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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. At our last assessment we rated this key question outstanding. At this assessment the rating has changed to good. This meant people’s needs were met through good organisation and delivery.

This service scored 82 (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.

For example, when a relative asked for the service to help find a missing pendant alarm, a staff member attended and located it. While there, they noticed the person’s favourite nightdress needed washing. They started the laundry and put it out to dry so it could be worn that evening. The family expressed their gratitude. This response resolved the immediate safety concern and, through familiarity with the person, preserved a small but important personal routine for them.

Another person’s relatives wished to preserve established day-care relationships for their family member, rather than move immediately to live-in care. Two additional long days and Saturday support increased family capacity while the person remained at home with familiar relationships and the option to increase support when they were ready for this.

The service was flexible to help accommodate people going out or who had appointments. Visits were rearranged for people’s convenience. This meant that changing circumstances did not prevent the person receiving the care and support they required.

People told us they received person-centred care in line with their needs and preferences. One person commented, “They anticipate what I need before I need it. For example, like I will be thinking, ‘I could just fancy an orange squash’ and they will say, ‘Do you fancy an orange squash?’ Uncanny.”

The whole staff team was dedicated to meeting people’s needs and enriching their lives as much as they could. A staff member told us, “I enjoy making a difference and helping someone to feel more independent. Learning about my local area from clients who have lived in the area a while. A smile or a laughter during a visit is priceless. Sharing and making a client feel noticed and not ignored. A purpose to get up in the morning for the client and the carer.”

Care plans were written in a person-centred way which included details about the person and their individual needs and wishes. For example, a person’s care plan stated, ‘[Person] does not like water on [their] face or ears, so care must be taken to avoid splashing.’

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

People received care from regular staff members who knew them well. This meant people had trust in the staff who supported them. It also meant the staff were able to notice any subtle changes in a person and seek medical help when needed without delay.

People told us they received good care, and their healthcare needs were met and relatives echoed this. There were regular reviews organised to help ensure any changes to people’s needs or wishes was discussed and care adjusted to meet their needs.

People’s care plans described their healthcare needs and how to meet these. For example, if a person was living with a chronic health condition, there were clear instructions for staff to follow, so they could anticipate the person becoming unwell and take appropriate action.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. When care requirements changed for a person, there was clear communication with the person and their relatives, identifying the allocated staff members, exact interim and regular visit times, start dates and temporary weekend limitations.

Where another person had required additional hours, the service had sent confirmation of when this would begin. This meant relatives could organise their own responsibilities around a clear and realistic plan, rather than discovering gaps after the change had occurred.

Information was also adapted to each person’s needs. Care records identified approaches where hearing loss, cognition or anxiety could otherwise reduce understanding or involvement.

People’s communication needs were sought during the pre-admission assessment so information could be made available to them in a format that suited them. People were provided with information about the service, what to expect and relevant contact details if they needed to get in touch at any time, they had a query or a concern.

People's care plans detailed their preferences and any aids they needed to support effective communication. For example, one person had a hearing impairment but did not wish to wear their hearing aids. This meant there was a risk that communicating with the person could become difficult, leading them to become anxious or confused. Staff were advised to speak loud and clear, making eye contact. This approach supported the person’s understanding, and helped to reduce their anxiety, and to enable them to give informed consent.

People and relatives told us communication was effective, and they were provided with all the information they needed.

People were listened to and involved in the planning and delivery of their care. They had the opportunity to discuss any wishes they may have. There were regular care reviews where people could discuss their needs and any changes necessary.

Complaints were listened to and addressed appropriately. People and relatives told us they knew how to make a complaint and felt this would be taken seriously. Their comments included, “No complaints but we have only been here 2 months and I`d ring [Registered manager] with any” and “No complaints but if we had, and we don`t, I`d ring the office.”

People were given all relevant information about the service, including the complaints policy. The registered manager told us, “We don’t have a newsletter. What I do, if there are updates, we send letters, remind people of bank holidays double rate, in case they want to move the date of a visit. Typically, we inform people with emails or letters. If a member of the team leaves, there will be a handover and introductions made. We update our information packs. These include photos of us all, who we are and what we do, and how they can contact us.”

