Home Instead Mid Norfolk

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 outstanding.

This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 93 (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 was exceptional at making 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.

Staff demonstrated an exceptional understanding of the people they supported. They enabled them to provide highly personalised care that went beyond meeting physical needs to promote emotional, social and psychological wellbeing. Care plans were detailed, holistic and person-led which clearly reflected what mattered most to individuals and guided staff to deliver care in ways that were meaningful and respectful. Staff told us, “I have [person] who keeps up to date with current affairs. I therefore listen to the news before visiting so we can have a topical conversation. I know how another [person] prefers [their] sandwiches to be cut into manageable pieces. Another [person] likes flowers in the vase cut from [their] garden as [they] are not able to access the garden.”

People and their families, where appropriate, were actively involved to plan and review their care and were empowered to make choices about their daily lives. Staff consistently listened to people, respected their views and adapted support in response to changing needs and preferences. This care remained flexible, responsive and aligned with people’s wishes at all times. In making connections with people, a staff member told us of someone who had difficult verbalising, and said, “But with our shared love of music I played [their] piano and [they] sung along.”

There was a strong emphasis for staff to build trusting and compassionate relationships. People were supported by staff who knew them extremely well and responded sensitively and intuitively to their needs. This enabled staff to recognise subtle changes and act promptly, to ensure people felt safe and understood and valued. A relative said, “The carers are observant and pay attention to detail addressing any health issues before it becomes an emergency.”

The provider demonstrated a commitment to going above and beyond to enhance people’s quality of life. Thoughtful, personalised approaches and creative problem solving ensured people experienced care, which was not only effective, but enriching and empowering. As a result, people consistently experienced positive outcomes and a high standard of care that prompted dignity, independence and overall wellbeing.

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

Staff at all levels had an excellent understanding of the professionals involved in each person’s care. Care plans were comprehensive and clearly detailed the involvement of health professionals, the responsibilities of staff, and clear guidance on when and how to escalate concerns. This included specific instructions related to clinical needs such as catheter care, skin integrity and wound management, which ensured staff delivered safe, informed and consistent care. The consistency and continuity of the small number of staff providing care to each person, ensured truly meaningful, supportive relationships were developed. The impact of this was emphasised by people and their relatives on people accepting care, feeling comfortable and confident, thus ensuring their care and support needs were met. One relative told us they had started using Home Instead for one of their parents, once they had passed their remaining parent needed support. They said the same team of carers were provided for both parents. They told us, “This has made such a huge difference to [person’s] acceptance of care knowing the carers. They have developed a lovely trusting relationship which is a good thing as [person’s] needs will increase.”

The provider went above and beyond to ensure smooth and effective transitions between services, particularly on admission to hospital for treatment or hospice for end of life care. The care and support did not stop there. For one person admitted to a hospice staff continued to visit to help provide continuity and a friendly face during a particular stressful, frightening time for the person and their family, doing such things as reading a book, holding hands or singing to them. This was most appreciated by the family who acknowledged what this meant to them at such a difficult time.

The provider was deeply connected to the community it served by maintaining a visible and welcoming presence. By having an open-door policy at their accessible local office, they made it easy for people and staff to pop in. They actively partnered with professionals and charities to highlight the challenges older people faced. Committed to education, they sponsored a dementia simulation bus to give people a first hand look at life with dementia. They supported families and carers through informative local talks and a monthly dementia café.

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

The provider truly met the Accessible Information Standards. Information was available in a range of formats, including easy-read documents, if required, which enabled people to fully understand their care, make informed decisions and promoted their independence. This proactive and inclusive approach supported equality and ensured no one was disadvantaged in accessing information.

People’s communication needs were assessed and information provided in a way which was meaningful to them and not only met their care needs but also helped them to achieve their goals and keep their independence. Staff were aware of using people’s preferred communication methods as they had been assessed and documented in detail in their care plans. They also knew them so well they understood their body language, facial expressions and emotional responses to understand their needs and feelings. This meant, especially if people had problems communicating, staff could identify if they were concerned and took the time to identify any issues and find solutions for them. Staff gave many examples of how they supported people including shopping for greetings cards when the staff member read the messages in the cards and described the pictures for a visually impaired person, so they could make the choice and for another using labels on food with large writing including cooking times so they still prepare food for themselves independently. To ensure another person’s needs were being met an specifically individualised pain score was developed which staff used with the person to identify their level of pain with plans in place for each level, so they received responsive treatment at times it was most needed. These examples show proactive, caring, individualised approaches being used with people to enhance, help decision-making and keep people independent through communication.

People were kept well informed about their care and support arrangements. For example, those who wished to know which staff would be supporting them and at what time, were provided with rotas. When changes occurred, such as delays in care calls, people were contacted promptly to keep them updated. This responsive approach respected people’s time, reduced anxieties and demonstrated a high level of consideration and respect.

The provider was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. People were consistently at the heart of the service, and there was a strong, open culture where feedback was actively encouraged, valued and acted upon. Staff routinely involved people in decisions about their care and endured they were kept informed about any changes made as a result of their feedback.

