Archived: Lancashire Domiciliary Care Service

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 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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Staff considered people’s physical, mental, social and communication needs, but care plans were not always correct, complete or consistent. For example, a person used a wheelchair, but information in their care plan said they needed a walking stick or frame. Another person’s care plan stated they could shower independently, but elsewhere said they needed full support.

Relatives said they were involved in initial assessments, but several felt their involvement in reviews had reduced over time. One relative said, ‘We used to be involved annually, this is no longer the case.’ Another added, “We worked closely with staff to draw up [person’s] care plan. More regular reviews would be useful.”

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 kept up to date with changes to legislation and best practice through forums, email alerts and links with the local authority They shared key updates with staff using a companywide messaging system.

Care plans included information about people’s nutritional and hydration needs; with guidance prominently displayed to prompt staff when modified diets were required.

One person was fed by enteral tube, and detailed plans and protocols were in place. Staff received enhanced training to manage this, as a result the person had experienced no health issues or complications.

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.

Information was shared effectively between teams and healthcare partners. A healthcare partner told us, “Handovers are to an adequate level, reporting any changes with (people) throughout the week. Information is handed over to the staff, recorded and appears to be actioned appropriately. Leaders are responsive to advice.” A communication book and regular handovers supported day to day information sharing about changes to people’s health and care needs.

Staff provided additional support for people to attend medical appointments or during hospital admissions, and kept relatives informed. A relative said, “[Person] was in hospital and they did let me know, [staff] stayed with them and took great care of [person].”

The provider did not always support people to manage their health and wellbeing, and staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

The provider had tools to monitor people’s health and wellbeing, but these were not consistently completed to identify signs of clinical deterioration. For example, one person at risk of constipation had large gaps to their daily bowel records, and signs of stomach pain were not escalated or followed up with their prescribed laxatives.

Whilst we received mostly positive feedback about staff supporting people to make healthier choices, a couple of relatives raised concerns about the frequency of ‘unhealthy’ meals and the lack of regular exercise.

The provider had recently secured funding for adapted bicycles, enabling people with physical disabilities to borrow them, to support their health and wellbeing.

Following feedback, the registered manager reviewed bowel monitoring arrangements and improved staff guidance.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and met the people’s expectations.

The registered manager told us the service was reviewing how it recorded outcomes linked to people’s health, wellbeing, aspirations and skill development. They planned to use the new electronic care planning system being used to track progress.

Staff gave examples of how they supported person centred outcomes. One staff member told us, “I will ask people what they want to do or achieve. Some [people] are set in their ways, but we try to set goals for them.”

During the inspection, we visited a provider run café staffed by volunteers, including people supported by the service. People spoke about the skills they had developed and showed workbooks outlining planned tasks and expected outcomes, such as food hygiene, recognising different foods, improving preparation skills and building confidence.

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

Staff confirmed they received training in the MCA, and understood the importance of making sure they obtained consent before they delivered care, support or treatment. A senior staff member said, “When I’m working, I will check how staff interact (seek consent) and how they recognise body language for those who are non-verbal.”

The provider had systems for checking and reviewing people’s capacity to understand and make decisions; and involved the appropriate relatives and partner agencies when making decisions for those who lacked capacity.