People were involved in regular care plans reviews to check if everything was ok and if there were any changes to people’s needs. People were issued with yearly questionnaires so they could have the opportunity to give their feedback about the service. Feedback we reviewed indicated everybody was happy with the care they received.

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

The service was responsive to people’s needs, including last minute requests or emergencies. For example, a person who had fallen received support while an ambulance delay was expected. When another person became non weight-bearing, rapid response, equipment and double-up care were coordinated to help ensure the person’s needs were met.

When a person’s private live-in care worker became unwell, additional hours to support the person were created within four hours. This meant they received the support they needed.

People told us they had access to the care and support they required and were happy with this. Relatives stated they felt their family members’ needs were met because the staff cared and monitored them closely.

People were supported to access the community if this was part of their agreed care package. For example, attending places of interests such as garden centres and parks, going to cafes and shopping.

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. People told us they were consulted in relation to their cultural and spiritual needs.

The provider supported people with a range of needs to pursue outcomes that mattered to them. For example, one person was supported with a range of interests including swimming, work experience, technology, shopping and friendships. This meant they were able to achieve greater independence, confidence, skills and social inclusion.

Another person receiving chemotherapy was supported around fatigue, skin problems, medicines availability and mobility while continuing exercise and social contact when well enough. A further person with fluctuating cognition and mobility was able to remain at home through coordinated family and professional support.

The provider had an equality and diversity policy in place and was committed to creating a welcoming and inclusive atmosphere for all people and staff, regardless of sexual orientation, gender identity, or gender expression. Some staff were from different backgrounds, but all were able to speak in English. One person for whom English was not their first language was paired with a staff member who spoke the same language.

People’s care plans indicated they had been consulted in decision making, including whether they preferred to receive care from a male or female care worker. Their care plans reflected people’s physical, mental, emotional and social needs.

The provider and staff ensured people’s wellbeing was taken seriously. The registered manager told us, “One person wished to do food shopping on a Friday and visit places such as the local garden centre. Some people visit churches on a Sunday and are supported to attend.”

People were given exceptional support to plan for important life changes, so they could make informed decisions about their future, including at the end of their life.The registered manager told us, “We meet end-of-life needs by recognising that care has to change as the person changes. From the enquiry stage we ask about future wishes and whether a Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) or a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) is in place, including where it is kept, and record this within the care plan.

One person’s wish to remain at home was supported through ReSPECT/DNACPR information, palliative and hospice involvement, anticipatory medicines arrangements and family communication. When the person’s condition deteriorated and they were found unresponsive, the agreed palliative pathway was followed. This meant they remained at home, and their [relative] was able to stay with her until the end. This outcome was in line with the person’s expressed choice.

A ReSPECT form is a personalised document that records a person's clinical care preferences and emergency treatment choices if they become unable to communicate or make decisions. A DNACPR form It is a written clinical recommendation telling doctors, nurses, and paramedics not to try CPR if your heart or breathing stops.

The registered manager provided evidence of how the exceptional support they had provided to a person and their relatives when the person was reaching the end of their life had resulted in a peaceful and positive experience. Through close monitoring and care, it was identified the person was becoming increasingly fatigued, had reduced nutritional intake and mobility difficulties. Without delay, equipment and professional support were introduced. The registered manager stated, “We also provided increased visits and overnight support quickly in response to [person’s] changing needs and to provide support and respite for family who were very involved in [their] day-to-day care.”

Until the end, the staff worked alongside district nurses, the hospice team and the person’s family to keep [them] comfortable and supported in the way [they] wanted. The relatives confirmed that the staff had supported both the person and the family exceptionally well.

Where people’s care needs increased, care plans and risk assessments were updated to reflect changes and all staff informed. The registered manager told us, “We work closely with families, district nurses, GPs, palliative and hospice teams. Our staff training covers recognition of dying, communication, comfort and symptom support, eating and drinking, mouth care, breathlessness, pain, advance care planning, care after death and staff wellbeing.”

Staff received training in end-of-life care, and people had end of life care plans in place. These were regularly reviewed and updated. They contained people’s wishes if they felt comfortable discussing these.