Basingstoke

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• 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 75 (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 was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The registered manager clearly understood the range and complexity of needs the service could meet. They explained the service did not provide live‑in care as they did not have the staffing infrastructure for this model of care. The service organised care rounds by geographical area, which promoted continuity of care and enabled leaders to identify capacity for additional care packages.

Senior staff completed assessments before care commenced. These assessments captured people’s preferences, routines and personal care needs. People told us they participated in their assessments, and care plans reflected agreed arrangements. The registered manager said they involved relevant stakeholders to ensure assessments fully documented people’s needs. Senior staff maintained regular contact with people when care packages started and completed initial and ongoing reviews to ensure care met people’s needs and expectations.

The provider planned and delivered people’s care and treatment with them. They did this in line with legislation and current evidence-based good practice and standards.

People said they were satisfied with the support they received with eating and drinking. Care plans clearly set out the support required, including individual preferences and strategies to promote good nutrition and hydration. For example, staff understood the importance of promoting nutrition and hydration and encouraged access to food and drinks outside scheduled visits.

Senior staff completed risk assessments relating to malnutrition and skin integrity with people’s consent to identify and respond to changing needs. Where staff identified concerns, the provider took timely action and involved relevant professionals. For example, staff raised concerns about 1 person’s diet, resulting in an additional care visit to support them with meals and access to food vouchers. This reduced the risk of malnutrition.

The registered manager demonstrated good knowledge of relevant legislation and best practice guidance, including the Mental Capacity Act (2005), NICE guidance and Skills for Care resources.

The provider worked well across teams and services to support people.

The registered manager had clear systems for communication and accountability when working with external professionals. Where people received support from other stakeholders, the provider clearly defined and recorded each party’s role. The registered manager kept accurate records of correspondence, which promoted coordinated and joined up care.

A health and social care professional told us the provider worked effectively in partnership to support a person with falls management and a medical condition. They said staff were proactive in identifying concerns and responsive to requests for information, which helped ensure timely professional input.

Staff said systems were in place to share essential information, including updates through the electronic care planning system and regular communication from senior staff when needs changed. This supported a consistent approach to care.

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.

Care plans clearly recorded people’s healthcare needs, including how conditions affected daily life and the support staff should provide. People said staff support led to positive health outcomes. For example, 1 person had a diabetes risk assessment and care plan that set out their daily presentation and staff actions if the person moved outside their baseline. This helped the person to safely monitor and manage any changes in their condition. In another example, staff told us how they adapted their approach when supporting one person who was living with dementia. They told us how the person’s needed fluctuating levels of support and strategies they adopted to help live well with their condition.

The provider ensured that outcomes were positive and consistent. However, they did not always ensure quality and accuracy in the recording of care provided.

People said staff were proactive in monitoring their health, medical conditions and wellbeing. They told us they trusted staff to support them to access professional input when needed.

The provider agreed clear outcomes for care with people and recorded these in care plans as specific tasks for staff to complete at each care visit, this included tasks promoting independence and monitoring health. Senior staff regularly reviewed care records and completed care visits themselves, to maintain an up-to-date understanding of people’s needs and the suitability of care arrangements.

Systems were in place to monitor care delivery, highlight missed, late calls and to monitor call durations. This included electronic call monitoring for visit completion, timings, key care tasks and medicines administration. Senior staff completed detailed audits of this data to review whether care arrangements remained appropriate. They used this information to evidence changing needs and support requests to commissioners for amendments to care packages. Where care needed adjusting, senior staff discussed this with people and updated care plans. They also carried out formal reviews to ensure care continued to meet people’s needs and reflected agreed outcomes.

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

People told us staff asked their consent on each occasion they supported with them with their personal care. They told us they consented to care agreements with the provider to help ensure there was a mutually understood plan of care in place.

The provider had effective systems to obtain valid consent to care. People, or their legally appointed representatives, signed care agreements to confirm consent. Staff demonstrated a good understanding of the Mental Capacity Act (2005) and told us they always assumed capacity and sought consent at each care visit. One staff member told us, “A big part of my role is supporting individuals to make their own decisions wherever possible.”

Care plans identified where people may have fluctuating capacity around consenting to their care due to ongoing medical conditions. Care plans documented how to work with people to best aid their understanding by using communication strategies people engaged most effectively with. This helped to ensure people were given the best opportunity possible to engage with decisions about their care. Where people lacked capacity to make specific decisions, the provider followed Mental Capacity Act processes to ensure decisions were made in people’s best interests.