Thames Homecare Services Greenwich Branch

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.

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 63 (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 had undertaken assessments with people to identify their specific needs for care and support. People and their relatives told us they were involved in the assessment of their care needs. Comments included, “I was involved in [family member’s] care planning, they prefer me to handle things and trust me to do what is right” and “I was fully involved in my care plan.”

Staff told us they informed managers when things changed so care plans could be reviewed. A member of staff said, “If anything changes, I let the supervisors know straight away so the care plan can be updated.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. However not all care records were in line with legislation and current evidence-based good practice and standards.

The risks associated with eating and drinking were not always managed well. Eating and drinking guidelines were not always sufficiently detailed when people were at risk of choking. The risk of dehydration was also not being consistently managed well as staff were not always recording people’s fluid intake so there was a risk people would not get the necessary fluid to maintain good health.

Despite our concerns with the quality of information in relation to nutrition and hydration we received generally positive feedback from people about how staff ensured they had enough to eat and drink. Comments included, “[Family member] is at risk of malnutrition, they forget to eat and has no appetite, the carers organised for them to get nutritional shakes and [family member] has even put on some weight” and “The carers prepare my meals and drinks, I have whatever I order from the supermarket, when they leave, they make sure I have a drink and a snack.”

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 and relatives were confident staff worked well with external health and social care professionals to support their health and wellbeing. Comments included, “They communicate with different people such as the health visitor, and sometimes the district nurse. So, we have a sort of plan together” and “A nurse and a physiotherapist have visited me at home.”

Staff told us there were effective systems in place to communicate with external health and social care professionals when people’s needs changed or additional support was required. A member of staff said, “We often share information with community health teams, if people’s needs change or they need some additional support or equipment.”

Feedback from people, relatives and professionals indicated care was delivered by staff who understood their medical conditions and the day-to-day interventions required to maintain their wellbeing. In most cases people and relatives described staff who were knowledgeable, attentive and skilled. Despite this we found staff did not have access to all the information they needed about people’s health conditions. We found a range of health conditions where more information was required to ensure staff would understand how the condition affected them, signs of deterioration and the steps to take if people’s conditions got worse.

Notwithstanding the gaps in records people told us staff supported them to access healthcare services when required. Staff could recognise when someone was unwell or in pain and reported concerns to the relevant healthcare partners to ensure people received timely support.

The provider routinely monitored people’s care and treatment. Care records detailed people’s outcomes they wished to achieve as part of their care journey. People told us senior staff carried out regular spot checks and telephone monitoring calls which enabled leaders to gather feedback and understand people's experiences of the service. Records indicated, the provider had undertaken recent reviews of people’s care and support needs, which helped to ensure people’s records remained up to date with information about their current needs. A person told us, “The care plan is always being assessed, we had a meeting with the manager and the assistant manager two or three months ago, because [family member] needed slightly different care.”

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Processes were in place to ensure the service acted in accordance with the provisions of the Mental Capacity Act (MCA) 2005 however these were not being consistently applied. Consent forms were in place however it was not clear whether people had provided formal consent to care as several consent forms stated the person provided verbal consent. Although verbal consent was recorded, some records did not contain sufficient detail to demonstrate how informed consent had been obtained, who provided it or why the person was not able to sign to show they had consented to their care plan.

The provider had completed mental capacity assessments for some people however information did not always detail how the person lacked capacity. For example, one person’s capacity assessment stated that the person was unable to retain the information, but it did not explain how this judgement was made. Another person’s record stated they lacked capacity but there was no mental capacity assessment in place or evidence of a best interest meeting taking place.

For people who had a Do Not Attempt Resuscitation (DNACPR) decision in place, there was no evidence that this had been discussed with them or relatives who were involved in their care.

Despite these shortfalls staff told us they had received training in mental capacity and understood the principles of the Mental Capacity Act 2005 in supporting people who cannot make specific decisions about their care and treatment. Staff also told us they always asked for people’s consent before carrying out care tasks.