Support at Home

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 67 (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 ensure people’s care and treatment were effective, as people were not consistently involved in discussions about their health, care, wellbeing, and communication needs.

We were not always assured that people’s needs were fully assessed and accurately reflected within care records. While assessments had been completed, care plans did not always contain sufficient detail to clearly guide staff in delivering consistent and effective care.

For example, 1 person was assessed as requiring support and prompting with personal care. However, they told us they would like more support and to have more frequent showers, stating, “They don't shower me often.” We found limited evidence to demonstrate that the person’s preferences and choices regarding the frequency of personal care had been clearly recorded. There was also insufficient guidance for staff on how to support the person where care was declined or delayed. Furthermore, daily records contained limited information about how often personal care was provided, which meant we could not be assured that care was being delivered consistently in line with the person’s needs.

However, there were records to show the provider had completed assessments and reviews when the person's needs changed. This demonstrated there were processes in place to identify changes in the people’s needs.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

We were not always assured that care and treatment were consistently delivered in line with evidence-based practice. This was because care plans did not always contain sufficiently detailed or up-to-date information to guide staff in meeting the person’s needs effectively.

However, staff demonstrated a good understanding of the person and how to support them, including how to respond to their needs and escalate concerns where required. This indicated that, whilst staff knowledge was present, further work was needed to ensure this was consistently reflected in care documentation to support the delivery of effective, evidence-based care.

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 system in place to ensure the staff team worked together. They shared information about people both verbally and in the form of handover notes. Staff told us they felt this was effective and helped them support the person.

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.

Staff were aware of the person’s health needs and the support they may require. The person’s health needs had been assessed, and care plans were in place to support and monitor these where necessary.

Records showed the person had access to relevant healthcare professionals when needed, which helped ensure their health needs were appropriately met.

The provider had systems in place to monitor people’s care and treatment. People were supported to achieve positive outcomes;

The person was supported to develop goals and outcomes based on their individual wishes and aspirations. Staff told us that progress towards these outcomes was discussed and reviewed to ensure the person’s needs continued to be met. For example, the person was supported to complete their own online supermarket shopping on a weekly basis and staff provided support to help them choose items.

The person also had access to a communal lounge where they could choose to sit and have breakfast, supporting choice and social interaction. This showed that care was adapted to help people achieve positive outcomes and improve their day-to-day wellbeing.

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

The person was supported to make decisions about their care and treatment, and staff sought consent before providing support. Staff demonstrated an understanding of the importance of gaining consent and respecting the person’s right to make their own choices, including the choice to accept or decline care.

This showed that the service was supporting the person in line with the principles of the Mental Capacity Act 2005 (MCA) and promoting their independence, choice, and control.