Cera - Cumbria

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 71 (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 and reviewing their health, care, wellbeing and communication needs with them.

Assessments were carried out by senior members of staff, and people’s needs were comprehensively assessed to ensure completion of detailed care plans.

Care plans were written in the persons own voice and focussed on people’s strengths as well as their needs.

We found evidence of people’s families and other professionals being involved in the completion of the care plan where appropriate.

Care records were up to date, and staff were able to do this through the use of handheld devices which they used to record and update information during each care call.

Regular reviews of care plans were undertaken, which included people and their families. These were recorded appropriately and plans updated where necessary.

We found evidence of the provider raising requests for people’s reviews with local authority staff when they felt people’s needs had changed.

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.

People were supported to manage their food and fluid needs and staff recorded this in daily notes. During recent periods of very hot weather the registered manager notified all staff to ensure people had additional fluids available to them and to encourage people to maintain their fluid intakes.

People told us they felt staff met their needs. One person told us “I have been having these girls for about a while now and they come every morning. They make me toast and marmalade, they treat me nice, they are all always nice and friendly towards me.”

Staff received training and guidance on identifying and monitoring people’s skin and how to raise concerns around this. Specific training called “Think if its pink” was part of all staffs mandatory training and allowed staff to follow clear guidelines and processes to monitor and record skin issues. A staff member we spoke to told us that they had followed this procedure and had contacted the registered manager to request an additional care call to support repositioning of a person with skin concerns.

The registered manager told us of an example where a person had been struggling to swallow but had not informed anyone of this difficulty. During a conversation with the person, they agreed to a speech and language therapy referral which was then undertaken. The person was noted to require thickened fluids which was then added to their care plan.

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.

The provider had good working relationships with other services and teams including district nurses, social workers and commissioners.

Staff were included in reviews of people’s needs undertaken by the local authority.

Feedback from the local authority included, “Staff are good at requesting variances for service users to provide further support.” They also told us, “Staff are good at emailing us if they have concerns about someone, this has prompted us to hold a review of their care needs.”

Care plan information was available to be sent with the person should they have a hospital admission.

We found evidence of referrals being made to other agencies and requesting reviews, meetings or clarification around the use of equipment.

A visiting professional told us, “The staff are professional and able to provide information when requested and are available for joint visits.”

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 able to support with people’s attendance at medical appointments if family were not available.

Staff had training in oral hygiene and monitoring this was incorporated into people care plans where relevant.

People were supported to follow their wishes, for example one-person had a cookbook that they liked to use, staff supported during their call to help prepare the meal chosen by the person.

A staff member told us they always check the previous carers notes when on a visit. This is to ensure they know the person has had at least one hot meal per day.

Another person had exercises suggested by a physiotherapist and staff supported these with additional time added onto one of the care calls.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Ongoing monitoring of people’s needs were evident from care plan reviews and updates. Staff were able to feedback to the management team if they were aware of any changes in people’s needs.

Feedback from people and their families was requested during review meetings or more formally through email requests. The registered manager also requested feedback when undertaking spot checks to people’s homes or when they had telephone conversations with people or their families.

Feedback was collated and actioned and was summarised in a “You said, we did document.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. The provider did not always ensure that records on consent were accurate.

We found evidence of risk assessments and best interest meetings not always being recorded or documented for people. This may mean that people and their families were not aware of the concerns being identified. This was fedback to the provider during the inspection, and we were informed this would be addressed.

We also found evidence of a lack of clarity around whether or not power of attorney was in place for some people. This could mean relevant people were not involved in making decisions on behalf of people receiving care. The provider told us they would resolve this.

Staff were trained in the use of the Mental Capacity Act 2005 and told us they asked for consent before undertaking tasks with people. Staff told us if they were concerned about a person being able to give consent, they would contact the office or family members to try and resolve the issue.

Do not attempt cardiac pulmonary resuscitation forms were evident and clearly visible on peoples care plans. These were immediately accessible for staff.