Two Rivers

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

This is the first assessment for this service. This key question has been rated good. This meant people’s needs were met through good organisation and delivery.

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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

The service demonstrated a commitment to person-centred care. Care plans were person-centred, and reflected people's interests, cultural backgrounds and goals. Daily records demonstrated staff supported people in line with their wishes and assessed needs, while activities and personalised environments promoted individual choice, inclusion and wellbeing.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The provider coordinated people’s care effectively. Managers regularly reviewed people’s needs with involvement from healthcare professionals. Staff described positive working relationships with district nurses, GPs and specialist services such as speech and language therapy, enabling timely access to advice and support. Relatives told us staff responded promptly to changes in their family member's needs. This collaborative approach helped ensure people received joined-up care, timely interventions and continuity of support. A relative told us, "Staff respond straightaway and they keep me in the loop."

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider adapted information to meet people's communication and accessibility needs. Staff used communication profiles, support plans and hospital passports to understand how people communicated and how best to provide support. The provider also made information available in accessible formats, including easy-read documents where appropriate, to help people understand information about their care and support.

Staff had access to detailed guidance about people's communication needs, preferences and support requirements, helping them provide consistent care. Relatives told us they received regular updates and were kept informed about important aspects of their family member's care.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

The provider encouraged people and those important to them to share their views through meetings, care reviews, surveys and regular communication with families. For people who were unable to communicate using words, staff used their knowledge of the person's communication style, social cues and preferences to understand their wishes and involvement in decision-making. Family members, advocates and professionals were involved in care reviews, making decisions and other significant aspects of care and support. Relatives told us they felt listened to and felt involved in decisions affecting their family member. They told us management responded to concerns appropriately and communicated outcomes to them. One relative told us, "Yes, they respond straightaway and they keep me in the loop."

The provider made sure that people could access the care, support and treatment they needed when they needed it.

The provider identified and responded to people's individual needs to help ensure they could access healthcare, activities and support without barriers. Care plans, risk assessments and healthcare records reflected reasonable adjustments for people's communication, mobility and health needs. Staff used communication profiles, hospital passports and personalised communication guidance to help healthcare professionals understand how people communicated and how best to support them. During the assessment, we observed staff adapting activities to people's individual needs by providing one-to-one support, encouraging participation and supporting people with different mobility and communication needs to take part. Staff also used specialist equipment, including hoists and slings, and arranged suitable transport to support access to community activities and healthcare appointments. Staff ensured people received timely support in ways that reflected their individual needs, preferences and abilities.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff recognised and responded to people's individual communication, cultural, religious and health needs to help ensure they received equitable care and support. Staff supported people to access healthcare services, community activities, religious events and social opportunities in ways that reflected their preferences, abilities and assessed needs. Staff adapted support for people with mobility needs, communication requirements and multiple health conditions by using specialist equipment, professional guidance and personalised support planning. Staff encouraged people to lead active and meaningful lives through regular outings and activities that reflected their interests and helped promote inclusion, independence and wellbeing.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The provider worked with people, family members and relevant professionals to plan for future care and support needs. Care plans included personal goals, aspirations, health action plans, end of life plans and regular reviews which reflected people's wishes, needs and preferences. Staff involved people in reviewing goals and future plans wherever possible and adapted support when people's needs or preferences changed.

Staff supported people to develop independence and pursue meaningful opportunities that reflected their interests and aspirations. For example, people took part in community activities, cultural events, religious observance and social opportunities designed around their individual preferences and support needs. Family members and relevant professionals contributed to future planning where appropriate, helping to ensure support remained responsive and reflected what was important to the person.