County Medicare Professional Nursing & Care Services LTD

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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 is the first assessment for the service under this registration. This key question has been rated Good.

This meant people’s needs were met through good organisation and delivery

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 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.

The registered manager and staff told us they worked to ensure all care provided was person centred. Relatives told us they and their loved ones were involved in developing their plans of care. One relative said, “As his condition has changed his care and involvement has been increased and altered to meet his additional needs.” Another told us, “They do talk with [name] and check he is happy with the care. They will do a review periodically and discuss his needs with him.”

Where people were reluctant to receive care staff worked with them to develop a plan that would suit their needs and reflect their choices. This included knowing about people’s interests and hobbies. One relative said, “They (staff) understand that sometimes just sitting talking or helping someone with a jigsaw is as valuable as performing physical tasks.”

The registered manager and staff were aware of the importance of supporting people’s well-being. As part of some people’s care packages, they received companionship visits. This meant staff spent time with the person to allow their loved one’s time to go out and know the person was safe. The registered manager used information about the person’s interests and matched this with staff interests. This helped ensure the visits were meaningful to the person. We were told about one person’s interest in music. The person had musical instruments, so as far as possible, a staff member who was also able to play musical instruments, was allocated to these visits. The registered manager told us how these visits had developed and the staff member was trying to source a different instrument to play with the person.

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.

County Medicare is a small service that provides care and support to people living in the local area. This meant that staff knew people well, which enabled good continuity of care for people. People told us they received support from people who knew them. One relative said, “Because they are regular faces, [name] does recognise them and this makes [name] feel safe.”

The registered manager told us that if there were any concerns in relation to people’s health or social care needs appropriate referrals would be made. They told us that care staff would inform the management and office team of any concerns and then the management or office team would contact the relevant professionals. The registered manager told us this helped ensure good continuity of care as one staff member would be managing the concern.

Feedback from external health and social care professionals was positive. One professional told us, “There is a positive ‘working together approach’ which makes all our roles more effective in supporting [people].”

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

Information was available to staff to ensure they had all relevant, up to date information about a person and their care needs when they visited. People had copies of their care plan in their homes which included all relevant information and contact details for the service. Staff told us they received regular updates about changes to peoples care and support needs. One staff member said, “They (management team and office staff) know what it’s like if you walk into someone’s home blind. They make sure we have all the information we need.”

People’s communication needs were considered. Some people were at risk of becoming disorientated to time. Therefore, staff made signs to prompt them, for example, to have their breakfast. Staff reported this had been successful in encouraging the person to eat their meals and reduced them being reliant on snacks.

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.

Surveys were sent out to people and the results analysed to identify any areas that needed to be developed. Feedback was positive. People told us they were involved in reviewing their care and support needs to help ensure staff had all the relevant information. One person told us, “[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.”

People’s relatives told us they were listened to and involved. One relative told us, “The managers are very receptive and if I feel something needs to change, they will deal with it. They are very good at communicating and I am kept up to date and well informed.”

People knew who was coming to visit them and at what time. One person said, “We have a rota so know who is coming and at what time.” People were also updated throughout the day about any changes. One person told us, “If they are going to be late, they will always call me but this rarely happens.”

The registered manager told us how they would ensure that people and their relatives were involved in decisions about their own care and support. They told us they had a weekly call with person, who was particularly anxious, to discuss any concerns the person had about their support. The registered manager told us this was to ensure any concerns were addressed before they become larger issues.

We received concerns about communication in relation to one person. We discussed this with the registered manager who was aware of the concerns and told us about steps they would put in place to address with all those affected.

There was a complaints policy and complaints received were responded to appropriately and used to improve and develop the service. One relative told us, “I only have to mention if I have a concern or issue and they are straight onto it. They are very proactive and helpful.”

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

People were involved in planning their own care and support. They were able to choose the times of the visits. There were on-call arrangements so people and staff could contact the service for advice and support out of hours. The registered manager had identified that one person was less able to contact the service. Therefore, they had arranged for a new telephone to be installed which staff pre-programmed with numbers important to them. The person now only had to press the relevant button to contact staff. The buttons had pictorial references which also helped guide the person. Staff told us this had been successful.

The registered manager and staff worked closely with people, relatives and other healthcare professionals when appropriate. This supported people to have access to advice or care they needed. Feedback from professionals was positive.

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 and relatives felt listened to. One person told us, “They (staff) are always very receptive and listen to anything I have to say.” Staff treated people as individuals and understood people’s personalities and how they chose to live their lives. One person said, “We are totally treated with dignity and respect and very much as individuals.” A relative told us, “They are a small team of consistent carers who are very good and offer a personal individual service.”

One person had family overseas. They were unable to use the telephone independently. Staff arranged that they would alert the family when they were due to visit. The family member would then telephone when the staff were present to enable them to support the person to keep in touch with their loved ones.

The Registered manager and staff knew people well. They understood people’s personal challenges, their families and support networks. Staff were aware of people’s individual, cultural and spiritual preferences. They understood the importance of these dynamics in providing the appropriate care and support. One staff member said, “People say they are not religious, but they have beliefs. It’s important to incorporate those into their care.”

People were 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.

There were systems in place to ensure staff had information about how people would like to be supported at the end of their lives. Some people had ReSPECT forms in place (Recommended Summary Plan for Emergency Care and Treatment). These included whether or not the person wished to be resuscitated in the event of a cardiac arrest. Where these were in place there was information for staff in the care plan. There was an opportunity for people to discuss their end of life wishes with staff. People did not always wish to do this and this was respected. Staff told us following an assessment a person was asked if they had any end of life wishes they wanted to discuss. Staff said that following the introduction to the subject the person had thanked staff as this opportunity had opened discussions for the person and their family which they had found beneficial.