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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 good. At this assessment the rating has remained good.

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

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 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.

Care was consistently delivered in a highly personalised and person-centred way, with a clear focus on building meaningful relationships and understanding what mattered most to each individual. Care plans were exceptionally well written, compassionate, and detailed, providing a rich insight into people’s lives, histories and preferences. They included meaningful background information such as previous occupations, significant relationships, and places that held importance to the person, alongside information relating to protected characteristics. This ensured staff had a holistic understanding of each individual and could deliver care that truly reflected who they were.

There was a strong emphasis on relationship-led care, which enabled people to feel valued and understood. One staff member told us, “[The service] focuses on relationship-led care, continuity and matching staff to clients so support feels personal rather than task-focused.” This approach was reflected in the consistency of staff supporting people, which helped to build trust and familiarity. A relative told us, “They’ve gone above and beyond, and [person] has made friends with them as it’s the same 3 or 4 staff every day. They haven’t let me down at all. There’s a set routine that the staff follow.”

People’s preferences, wishes and individual routines were clearly understood and respected. Another relative said, “They understand their preferences, likes and dislikes.” This demonstrated that staff not only knew the people they supported well but actively used this knowledge to deliver care that felt personalised, respectful and meaningful. The culture within the service placed people at the heart of everything they did, ensuring care was consistently tailored, flexible and responsive to each person’s unique needs and choices.

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.

The service demonstrated a good understanding of care provision and the importance of continuity and integrated support. The registered manager showed clear awareness of the diverse range of healthcare needs within the community and recognised the current limitations of the service in supporting people with more complex needs. They spoke openly about plans to thoughtfully expand the service in the future to meet these needs, reflecting a proactive and forward-thinking approach.

People and their relatives consistently highlighted the service’s flexibility and willingness to go beyond expected levels of support. One relative told us, “They’re always keen to see any additional way they can help. When visiting [person] in hospital they were offering to bring [relative] in to the hospital to see them.” This demonstrated how the service worked to maintain important relationships and support people’s wellbeing during periods of change or ill health.

Continuity of care was a clear strength, with a small, consistent team of staff supporting each person. This enabled staff to build strong relationships and quickly recognise any changes in people’s needs or wellbeing. One relative said, “It’s always one of three or four staff so they notice any change or anything worrying.” All the people and relatives we spoke with were highly complimentary about this approach. One person summarised the ethos of the service, telling us, “There’s obviously an excellent underlying philosophy within the service.” This consistency helped ensure safe, coordinated and person-centred care was delivered.

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

The service was highly accessible and delivered information in a variety of formats to meet people’s individual needs. All reviews were conducted face-to-face, which enhanced accessibility, particularly for people with communication needs, including those living with dementia.

Relatives spoke positively about the service’s responsiveness. One relative commented, “I can get hold of them at a moment’s notice.”

Care plans clearly outlined people’s communication needs, ensuring staff had a good understanding of how best to support each individual. The use of small staff teams enabled continuity of care and allowed staff to develop meaningful relationships with people, helping them to understand both verbal and non-verbal communication cues.

Staff demonstrated a strong awareness of individual needs. One staff member shared, “There was a client who’d had a stroke and lost their speech. They understand and can hear. We work out what they’re asking for. I get to know individual people and their needs.” This approach ensured people were supported in a personalised and inclusive way, promoting effective communication and positive outcomes.

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.

People and their relatives told us they were actively involved in reviewing their care and that this was done regularly. Several people confirmed they had recently taken part in an annual review, providing them with an opportunity to discuss their care and any changes needed. In addition to formal reviews, the service completed in-person quality monitoring visits between care plan reviews. This approach gave people further opportunities to raise concerns, share feedback, and remain actively involved in shaping their care packages.

Feedback about the service was consistently positive. One relative told us, “[The service] has been absolutely brilliant. Because they have basically done what they've said they would do. Often people say they will do something and won’t deliver.”

The service also gathered feedback through satisfaction surveys, achieving a strong response rate of 60%. Results were highly positive, with 100% of respondents confirming, “I am involved in planning and reviewing my care.” This demonstrated the service had effective systems in place to listen to people and ensure they were meaningfully involved in decisions about their care and support.

The service ensured people and their relatives had equitable access to information and support by offering a range of communication methods to suit individual needs and circumstances. This flexible approach enabled people to remain informed and connected with their care, regardless of location or preference.

One person told us they used email to keep in regular contact with the service and to stay updated on any agreed changes to their care. Relatives, particularly for those living further away, also highlighted the benefits of the care planning app, a secure mobile phone application that allowed people and relatives to view notes input onto the system by staff following their visits. One relative said, “It’s good that they’ve got the online app so I can read what the carers are saying.”

The service was described as flexible and responsive, helping to ensure people’s needs were met promptly and fairly. A relative shared, “They really are peace of mind for me. If I’m away, they are flexible. They seem to be able to accommodate any request.” This demonstrated the service’s commitment to reducing barriers and promoting equal access, ensuring people and their families could stay involved and informed in a way that worked best for them.

The service demonstrated a consistent approach to ensuring people experienced positive outcomes and received equitable care tailored to their individual needs. Care was delivered by small, consistent staff teams, which supported continuity and enabled staff to develop a strong understanding of each person’s preferences, communication styles, and individual circumstances. This helped to ensure people received care in a way that was both person-centred and inclusive.

People and relatives told us the service was reliable and delivered care as agreed, contributing to positive experiences and outcomes. One relative said, “It means my sibling and I can go round and be their children without having to worry about their care.” This consistency helped to build trust and ensure people’s needs were met fairly and effectively.

The service made adjustments to meet a range of communication needs, including supporting people living with dementia or those who had lost verbal communication. Staff demonstrated patience and adaptability, ensuring people were understood and involved in their care regardless of their communication abilities. This reduced the risk of people experiencing inequality in how care was delivered or outcomes achieved.

Systems such as regular reviews, quality monitoring visits, and satisfaction surveys supported the service to identify and address any inconsistencies in 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.

The service worked collaboratively with people, relatives and healthcare professionals to respond to changes in people’s needs, particularly where there was a deterioration in health. Relatives spoke positively about the support provided at these times. One relative told us, “[Person's] health deteriorated a couple of weeks in and the GP thought she wouldn't live long. The service worked with the district nursing team and put an end of life care plan in place.” This demonstrated the service was responsive and able to coordinate care effectively with other professionals to support people at the end of their lives.

The registered manager also described how they had engaged in discussions with relatives when another person was approaching the end of their life, ensuring families were kept informed and involved in decision-making.

Care plans clearly recorded Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions, helping to ensure people’s immediate clinical wishes were understood and respected. However, care records generally lacked detailed information about people’s wider end of life wishes, preferences and values.

While the service responded well when people were nearing the end of their lives, this approach was more reactive than proactive. There was an opportunity for improvement in supporting people to have earlier conversations about their future care and end of life preferences, while they were still able to fully participate in these discussions. This would help to ensure care is consistently aligned with people’s wishes and provide greater reassurance for both people and their families.