The management and office team were highly visible and accessible. People and their relatives were actively encouraged to share feedback, raise concerns or make complaints. People felt confident these would be taken seriously and lead to meaningful improvements. A wide range of systems were in place to support this, including both formal and informal methods of communication.

Formal systems included regular quality assurance questionnaires distributed to people and their relatives. Feedback from these were carefully reviewed and clear actions were taken to improve the service. Informal approaches, such as phone calls, or “check-ins”, and welcoming people into the office to share their views, further strengthened engagement and ensured feedback could be shared in a way that suited individual preferences. This early intervention approach meant issues were resolved quickly and prevented them from escalating into more significant concerns. This evidence in their low number of complaints and high scores in their quality assurance results.

People and staff told us the management team were responsive and took prompt action when needed. This reflected the strong culture of listening, responsiveness and continuous improvement across the service. This also demonstrated an outstanding approach to managing feedback and complaints. Systems were highly effective, inclusive and embedded in practice, which ensured people felt heard, respected and confident that their views would drive positive change. A staff member told us, when they had raised a concern, “This was acted on immediately by Home Instead. It was handled in an open and honest way, with appropriate investigation and clear communication. The issues were addressed quickly, and learning was taken from it to help improve practice and ensure better outcomes in the future.”

The ease of communication and sharing information was highlighted as important to relatives. One relative said, “The team, both [care staff] and administrators are excellent. It is not always easy for them to communicate as [person] likes to be main point of contact and is very deaf, so sometimes we have to get involved to help, but they are always willing to try and share information. We feel well supported as a family.”

The provider was exceptional at ensuring people could access the care, support and treatment they needed when they needed it. There was a strong understanding across the staff team of the importance of inclusive, rights-based care, and staff consistently ensured care was needs led, person-centred and free from discrimination.

The provider showed a highly responsive approach to develop staff skills to meet people’s complex needs. Training was tailored to ensure staff were confident and competent to deliver specialised care, including in conjunction with health care professionals as required. Health care professionals said, “When I did the training day, the staff were very engaged and wanted to work together in the best interests of the client.” This approach led to improved outcomes and enabled people to gain and remain as independent as possible within their own homes.

People and their relatives told us staff were always on time and stayed for the full visit, which was backed by records reviewed. Data confirmed there was exceptional punctuality of call times. When people’s health and support needs changed the provider responsively organised more visits to help maintain their health and wellbeing. Due to staff knowing people thoroughly, they excelled at identifying when to involve external health or social care professionals. This meant people when people’s needs changed, they received dedicated and personalised care promptly.

The provider ensured people and their relatives had easy access to be able to contact them in all hours, so they could respond swiftly to any concerns raised and give them the reassurance and support needed. This was confirmed by feedback we received from people and their relatives. People and their relatives had access to a digital application where they could access their own care records. This gave relatives reassurance about the care provided as they could review in real time and any changes made to care and support plans. One said from this, “They record events accurately.”

This showed the provider’s culture was to be open, transparent and that they welcomed contact to ensure people received high quality care in a timely proactive manner. This was corroborated by a health care professional who told us, “I have also observed examples where this commitment appears to go beyond standard working hours or contractual expectations. My impression is that the team take their responsibilities seriously and are prepared to go above and beyond where needed, because the priority is providing the best possible care and support for individuals.”

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

People’s individual characteristics, including cultural, religious, communication and accessibility needs were assessed and clearly documented within care plans. This enabled staff to provide exceptionally personalised care which respected people’s preferences and promoted inclusion.

A number of examples were given where people achieved their personal goals, increased independence or were enabled to continue to be part of their local community, which was such a key part of their lives. For one couple the importance of their faith was not only as a familiar routine but as a meaningful part of who they were in their community. Their care calls were organised to ensure they were supported so this could remain a consistent and achievable part of their routine. For another person who lived on their own, although their family visited regularly, they had become increasingly lonely. Staff identified from spending time looking through photographs and chatting, their favourite places to visit and their love of animals. However, it was not only organising outings it was the sharing of these which was important. A small team of staff were identified with similar interests who took their time during outings to chat, listen and share stories and created a diary with photos of where they had been to reminisce. The impact for these and other people has been huge, ensuring they have purpose, focus and enjoying being out in their community.

This meant the provider’s approach was innovative, listening to people and what was important to them. Then working with them and enabling them to achieve their wishes and goals in such a person-centred way, which enhanced their lives and gave them a sense of worth and purpose. People were truly at the heart of the service provided.

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.

At the time of assessment, the provider did not support anyone who required end of life care. However, systems were in place to ensure people’s wishes, values and preferences were captured to assist with future decisions. Staff had training on providing end of life care. Checks were also carried out to establish whether people had relevant documentation such as Recommended Summary Plan for Emergency Care and Treatment (RESPECT) forms or Cardiopulmonary Resuscitation (CPR) decisions. A RESPECT form is a nationally recognised document which records a person’s wishes and clinical recommendations for emergency care and treatment and includes decisions about CPR to ensure these were known and respected by health care professionals.

Care had been provided for people for end of life when their wishes were to remain at home, and this also included support for their family. When this had no longer been possible staff had supported the person in moving to hospice or hospital care, carrying on visiting to support, giving that continuity and reassured during a difficult time for both the person and their relatives.