Closer Care Services - Main Office

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 requires improvement. At this assessment the rating has changed to 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 and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The registered manager assessed and recorded people’s needs prior to the person receiving care. A person said, “[Registered manager] came out to visit me and went through my care plan and what we could do, Iwas involved in making the care plan. I have a copy, it's in a folder."

People who already used the service had received a full care plan review since the last inspection to ensure all information was accurate about their needs and wishes. Care plans were now much more detailed and contained person centred information.

The registered manager had reviewed people’s communication needs and clearly recorded these in care plans.

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.

The registered manager had made improvements to care plans since the last inspection. All care plans had been fully reviewed and updated. Where people were at risk of skin breakdown, for example, clear risks had been recorded, along with risk reduction measures. This meant staff had guidance on the early identification of potential wounds. We saw evidence of staff clearly documenting changes in skin condition, and supporting people to contact healthcare professionals when needed.

A relative told us, "I can't fault the carers, they have managed to deal with a lot [of health needs for the person]."

Care plans described what people liked to eat and drink, and any dietary requirements. People and relatives told us staff left out plenty of drinks, especially during hot weather.

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.

People told us staff worked well with other healthcare professionals. Relatives told us staff were responsive when external health partners needed to become involved. A relative told us, “One thing I've noticed is [staff] are always on the ball, with changes within [person’s] body, they come straight to me or will call the GP or District Nurse and then keep me updated."

The provider understood how to seek support from health and social care professionals when required, such as obtaining mobility equipment.

Where people had been admitted to hospital, relatives spoke positively about the flexibility of the provider. One relative said, “[Registered manager] been very flexible when [person] has been in hospital, they’ve stopped care when required and when we've needed additional care they've responded to that as well.”

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

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.

The provider had developed a range of oversight processes including care plan audits, medication audits, welfare calls, spot checks and supervision systems. Managers used information from these processes to review quality, monitor outcomes and identify areas for improvement.

Care staff monitored people’s wellbeing at each care visit, and followed instructions provided by other healthcare professionals. One relative said, “[Staff] do all the repositioning the District Nurses suggested and now [person's] pressure wound has healed up nicely."

Relatives told us the service was receptive to people’s changing needs. One said, “[Provider and relative] have modified things as we've gone along, seen what works and what doesn’t, we've increased some of the hours they go in each day.”

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

People’s consent was sought prior to delivering care where applicable. The registered manager had completed additional training to improve their knowledge of the Mental Capacity Act 2005 and the associated codes of practice.

Capacity assessments had been completed for all people who lacked capacity to consent to specific areas of their care. Where these deemed people to lack capacity, best interest decisions had been completed. However, best interest decisions were not always detailed, particularly around the risks posed to the person if the best interest decision had not been made. Following the inspection, the registered manager took action to strengthen these records. They reviewed existing best interest decisions and added further detail to show how decisions had been reached, the risks considered, and how the least restrictive option had been chosen.