Home Instead Mid Norfolk

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 service. This key question has been rated outstanding.

This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 96 (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 always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs had been fully, holistically assessed prior to support starting with tailored care packages being created with the person at the centre. People’s needs, wishes and aspirations were discussed at the initial meeting, which was captured word for word using artificial intelligence. This meant the assessor could have free flowing conversation to prompt and identify not only what was needed for the physical needs of the person but their emotional and social wellbeing to help ensure their independence and dignity was maintained. This formed the basis of the initial care plans.

People’s care records were then reviewed after a few weeks to identify specific ways they liked to be cared for, using artificial intelligence to summarise the care provided. Changes were then made using this information at a review with the agreement of the person and/or their family. This ensured people’s care records were developed in a truly person-centred way which resulted in people receiving care which was exceptionally individualised. People told us their initial assessment was thorough and included identifying all risks and putting plans it in place. People felt included in care plan reviews and any changes were made with their agreement.

The positive culture of the service and the ethos of providing genuine individualised support and care started from not only knowing people well but also the care staff. Their likes, interests and hobbies were matched to the people they cared for. The small team of care staff were picked to ensure consistency for each person. This and the thorough assessment process ensured staff had all the information needed to start building trusting, caring relationships and created the foundations for future care. The impact of this on people’s health and wellbeing was immense. As staff knew people so well, they could identify any concerns at early stages and were confident in raising these, so their care needs were meet without any delay and before any significant effect on their lives.

The service’s dynamic proactive approach of working with people to ensure the care and support provided could be flexible to meet changing needs, helped one person during their recovery from life changing injuries from a fall and a long hospital stay. Although other options to help with their rehabilitation including wards or care homes were available, they remained resolute they wanted to come home. The service understood the power of familiar surroundings so worked with the person using a very personalised approach focussing on their specific changing needs, goals and outcomes for their emotional, social as well as physical wellbeing. Regular assessments were held and check ins to ensure care and support was adapted when needed. This led to a smoother recovery journey allowing the person to focus on healing and reclaiming their independence. After a period of rehabilitation, they thrived at home, once again enjoying lunches with friends and going out in the community. The person said, “All I can say is the people around me said they never thought I would get out of hospital alive. The turning point was coming home and having Home Instead help me. It has been a live saver for me.”

The provider consistently planned and delivered care in genuine partnership with people, ensuring their preferences, wishes and what mattered most were central to every aspect of care. This was underpinned by a strong commitment to legislation, person centred values and evidence-based good practice.

There was a strong culture of prevention and early intervention. Hydration, nutrition and skin integrity were closely monitored and staff demonstrated excellent awareness of early warning signs as they knew people so well, including changes in presentation, reduced intake or increased risk of infection. Proactive steps were consistently taken to mitigate risks, which included timely referrals to GPs and other health care professionals.

The registered manager proactively engaged with a variety of external sources to enhance their knowledge including undertaking training, and internally via courses and updates, to ensure any changes in legislation and good practice were identified. Best practice webinars were also held each month to share information and ensure it was embedded within practice. This included for such things as trends in coroners reports which recently highlighted concerns about the management of flammable creams.

People and their relatives told us their needs were assessed thoroughly to identify needs and worked with them to achieve them. One relative told us, “[Person] has become picky with food now but we [service and relative] put together a menu that we know [they] likes and the carers ensure [they] has well prepared food and drinks. They also alert us if [person] is not eating very much.” We found other examples where staff supported people in similar ways, including for another person their relative, said, “They are very considerate and think outside the box to try to make [person’s] care more efficient. They now use a sippy cup with a lid that makes it easier for [person].”

Health care professionals told us they worked with the manager and staff to problem solve to meet people’s mobility needs. They had also attended one of the staff’s team days to speak about their role and taught techniques to aid care. They said since they had been working with the provider, they had seen, “continual improvement” in the care provided. This ensured staff were up to date with evidence-based good practice and confident in ensuring people received safe care.

Staff demonstrated a deep understanding of each person’s needs and responded with compassion and professionalism. Records evidenced consistent, responsive care which adapted to people’s changing needs, ensuring their safety. Wellbeing and independence were promoted at all times. This proactive, co-ordinated and highly personalised approach ensured people consistently achieved positive outcomes and experienced a high quality of life.

