staff, people and relatives told us they felt able to raise concerns and they were confident these would be dealt with.

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

While people’s care records did not always provide adequate information and some people told us their calls were not always on time, the continuity of care people received from consistent staff members and the awareness staff demonstrated of people’s needs meant people could access the care they required when they needed it.

Staff worked flexibly around people’s routines and needs to ensure people received care at times that suited them.

People and relatives told us the service was accessible and responsive. One relative told us, “I’ve got the office number; they’re very good at getting back to me,”

Staff and leaders actively listened to information about people who were most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff tailored support to people in ways to ensure they could achieve comparable experiences, regardless of disability, health condition, or background. For example, staff provided mobility support so people could access services within their wider community.

People and relatives told us staff treated people fairly and responded consistently to individual needs, demonstrating equity in both experiences and outcomes. People achieved outcomes comparable to others, including maintained independence and consistent access to social opportunities that were meaningful to people.

An equality and diversity policy was in place, and staff had received equality and diversity training, which meant the service was aware of some of the challenges people faced in experiencing equitable outcomes.

People were not always 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.

Information about people’s important life decisions was not always known. Most people’s care plans did not include information about their longer-term wishes and preferences which could be important to them.

Most staff had not received palliative care training, which was relevant to a person’s needs.