Right at Home Bexley & Dartford

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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 this newly registered service. This key question has been rated 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 provider carried out assessments of people’s needs prior to their package of care and support starting. The assessments were then reviewed frequently. The registered manager told us assessments followed a structured schedule. They were reviewed at 2 weeks, 6 weeks, 3 months, 6 months, 9 months, and 12 months. After the first year, assessments were then conducted every 3 months and on an as and when required basis, such as following a hospital discharge or significant change in a person's needs. The registered manager said, "This approach ensures that assessments and reviews are timely, appropriate, and tailored to the client’s stage in their care journey." Staff told us they reported any changes to people’s care and support needs to the management team. A staff member said, “I inform the office of changes to people’s care and new requests and tasks are added.”

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.

Most people were provided with care and support which met their needs and expectations. A person said, “They support my personal care needs very well.” Relatives told us, “They check for bed sores. They change his catheter”; “They have started to get him to do some things himself. They understand his preferences” and, “They give her a wash twice a day.” A relative was not happy with the care and support and had communicated this with the provider. The provider was in the process of investigating this complaint.

When people had support with preparing and cooking food, the food provided was purchased by relatives and cooked by staff. People were making food choices. A relative said, “They did breakfast and just started doing lunch. They ask what he wants.”

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.

The provider told us that they shared information about health concerns with relevant healthcare professionals and with relatives. They had also provided support to people using the service and their families outside of their commissioned role. For example, supporting local tea dances and dementia groups. A relative told us, “They invited people over. They laid on afternoon tea. Carers, management and service users were there.” The staff team was small and worked well together. The management team knew people well, this was evident from the phone calls received at the office. A member of staff told us, “Everything is generally good; training, time management, culture, and teamwork are strong.”

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 could tell us how they would access additional support from healthcare professionals to help people manage their health, should it be required. The management team gave us examples of when they had made contact with people’s GP or the district nursing service when people had become unwell. A staff member said, “Report to line manager/director, who then contacts GP or emergency services as required.” A person said, “Once when they came to a bedtime call, I had some difficulties breathing. The carer held my hand, reported it to the office and stayed until other help arrived. She assured me she would not leave me until further, more qualified help arrived.” A relative told us, “The carer thought her face had dropped, so called the doctor.”

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 carried out regular telephone monitoring reviews of the service to check that people were happy with their care. We could see that adjustments had been made to care and support in relation to the feedback. There had been 1 complaint about the service which was still being investigated when we inspected. There had been 1 concern, which had been resolved. Compliments about the service had been received. A compliment said, ‘Thank you so much for your help in trying to get some “life” back into me. Also, and finally, your staff are brilliant with me. I could not be in a happier place.’

People told us, “I had concerns, worries dealt with satisfactorily. The carers are lovely”; “I have no worries of concerns” and “I have so much to say about how good they are. I could not have better care.”

Supervisions and spot checks had taken place frequently; staff were provided with an opportunity to discuss any concerns they may have about people’s care or how it could be improved. A member of staff told us, “I feel well supported, I have had supervision and spot checks.”

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. We checked whether the service was working within the principles of the MCA. Staff told us they had received MCA training. A staff member said, “It’s about assuming capacity unless proven otherwise. People should be supported to make their own decisions, and their rights should not be taken away without evidence they lack capacity.”

People made choices and day to day decisions about their lives. Relatives said, “They ask him what he wants to wear. He will choose on a good day. They take a lot of care”; “She can make choices. Choices with meals and clothes. They would let her stay in bed if she wanted to. One day she wanted to stay in bed, and they informed me as it was not like her” and, “They give her choices, like if she wants a full wash. They listen to her. If I say something they will double check with her.”