One to One Support Services

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 79 (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 demonstrated an exceptionally proactive, thorough and person‑centred approach to assessing people’s needs before support began. Assessments were consistently holistic and individualised, capturing people’s health and care needs and their communication preferences, cultural background, personal history and strengths. This ensured care planning was rooted in what mattered most to each person.

Leaders gathered detailed information directly from people and their relatives and routinely engaged with a wide range of external professionals, including GPs, community nurses, therapists and specialist clinical teams. Where required, clinical assessment tools were used comprehensively and accurately, enabling staff to deliver the best possible outcomes. When changes were made to people’s care, data was gathered to review the impact of the changes. This meant people benefitted from care which was reviewed and adjusted to achieve the best possible outcomes.

For people receiving one‑to‑one support, the provider built bespoke teams around them, carefully matching staff skills, experience, communication styles and personal interests to the person’s needs and preferences. The provider ensured staff were given dedicated time to develop a deep understanding of each person’s wishes, routines and communication methods before joining their regular team. This resulted in people being supported by staff who knew them exceptionally well and were able to build strong, trusting relationships. Staff demonstrated a high level of insight into how to maximise communication and rapport, which people clearly benefited from.

People’s nutritional and hydration needs were met in line with current standards and evidence-based guidance. People were supported to manage their dietary needs and associated risks, (including where people had complex needs) from the risk of poor nutrition, dehydration, swallowing problems or other medical conditions that affected their health.

People’s communication needs were assessed continuously throughout their care journey. Where people communicated their needs, emotions or distress, they were supported, in a positive way that protected their rights and dignity. Staff used this information to build trust, strengthen relationships and ensure people felt confident expressing their needs and preferences. Teams supporting people who used the service, met regularly in cluster meetings to share observations and review progress. This ensured a consistent, coordinated approach to care.

Leaders demonstrated an excellent understanding of the Accessible Information Standard (AIS). Information was consistently provided in formats that genuinely enabled people to understand, participate and make informed decisions. A partner agency told us, “One to One have extensive knowledge regarding the needs of deaf people who use British Sign Language to communicate. They have an extensive understanding and knowledge of deaf culture. This is throughout the management to the staff they employ who support the people who need their service.” This reflected the provider’s deep expertise in meeting the needs of people with sensory impairments and highlighted how familiar, skilled staff enhanced people’s safety, comfort and wellbeing.

The provider’s internal training academy offered a comprehensive range of specialist training,including sensory impairment, communication and British Sign Language. They were registered with the local council for the Advancement of Communication with Deaf People and worked with industry experts to deliver high‑quality learning. Courses were also offered to the wider community, demonstrating the provider’s commitment to promoting inclusion and improving communication beyond the service itself.

Overall, the provider’s approach to assessing needs was exceptionally person‑centred, inclusive and empowering. People were placed firmly in control of their care, with assessments that truly reflected their identity, preferences and goals. This approach ensured people were consistently supported to achieve the best possible outcomes.

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. They used recognised assessment tools, and evidence‑based best practice, completing early initial reviews designed to check whether the assessment and care package had been implemented effectively. This provided an opportunity for people, their relatives or advocates to give feedback at an early stage, ensuring the service could respond quickly to any required changes and maintain high‑quality, personalised care.

People’s views were sought to ensure information remained accurate, relevant, and person‑centred by completing ‘How am I doing’ forms. Staff were knowledgeable about people’s individual needs and demonstrated genuine commitment to delivering high‑quality care. People told us staff understood what mattered to them.

Staff and leaders worked collaboratively to share skills and improve care outcomes. Feedback from involved professionals included, “Care Plans and Risk assessments were comprehensive. There has not been any identified incident that required communication regarding deterioration, we do not have any concerns regarding the providers ability in this area” and “They have approached us in the past to discuss what else they could be doing to support us.”

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.

People confirmed they felt listened to and that any feedback they provided was acknowledged and responded to. Staff teams supporting people day to day shared detailed handover information and notes, demonstrating an understanding of any changing or developing care needs. Hospital passports were up to date with the person’s current health, care, wellbeing, and communication needs.

