Archived: Nwando Domiciliary Care

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 Good. At this assessment the rating has remained Good.

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 made sure people’s care and treatment was effective by assessing their health, care, wellbeing and communication needs with them. Improvements were required to reviewing the above.

The provider completed initial assessments of people’s needs prior to the care package being agreed and starting. The provider confirmed assessments incorporated information from people using the service, those acting on their behalf, professionals involved and the Local Authority. This was to ensure all information was captured depicting the care and support to be delivered by staff. Relatives confirmed they had been involved with the above assessment. People and relatives told us, “Yes, I was involved initially in [family member] support plan” and “Two managers came to talk to me about my care needs, and we discussed my timings and the routine I required.”

Reviews of people’s support needs had occurred, but not all people spoken with felt this was thorough or had received a revised copy of the support plan. Comments from people using the service and relatives included, “My needs are reviewed annually but they didn’t discuss much in any detail”, “We have had so many reviews, and we go over the same issues” and “They reviewed [family member] care needs 3 to 4 months ago but didn’t leave us with a copy of the plan.” The impact of this means that without clear outcomes from reviews, people and those acting on their behalf may feel decisions are being made for them rather than with them and therefore undermining their sense of autonomy.

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 registered manager used evidence-based guidance and recommendations when needed. For example, the registered manager applied suggested healthcare tools such as Waterlow to assess an individual’s risk of developing pressure ulcers. There was also evidence of assessments by the Speech and Language Therapy teams [SALT] where a person was at risk of choking and experienced difficulty when swallowing. Guidance was also sought from the local dietician service.

Staff supported people as needed with the provision of meals, snacks, and drinks to ensure their nutritional and hydration needs were met. A member of staff told us, “I support people with a variety of dietary requirements. I follow the care plan closely and ensure food preparation meets their needs and preferences.” Generally, comments from people using the service and relatives were positive. Comments included, “The regular carers know my likes and dislikes, for example, I have open sandwiches for tea”, “They [staff] give [family member] their breakfast, warm a ready meal for their lunch and at teatime they have a sandwich” and “I prepare and cook [family member] main meal but the carer gives them their meal, helping them as they have difficulty swallowing. Staff also make a sandwich or something appropriate if it is not lunchtime.”

The provider worked well across teams and services to support people.

Information demonstrated the service worked with others, for example, the Local Authority, healthcare professionals and services to support people’s ongoing care provision. For example, a person’s support plan included where others had input into their support and care, such as from a dietician, SALT and physiotherapist. Staff told us they had the information they needed to support people.

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 had access to healthcare services when they needed it and confirmed their healthcare needs were met. People and relatives confirmed staff were responsive to their needs. A person told us, “If I am unwell, they [staff] will talk to me about it and telephone my GP for me if necessary.” Additionally, they stated that when their health had significantly deteriorated, staff had contacted the emergency services, and they had subsequently been admitted to hospital. On discharge from hospital, the person’s mobility was supported by the local physiotherapy team and appropriate equipment sought. The outcome was positive as they told us they had recently walked for the first time. Another person told us, “They [staff] recognise if I am not looking well.” They further stated that when an ambulance was required, the member of staff waited with them until the ambulance arrived. A relative told us, “Carers contact me if [family member] is unwell.”

A member of staff told us, “We are trained to recognise signs of health deterioration. Whenever I notice any changes, I report these immediately to the office and record it in the communication book, so it can be escalated.”

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.

An electronic software system was being used for care planning. People’s care needs were reviewed regularly each month as a minimum and in between if a person’s needs had changed. However, an incident occurred whereby the domiciliary care service failed to identify staff had not administered the correct dose of medication for a person using the service for some considerable time. Whilst there was no negative impact and outcome for the person using the service, this was identified by a healthcare professional and relayed to the service. A relative told us when new staff supported their family member with a specific healthcare task, staff had not known what to do. This was raised with the domiciliary care service and improvements immediately actioned.

Not all relatives were aware what was written about their family member. Comments included, “I am unsure if there is a copy [support plan] in the house, it is something I will check up on” and “I was very much involved in the setting up of my [family member’s] care plan, but we don’t have a copy in the house.” Following our assessment the provider wrote and confirmed people using the service were supported and monitored to improve outcomes. For example, the domiciliary care service helped people arrange essential support services like physiotherapy, medical equipment and doctor's appointments.

The Mental Capacity Act 2005 [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. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People and relatives confirmed staff sought consent before they undertook care tasks. Comments included, “I hear them [staff] ask do you want this or that doing”, “The staff are very respectful, and they do ask if [family member] wants a bath or wash. They do ask them how they want things done” and “They [staff] always ask me what I want, they don’t take things for granted.”

People’s capacity to make decisions were assessed, recorded and individual to the person and pre-assessments confirmed people or those acting on their behalf had consented to the provision of care to be provided by the domiciliary care service. Where people had been assessed as requiring their medication to be administered in a disguised form, by mixing with food or in a drink, this had been assessed in line with MCA principles, and in conjunction with those acting in the person’s best interest. For example, the person’s GP, pharmacist, Local Authority representative and next of kin. Capacity assessments are important so as to understand a person’s ability to make decisions, whether these are day-to-day or more complex.

A member of staff told us, “I always check whether a person has the capacity to consent to their care. We also involve family members or advocates when necessary. Everyone’s voice and dignity are valued.”