Home Instead Rugby

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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.

At our last assessment we rated this key question outstanding. 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 83 (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.

Systems and processes were effective in identifying people’s assessed needs and reviewing them to ensure people’s care, treatment and health needs were met, with the involvement of the person and their relatives. Relatives confirmed they were involved in the initial assessment to determine people’s needs. A relative told us, “We were involved in the conception of the initial assessment. We had the initial interview with all of us, felt very comfortable. The way staff member spoke to us, and [person] was inclusive.” A second relative said, “Initial care plan discussions with meetings at home, all clearly documented and understood.”

People’s care needs were stored electronically, on a system known as ‘Birdie’. This provided staff with access to people’s care records via handheld devices, which they could update, documenting any changes in people’s health and wellbeing.

People and their relatives confirmed they were involved in any changes into their needs, with relatives being very complimentary about having access to care records, which enabled them to monitor the service being provided. A relative told us, “The care plan is all on the ‘Birdie App’ which reflects [persons] needs and can be updated.” A second relative said, “The care plan is on Birdie’, which gets updated as their need changes, for example, more issues around their dementia now as time has gone on.”

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 provider used recognised assessment tools in line with legislation and current evidence-based good practice and standards. The provider sought people’s views and that of their relatives to ensure, where required, meals were provided in line with their needs and wishes. This collaborative approach had resulted in positive outcomes for people. A relative told us, “Carers cook for [person] which includes a cooked breakfast, her weight has improved and is blossoming with having nutritious food.”

Staff were passionate about the quality of care they provided, and knowledgeable as to people’s individual needs. A member of staff who provided the role of live in carer to a person living with dementia told us, “I do the cooking. The person can feed themselves with finger foods and solids, using a fork and spoon, but I always stay with them while they eat because they get confused. I support them with using a spoon for soup and porridge, and I encourage and prompt them throughout. I also encourage them to drink regularly. The person doesn’t know when they need a drink, so I make them, always to their preference. They love a cup of tea, and cake, of course!”

Staff implemented guidance in response to assessments carried out by health professionals. A relative told us, “My [person] has issues with swallowing so needs mashed up food. The carers manage this well as [person] is at risk of choking. All meals are prepared; staff also provide social interaction at mealtimes which is important.”

Dependent upon people’s assessed needs, staff supported people to prepare and cook meals. A person told us, “I receive some help preparing light meals like eggs at breakfast and I can use an air fryer, they contribute to my needs as required.” In some instances, staff supported people in the writing of grocery shopping lists and undertaking shopping. A relative told us, “Shopping lists are done with the carers.”

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.

There was a pro-active approach of encouraging good working relationships with a range of health care professionals, which included having access to GP Connect, which enabled, where necessary, the registered manager and leadership team access to clients’ records.

Staff supported people to access and share information with health care services. A member of staff who provided ‘live in’ support and care told us, “We have the hospital today, they are having a hip replacement, so today we are going for the hip replacement pre meeting.”

People’s care records were accessible to them, their relatives and staff who provided their care and support. Relatives were overwhelmingly consistent in sharing their positive experiences of having accessible information, and its impact on them. A relative told us, “Birdie can keep me informed, jolly useful.” A second relative said, “Notes kept electronically on ‘’Birdie App, very useful for us living so far away.”

Accessibility to people’s care records enabled staff to record information in real time, escalate information of concern in a timely manner and share information with relevant health care staff in an emergency. A member of staff told us, “Everybody has care plans. They’re on an app and give us all the information we need. All the risks, medical information, including if they are prescribed blood thinners or a DNAR (a document which records people’s advanced wishes should they stop breathing) are there. It’s easy to access all the important information too, especially Recommended Summary Plan for Emergency Care and Treatment forms (ReSPECT) (a document which records people’s advanced wishes regarding treatment in the event they unable to do so) as they need to be taken to hospital with them.”

The provider always supported people to manage their health and wellbeing to fully maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

The ethos of the service was to facilitate people remaining in their own homes, by encouraging and supporting people to maintain and, where practicable, increase their independence. A member of staff told us, “The whole ethos is for people to be at home. It is enabling people to stay at home instead of going into a hospital or a care home.”

People’s care plans explained the support people required to enable them to stay well and access healthcare services, where necessary. People with specific medical conditions, had detailed information within their care records which provided guidance for staff as to how this affected the person and how best to support them. For example, a holistic package of tailored care and support was in place to support a person with all aspects of their life, enabling the person to maintain a sense of purpose and engagement, with consideration to several health conditions.

Staff encouraged people to monitor and manage their own health, care and wellbeing. A member of staff told us about a person they support who had diabetes, who until recently relied on a visiting professional to administer Insulin. The member of staff told us, “[Person] is becoming more independent with their diabetes. The nurse comes in, but now [person] is self-administering, and is now checking their blood sugar levels throughout the day.”

Staff had undertaken training in topics which enabled them to identify and support people to manage and respond to health concerns. For example, diabetes and basic life support.

The provider monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

Peoples’ comments, and that of their relatives were overwhelmingly consistent in acknowledging the positive outcomes they experienced as a direct result of the quality of the service provided. A person told us, “Life is phenomenal now with the care they offer me, it has had a huge impact on my wellbeing. The staff know me inside out, so reliable and caring, it’s like having a friend visit, so in-tune with my needs.” A relative told us, “We have seen such a positive change in [person] as the carers are fantastic, consistency of staff, and all have to got to know [person] and their ways. It has also had a positive effect on my life, giving me peace, that [person] is safe and well cared for.”

People’s care records included their goals and aspirations, and all aspects of people’s care and support was regularly reviewed with the person, their family members and amended to reflect people’s changing needs. A person told us, “I have a care plan in my home, it has been updated.” A relative told us, “The care plan was discussed initially and reviewed regularly.”

Staff demonstrated unwavering commitment in supporting and enabling people to live their best lives. A member of staff told us, “We are enabling people to say in their own home, which is a privilege. A person I support was bed bound, in a hospital bed, downstairs. With staff support they are now back upstairs in their bed this year. The day the person went up to bed was the best night sleep they had had, it has changed them as a person, as they hated being downstairs and the noise of the hospital bed. They are now better rested, and their wellbeing is brilliant, they are so proud of themselves. Our encouragement has also meant we have progressed from small walks in the garden, to now walking around the whole garden.”

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

The provider understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA). The 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. Where people lack mental capacity to make particular decisions, any made on their behalf must be in their best interests, and as least restrictive as possible.

People and their relatives were fully involved in all decisions relating to their care and support. A person told us, “Staff are very kind and caring, always treat me with respect and dignity, and ask consent before any personal care.” A relative told us, “Very respectful staff, consent sought before any personal care and documented.”

Staff had undertaken training on the (MCA) and were aware that all care interactions required the consent of the person. A staff member told us, “Consent it always gained. We always knock on the door and enter the house, and we always ask consent in personal care, even making a cup of tea, we always gain permission.” Staff provided examples where people living with dementia were actively encouraged to make choices. A staff member told us, “I show them their clothes and ask if they like them, sometimes they will nod. Other times I act in their best interests and take account of the weather conditions.”