Care plans supported adjustments for any new team members, flexibility was built in as required with senior support teams who knew several people well and understood their needs. There were examples of how this worked in practice, for example, flexible hours being banked for when needed at a time specified by the person and background shadow staff in place for respite periods. This approach then lessened any distress of unexpected changes in staffing plans by having a familiar face already assigned to provide care and support to people.

The management team and senior support workers met regularly and, in some cases, very regularly with professionals to review people’s care needs. Regular reports detailing an assessment of people’s care and wellbeing activities were shared with commissioners and escalated to other relevant professionals as and when required.

Feedback from external professionals was mixed around the working relationship they had with the provider. For example, some spoke very positively about working alongside staff teams, commending their specialist support, working openly with other care providers, ensuring lines of communication and joint working were very open and positive and they had found an appropriate person was always available to speak with. However, others shared, “They do engage well however, information is not always clear and concise.”

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 confirmed they were supported to access and manage their own healthcare. One person shared how they were encouraged and supported to attend health monitoring and vaccine administration, and how they had been very reassured by the support of their staff when they were anxious.

Staff encouraged people to remain in their own homes by promoting independence and enabling people to maintain, and where appropriate, increase their daily living skills. When early signs of health deterioration were observed, people were supported to address them quickly. Staff had completed person centred care training that helped them identify and respond appropriately to people’s health needs. As a result, they were confident in recognising when someone’s health might be deteriorating and knew how to support them to access timely healthcare intervention.

Feedback in this area from professionals was positive with statements such as, “The provider generally communicates appropriately and shares relevant information in a timely manner. They engage well with professionals involved in an individual’s care”. Confirmation was also provided that staff had a comprehensive understanding of possible triggers or early signs of distress in people. They were described by one person to help them feel ‘calmer, safer and more in control’ in the face of challenging situations.

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

The provider demonstrated an exceptionally person-centred approach, ensuring individuals understood their care and support options and they remained central to all decisions about their care. People and their relatives told us that staff had in depth understanding of their needs, care plans were reviewed with them, and how staff responded promptly when any changes occurred. This helped ensure people continued to receive care that aligned with their preferences and supported their wellbeing.

Feedback from people and their families was generally positive. Several described activities and wellbeing outcomes directly linked to the support provided and they spoke warmly about the attitudes of staff. For example, one person shared how they had been, “Through a very recent tough time, [staff] have truly provided the best care with respect, trust and care of a very high standard” and another shared how they exceeded her expectations, “[Person] only has to phone if something extra is needed, such as a different time or package support and they will do their upmost to sort it.”

The provider had great oversight of people’s care. Key information was reviewed and documented clearly, shared where appropriate, and concerns escalated to healthcare professionals, to ensure people received timely and appropriate interventions. The provider completed regular feedback surveys, and the results were analysed to provide further information on areas they excelled or were potentially lacking and improvements could be found. For example, following the results of one survey they re-worded the questions following feedback that the previous questions did not allow fully for people to understand what was being asked. Further information was sought when people had scored low on areas to ensure the provider fully understood what people’s expectations were and how, if possible, they could meet them. The provider had also ensured people who had sensory disabilities were fully included and asked for feedback in ways which were their preferred method of communication.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. They respected people’s preferences regarding the gender of the staff delivering their personal care. Where individuals expressed a preference for male or, female only carers, this was clearly recorded in their care plan and communicated to the staff team.

Staff supported people to understand information, communicate their wishes and make decisions about their care in line with the Mental Capacity Act 2005 (MCA). Assessments and decisions around consent were appropriately recorded. We saw and records demonstrated the views, wishes and preferences of people were supported to make decisions about their care. Relevant friends, family members, carers and advocates were involved and kept informed, ensuring decisions were transparent and respectful.

Care documentation guided staff about what decisions people could usually make for themselves, and what they might need support with. Records reflected where a person’s ability to make decisions may be impacted by their wellbeing. For example, if a person was feeling very distressed, they would not be able to make decisions about how they could remain safe and records identified the actions staff could take to ensure support was provided in these scenario’s.

Staff had undertaken training and understood the areas of Mental Capacity Act 2005 (MCA) that were applicable. The use of restraint was understood and monitored, and less restrictive options used wherever possible. Where people were assessed as lacking capacity to make specific decisions, best interest decisions were carried out. These were documented in people’s care plans and showed who participated in the decision-making process and how the decision had been reached.