Dignity Direct Homecare Ltd - Sheffield

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.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained 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 54 (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. People’s needs and preferences were not robustly assessed or recorded, to provide adequate guidance for staff. We found discrepancies in several care plans, meaning staff were not provided with clear and up to date guidance to enable them to effectively support people. For example, 1 person’s care plan contained conflicting information about support they required to dress, and another person’s care plan contained conflicting information about their support needs in relation to household tasks. A person told us, “I spoke independently (to staff), and my views were taken on board. We were left a (care plan) folder. The plan doesn’t say much and is not clear. It’s not detailed and there’s a lot of blank pages. It’s not been reviewed.” Whilst another person told us, “They (staff) have it all (care plans) down on their phones and laptops. They check with us if it’s the same (needs) or if anything has changed.”

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. We could not be assured staff worked well with external professionals to deliver evidenced based care.People’s records contained information about professionals involved in their care. However, care records did not always contain specific guidance or information about people’s health needs. For example, 1 person was receiving support from tissue viability nurses to monitor and treat their pressure wounds, and this person’s care plan did not detail any information about how and when this care was delivered.

The provider worked well across teams and services to support people. Staff feedback we received was positive about how they worked well together. Staff told us there was a good morale amongst the team. A staff member said, “Morale is good. The team works well together, and everyone helps out when it gets busy.” Records evidenced staff contacted emergency services and GP’s following incidents. A relative said, “[Name] had an incident two weeks ago the carers rang for an ambulance and rang me as well.” We spoke with the local authority working with the service, who told us the provider was working with them to make improvements.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. Whilst we found no harm to people, care records contained little information about people’s health conditions, how these should be managed and symptoms staff should monitor for. We also found some health conditions which were not recorded in people’s care plans. Management responses to incidents involving skin concerns were often generic and repeated recording across multiple incidents, without clearly evidencing the specific actions taken to address skin integrity concerns.

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 andconsistent, or that they met both clinical expectations and the expectations of people themselves. Whilst we found some records relating to monitoring people’s desired outcomes, these lacked person centred information and were found to be generic. There was a lack of overall, ongoing monitoring to measure if people were working towards their goals and aspirations.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. People had not always consented to their care and treatment. Whilst we found most people had consented to their care, we found 1 person who had not. People’s care plans contained conflicting information relation to people’s capacity to consent. For example, 1 person had a diagnosis of dementia, and their care records contained conflicting information about their current abilities and level of independence.

Staff we spoke with told us they respected people’s decisions and ensured people consented to their day to day care. However, we received mixed feedback from people and relatives about staff seeking their consent. A relative said, “They (staff) always involve [name] and ask ‘What do you want doing’.” Whilst another relative told us, “Some carers do ask [name] and others don’t (for consent). If [name] says no they leave them. They don’t ask again.”