The provider always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

Health care professionals spoke highly and were consistently positive about how well the managers and staff worked with them to ensure outcomes were achieved and people lives enhanced. One told us how they had worked with the registered manager and staff collaboratively to help rehabilitate a person who was cared for in bed to not only walk again but to go back to sleeping upstairs in their own bed. This proactive joined up care had such a positive impact on the person not only regaining some of their mobility, but by significantly improving their mental wellbeing and their quality of life in enabling them to gain their independence and return to a form of normal life they had not experienced for a while.

Another professional told us how they had observed, “A willingness to work constructively with other local organisations across the region, including those providing similar or related services. In my view, this shows maturity and a strong community focus. The team appear to understand the importance of collaboration and a joined-up approach across the local care community.”

People and their relatives told us how exceptionally well the staff worked with other agencies to ensure continuity of care to meet the needs. One relative told us, “They work well with the lunchtime carer who is not employed by Home Instead and have a system of communication and handover so they all delivery a service that meets [person’s] needs.” This showed the provider worked proactively and collaboratively with health care professionals to achieve the best possible, if not exceptional outcomes for people in regaining and keeping their independence and quality of life.

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 vision and culture of the service was to enable people by supporting and providing the care they required to achieve their goals and enable them to stay in their own homes for as long as possible, as independently as possible. Feedback from staff showed they understood the importance of this to people and had this ethos in the way they provided care and support.

We heard examples of where staff worked with health care professionals to ensure people were kept well and healthy. One person was very vulnerable to sudden deterioration and had communication difficulties. Due to the trusting relationships which had been built with the staff who helped them both emotionally, clinically and physically and knew them well they noticed subtle changes and knew how best to communication with them. The carers had worked with the health care professional to learn how to manage their complex needs. Due to this they were less likely to go into crisis and be admitted to hospital. The person was now much more confident, felt listened to and had remained as independent as possible.

People’s care plans were holistic, detailed and provided staff with guidance on how to support the person in the way they wanted, including how their health impacted on them, to keep them healthy and safe. Staff kept detailed notes on the care they provided including how the person presented and any concerns they raised. Due to the level of detail, the artificial intelligence system was able to summarise the care provided and how they were presenting so this could be used to send to, or when liaising with, health care professionals. This was particularly useful when ringing a person’s general practitioner on their behalf to ensure all relevant information was shared. This summary could include trends for their use of medication including as and when required (PRN) medication. The impact of this was due to the accurate, up to date information being provided health care professionals could make informed decisions and people received timely care and treatment.

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.

Robust oversight processes ensured people’s daily care records were reviewed at least twice each day, with reviews going beyond routine checks to provide meaningful analysis. These were used proactively to identify trends, risks and subtle changes in presentation, enabling timely and responsive adjustments to care and support and ensured referrals to health care professionals were made in a timely manner. This dynamic approach ensured care consistently remained highly personalised, safe and effective. There was a strong culture of reflective practice and continual improvement, with staff using insights from monitoring to drive better outcomes.

Staff complimented the robust monitoring systems. Due to a small set of staff supporting each individual person, they had in depth knowledge of their care needs and of them as a person. This allowed them to identify subtle changes in the way they presented, which due to their experience, could highlight concerns, however minor, and ensure these were investigated and resolved at early stages. We were given many examples of this happening by both people and staff. One staff member told us when they were speaking to a person they noticed a change in their mouth. They asked if their mouth felt sore and were told they had been struggling with certain foods. They then organised for the GP to be contacted. This holistic and highly individualised approach resulted in a timely response to receive treatment and a marked improvement in the person’s quality of life. It exemplified the provider’s ability to understand the whole person and deliver care which is proactive as well as responsive.

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

People’s capacity had been assessed and documented within care plans to inform staff, in line with the Mental Capacity Act 2005 (MCA). This included for when Lasting Power of Attorneys were in place. People and their relatives told us consent was always sought before care was given. People were always given choice about what they would like to wear, food or drink they would like. A relative told us, “The carers are very inclusive and ensure [person] is happy with any task that they are going to undertake prior to proceeding. Communication is extremely good.” A person who received support told us, “The [staff] know exactly how I like things done. They always ask me first before carrying out any task.”