Ethica Care Hemel Hempstead & St Albans

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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 newly registered service. This key question has been rated requires improvement.

This meant people’s needs were not always met.

This service scored 57 (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 did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

The provider did not ensure systems were in place to ensure people’s care plans contained information about how staff should support them.

However, people told us the care given by staff reflected their needs once staff had developed an awareness of how people want their care provided and what was important to them. Not all people were engaged in planning and reviewing their care and some people said they were not aware whether a care plan was in place.

Staff told us information about people’s needs was accessible via the electronic care planning system. However, people and staff confirmed that this system was not always updated when it needed to be.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

People’s feedback varied about changes to their care. This included changes to their care calls or the staff planned to attend. Some people experienced consistency with their calls and were aware of who would attend. One person said, “The [electronic rota application] gives the rota for 7 days ahead, and you can see the people who are due to come. Now it’s being filled in on a 2-day basis. We always know who is coming. There’s a core of regular staff.” However, we also spoke with people who did not experience this consistency and were less satisfied with the continuity of care. People gave examples where staff either did not arrive at planned times, did not call when late, or had several staff attending who they did not know through the week. One relative said, “They are all very nice [staff members] that come round, very helpful. The only thing is if they are late, [person] is up and dressed. On occasion it has been 11 o’clock when they arrive and [Person] is an early riser. I am not sure what time they are supposed to be coming – I thought it was 9.30-10.30 a.m.”

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

Although this inspection identified improvements needed with information in care plans, the provider had taken our feedback constructively. The new manager had identified the need to develop peoples care records and discussed plans they had to support staff skills and update the relevant care records.

People were mostly positive about staff communication and how information was shared. Most people could access their electronic care records, although some people and relatives did have difficulty accessing or operating the electronic care plan APP.

The management team advised they were aware of the Accessible Information Standard and were happy to provide information in any alternative formats people requested.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

People and relatives gave varying feedback about how they were involved. Some people and their relatives told us they felt able to raise concerns or complaints with the office staff or managers. One person said, “I have phoned them to complain. A lady the other end was very sympathetic and said she would investigate it.” However, other people’s experience was not as positive. One relative contacted CQC and told us that clients were told they would receive a rota, yet 10 weeks had passed without one. They were repeatedly informed that the rota system will be in place but in the meantime, they did not know which carers would attend, the time they will arrive, or the duration of each visit. They explained how they had once again contacted the office to escalate the matter; however, staff responded with “OK then,” before ending the call.

Some people said their concern was managed without issue and they were kept informed of the outcome. Other people told us they received no acknowledgement of the complaint and did not receive an outcome. One person told us how they had raised a concern about a particular staff member. This was investigated and managers took action to ensure this staff member was removed from the person’s address. However, they were not informed of the outcome of their concern. Although staff acted on the concern, the complaints process was not followed fully as the person was not fully informed of the actions or involved in the investigation.

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

Staff ensured people could access the care, support and treatment they needed when they needed it. People confirmed staff supported them, along with their relatives to access health and medical services as needed. This was with the support of staff who also had a good understanding of how to help people and the level of support they needed. When people had seen a health professional the office team would contact them to understand what was reviewed and whether any changes were needed to the care provided. Office staff would discuss people’s changing needs with people and their relatives, and where needed act on their behalf to access treatment. For example, with calls to GP’s or collecting medicines from pharmacies.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Staff had a good understanding of people’s personal backgrounds, wishes and what was important to them. However, people’s care plans lacked information around protected characteristics and how to help ensure people received fair treatment.

People were not always 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 manager told us they were not supporting anyone at the time of the inspection with end-of-life care. However, people had received care and support at the end of their life prior to this inspection. The assessment of people’s future care preferences was not always explored, this included people’s end of life choices and plans. Staff who supported people at the end of their life had received specific training to support people at this stage of life. However, staff did not always positively support people to plan for their future care. The provider and some staff were not aware of their responsibilities towards people at the end of their life, and the requirement to provide support at that time. One staff member said, “I have been sent training modules for e-learning, one of those was for end of life before Christmas, I’ve not done it yet. I don’t see why we need to as it’s the district nurses who give end of life care, not us.” This meant that people's preferences and choices for their end-of-life care and where they wished to die, including in relation to their protected equality characteristics, spiritual and cultural needs, were not clearly recorded, communicated, kept under review and acted on.