County Medicare Professional Nursing & Care Services LTD

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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 the service under this registration. This key question has been rated Good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 79 (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.

Assessments were completed before people started using the service. This helped to ensure people received the support they both needed and chose. Care plans and risk assessments were developed to reflect the required support. This support was regularly reviewed to ensure it continued to meet the person’s needs. One person said, “[Name] came out last week and went through a whole booklet of questions to review my care. She gave me lots of opportunity to say what I want and how to progress going forward.”

The registered manager told us that on occasions they would assess people whose support from other companies had not been successful. They told us it was important to identify, with the person, what had gone wrong and work with them to develop a plan that fully met their needs. The registered manager and staff told us how this approach had been successful, as it met people’s needs and also allayed concerns the person may have.

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.

Records showed the use of nationally recognised tools for example the Waterlow score for assessing people’s risk of pressure damage. Staff received regular training and updates to help ensure they understood the current standards of care to support people effectively. Staff also received specific training in relation to people’s individual health needs.

Staff knew people well and monitored them throughout each day. They were able to identify when any changes in people’s health and well-being. For example, staff told us skin integrity was checked when personal and continence care was being given. Where people were at risk of not eating or drinking enough, staff completed food and fluid charts to provide an overview of the person’s intake. Where needed and safe to do so, staff weighed people to monitor their weight. For other people this was done with the support of other healthcare professionals. If any concerns were identified the relevant health and social care professionals were informed and support requested.

The provider always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

The registered manager told us they worked hard to establish positive working relationships with health and social care professionals to achieve the best outcomes for people. They proactively sought advice and guidance to ensure these outcomes were achieved through joint working.

Feedback from health and social care professionals who supported people who used the service was consistently positive. One professional said, “There have been occasions where we have had to work closely with the carers to provide care and provide them with guidelines via a carers care plan. They follow the instructions provided well and if they have any concerns or notice changes then they always telephone our service with an update and request a visit from a [professional] to review.”

A healthcare professional told us how staff went over and above to ensure the person with complex needs had the right equipment to support them. They ensured the equipment was right for both the person and themselves and the practicalities of using it. They ensured the person was involved throughout and understood the reasons for the assessment and equipment .

Another professional told us how the registered manager had contacted them to review one person’s care and support needs. The person’s calls had been taking longer at each visit. The professional told us, “The staff were understanding and acknowledged that this (the call), is not something that can be rushed but, at the same time, need to complete calls in the allotted time to prevent a knock-on effect with other people’s care provision. It was County Medicare’s suggestion that a review be completed and were keen attend with me so that all relevant parties were involved appropriately. [It was] agreed to trial a longer call in the morning to allow the client more time and effectively reduce their fears and restrict any potential increases in the other calls.” The professional also told us the registered manager presented as having a good knowledge of the person and their needs. They further added, “This showed a clear understanding and obvious compassion for the person and their situation.”

A further healthcare professional told us the registered manager had contacted them when one person required more support with their mobility. They said, “County Medicare have contacted our Service when the adult’s needs have changed and are proactive in joint working. In my experience the care team shared their opinion on the moving and handling situation and were open and honest if they did not think a piece of equipment was working and gave clear reasoning for this.”

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.

Staff understood people’s health needs. They were able to identify changes to people’s health and knew when to contact the relevant health professionals. One staff member said, “Anything different, anything new, I contact the office. They will contact the right services.” One person told us, “They are regular carers so know me very well. They can usually tell if I am not very well and will call someone to help me if necessary.” A relative told us, [“Staff] care will action things like calling a GP if [name] is unwell or sorting his medication out with the pharmacist.” A health professional told us, “They are reliable and competent at noting changes in their client’s condition and escalate this to the necessary professional provider.” Peoples’ care plans and records showed that referrals and ongoing discussions took place regarding people’s health and social care needs.

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.

There were systems in place to regularly monitor people’s care and treatment to improve outcomes and ensure the appropriate care was being provided. Where staff identified changes were needed to improve outcomes for people they ensured that measures were put into place so these outcomes could be achieved. This included working with health and social care professionals to ensure a multidisciplinary approach to achieving these outcomes. This had positive outcomes for people and had made improvements to people’s health and wellbeing. This included an improved approach to people’s mobility, nutrition and mental health.

One healthcare professional told us, “I was impressed by the professionalism of the staff and how they worked with both Adult Social Care and the person to achieve the best outcome with the least impact on the care being provided.” Another health and social care professional said, “There is a clear sense of ‘person centred joint working’ where the care team know the [person’s] needs and are proactive in ensuring they receive what is required in terms of the right care and support.”

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

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

When people were not able to make decisions for themselves, relatives or legally appointed professionals were appropriately involved with making decisions in their best interest. However, some mental capacity assessments did not demonstrate the involvement of people and / or their representatives. We discussed with the registered manager. They were able to tell us how and why the decisions had been made and who was involved. This demonstrated they were aware of ensuring decisions made involved people and families and were made in people’s best interests. This information was updated during the inspection to reflect involvement.

Staff received training around mental capacity and told us how they supported people to make their own decisions and choices. One relative told us, “They will always seek consent from [name] or myself before doing anything.” Another relative said, “They do make sure he chooses what he wants and will always try to accommodate his wishes.”