Homelium West Sussex

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 service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (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’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. We found people's needs were not always fully assessed or accurately reflected in their care records. One person’s care plan recorded they might think they had eaten when they had not. Their nutrition and hydration assessment identified weight loss. However, records did not show how staff monitored the person’s nutrition and hydration needs or whether food, fluid or weight monitoring was required. Another person could not use words to communicate and used gestures and visual prompts instead. Their care plan did not give staff clear guidance about how to recognise when the person was distressed, or how to support them to make choices or communicate with them effectively. Some people and relatives told us staff discussed their needs before care started and reviewed these when circumstances changed. Staff could access care records electronically and received alerts when changes were made. However, care records did not always contain detailed, accurate and up-to-date information about people’s assessed needs. This increased the risk that staff would not always recognise changes in people’s health and wellbeing or provide consistent support that met their communication needs.
 

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. People’s care and treatment was not always planned in line with evidence-based good practice. One person’s records identified they were at risk of pressure damage but did not provide clear guidance for staff about monitoring their skin, applying creams and escalating concerns. Records for another person showed they had sore areas and broken skin and had sometimes refused a prescribed skin cream. A body map showed staff where the cream should be applied. However, records did not show these concerns were reflected in an updated care plan, risk assessments or clear guidance for staff about monitoring and escalating concerns. This increased the risk of further skin breakdown because changes in people’s skin condition may not be recognised and acted on promptly.
 

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. We received positive feedback from professionals who worked with the service. They told us information was handed over effectively when people’s care transferred to new care workers. The service communicated proactively when people’s needs or risks changed, arranged joint visits before new equipment was used and acted promptly on professional recommendations. One professional told us, “The quality from Homelium has always been of a high standard with rapid response where required. They are accessible and easy to get hold of when we need to.” This helped to ensure people received coordinated care when their needs changed.

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. People and relatives told us staff encouraged people to remain independent, and the service adjusted visits to support attendance at healthcare appointments. A staff member described supporting people to adapt to equipment and giving them praise and encouragement when they made progress. They told us, “It’s all about encouraging people to remain in their homes and that we are there to support them.” People and relatives said they could discuss medical concerns with staff and staff would liaise with them if they were concerned about a person’s wellbeing. This supported people to manage their health needs and remain independent at home.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. The provider completed care plan reviews with people and their relatives. However, reviews mainly focused on people’s satisfaction with the service and whether care visits were delivered as planned. They did not consistently evaluate whether people were achieving their agreed health, independence or quality-of-life outcomes. For example, one person’s care plan identified maintaining their mobility as an important outcome. A subsequent review did not assess whether this outcome was being achieved or whether their support needed to change to help them maintain their mobility. As a result, the provider could not always show whether people’s care was improving outcomes or identify when changes were needed to support their health and independence.

The provider did not always follow appropriate processes when obtaining consent or making decisions on people’s behalf. Consent records did not always show that people had been supported to make specific decisions or that relatives had legal authority to consent on their behalf. For example, leaders decided not to tell one person about a family bereavement because they believed this would cause them distress. However, records did not include a decision-specific capacity assessment or a best interests decision. Records did not show how staff had supported the person to understand the information, participate in the decision-making process or why withholding the information was in their best interests. This meant the provider could not demonstrate that significant decisions were made in line with legal requirements. This increased the risk that decisions would be made without appropriate safeguards. It could also prevent people from being involved in important matters affecting their lives and receiving appropriate emotional support. Following our feedback, the provider completed a capacity assessment, and best interests record for this decision.