Darethealthcare UK Limited

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.

At our last assessment we rated this key question good. At this assessment the rating has remained good

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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People told us that their care and support was reviewed annually and they felt that the service managed their care well.

The manager told us that all people that were supported by the service received an in-person assessment, which was made with that person or someone who supported them, agreed and signed by them.

We saw care plans which showed that people had signed and dated assessments and notes regarding the care required and for the safety of the environment. All care plans had been reviewed that year and had been updated according to people’s needs and amendments were made when people’s needs changed. We saw that all people had received a mental capacity and best interests assessment which guided care staff on people’s ability and capacity to make decisions.

We saw good guidance for staff on how to communicate with people who had disabilities such as “Ensure that the person can see your mouth, speak clearly and slowly”.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Care plans identified specific health risks and gave detailed guidance for staff to minimise those risks. For example, some people supported by the service were at high risk of pressure ulcers, which develop when a person stays in one position for too long, especially over bony areas like the heels and elbows. However, daily notes written by carers about care given to people at risk did not show how they had been repositioned. This meant staff supporting the person later did not know which position to reposition them, which could increase the risk of causing a pressure ulcer.

The provider told us where risk was identified they would implement monitoring systems such as hydration levels or stool charts which monitors people’s digestive system. Some people were at risk of malnutrition, so the service had implemented a daily weight monitoring chart and a specific list of high calorie foods to support that person. The service identified and readjusted attendances for that person, so staff were given time to ensure meals were taken.

Staff told us they worked with people to ensure they received care in ways that suited them and would make suggestions to the manager to ensure people were supported in ways that suited them.

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.

The manager told us staff knew people very well and people that had been cared for by them for several years. Staff worked well together and did not always work with the same staff member when they provided doubled up care. To ensure staff were aware of changes with peoples care they used an electronic communication system. The manager told us there was no hard copy of a hospital passport kept at people's homes, if people needed to go to hospital, but healthcare professionals would be able to access their details online – though it was not made clear how they would access this detail out of office hours.

The manager told us the service would support people with more than personal care. For example, they had arranged the purchase of a television for a person who was unable to leave their room.

Staff told us the service was like a family and they supported each other. They gave examples of when staff would flex to cover incidents of other staff taking time off. We were given examples of how care staff would liaise and work with district nurses to provide joined up care.

The service did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. The service did not always support people to live healthier lives.

The manager had a good relationship with people they supported and encouraged people’s independence. We saw one person attend the office and interacted with staff who were respectful and friendly. People could access health care when they needed it. For instance, a person was supported to make their own optician’s appointment over the phone. Some people were unable to leave their homes and the provider supported them by arranging for access to a mobility scooter which enabled them to leave their home and increased socialisation.

One person told us, "The staff take me out shopping to Sainsburys to get my money out of the cashpoint”. Another family member told us “The staff make sure my loved one is well and they have a routine of calls which helps with continuity with Alzheimer’s that is important”.

Staff told us they worked with people with daily living tasks as well as personal care and where possible would take them out of their homes to social activities or engage with them.

All staff received training in subjects relevant to personal care, however, staff had not received training in basic life support, or more complex health related care such as catheter care. However, following our inspection, the provider immediately ensured specialist training was given to staff.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

People told us they felt supported by the service.

Staff told us they knew people well; they understood their needs viewed people and their care holistically.

The manager told us people's care and treatment was routinely monitored using systems such as the Waterlow score which assesses people's risk of developing pressure ulcers and Bristol stool chart which assesses digestive health. We saw a document that showed regular weight monitoring of one person who was at risk of malnutrition. Staff were able to explain how they used this to encourage people to eat nutritionally appropriate foods.

The provider told us they had improved outcomes for people through support and encouragement. For example, a person at risk of self-neglect and isolation was encouraged to attend health appointments with staff and they had also visited and developed a strong supportive relationship with office staff.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People told us that staff always asked permission and consent prior to providing care and treated them with “dignity and respect”. A family member when asked if staff asked consent first said “Yes, very much so. They have always done that, and the new carers follow their lead. So yes, they always ask them if they are ok and if this or that is ok”.

Staff had a good understanding of the need to gain consent to care. They told us they always asked for people’s consent before each care task and respected their right to decline care. Staff had a good knowledge around the Mental Capacity Act 2005 (MCA) and how to practically apply this in their everyday roles. The provider told people about their rights around consent and staff respected these when delivering person-centred care and treatment.

There were policies and procedures in place to ensure valid consent to care was obtained. We saw care plans contained a best interest and Mental Capacity Assessment. A best interest’s decision is when someone makes a choice for a person who cannot decide for themselves, ensuring the decision reflects that person’s wishes, feelings, values and wellbeing. This helped to ensure the provider was following the correct procedures around gaining consent to care.