Home Instead - Bromley, Chislehurst & Orpington

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 83 (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 were effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.The provider promoted a culture in which everyone understood each person’s needs and preferences in depth. Assessment was holistic rather than task-focused, and care plans respected each person’s views, wishes and feelings while building on their strengths.

The provider fully involved people and relatives in planning and reviews.The provider fully involved people and relatives in planning and reviews. One relative said, “My relative and I were involved with the assessment. My relative’s goals were around staying independent, going out and being healthy. All of these are being met.” By assessing the whole person rather than a list of tasks, people who had been withdrawing from life reconnected socially and remained living at home, and their family carers were able to keep caring. As a result, people became more socially engaged, more emotionally secure and experienced improved quality of life.

One person living with dementia experienced increasing distress and their family carer was struggling to cope. The provider assessed the person’s physical, emotional, social and environmental needs together. They arranged a small, consistent team to work with the person and identified that music soothed them when distressed. As a result, the person responded positively to their care team, the family carer received the support they needed, and the person remained living at home.

The provider assessed another person who had become withdrawn and socially isolated. Staff recognised their emotional wellbeing needed equal attention. It built social engagement, confidence-building and emotional support into the care plan. As the person built trust with a consistent team, they socialised more, formed friendships and communicated openly when struggling.Staff reported changes in needs promptly, prompting timely reassessment and, where needed, involvement of healthcare professionals. A health professional told us care was planned for each person in a holistic way. As a result, people received an integrated service that flexed to meet their needs.

The provider delivered care in line with current legislation, good practice standards and evidence-based guidance. Care plans incorporated specialist clinical guidance from relevant professionals, including Speech and Language Therapy, district nursing and GPs, and staff understood the rationale behind the approaches recommended.

Staff received condition-specific training alongside their core training, which equipped them to support people with conditions including dementia, Parkinson’s disease and end-of-life care needs. The registered manager kept practice up to date by reviewing clinical guidance regularly and updating care plans and staff guidance whenever recommendations changed.

The provider challenged requests that conflicted with evidence-based practice. In one case, a family member initially declined to share written SALT recommendations for a person with a known swallowing and choking risk and asked the provider to deliver care in a way that conflicted with clinical guidance. The provider met with the family member, resolved the matter sensitively, and made sure the care plan reflected the recommendations and that staff followed the required approach to managing swallowing risk. This kept the person safe and meant they received care in line with best practice

Where people needed additional expertise, the service or external professionals delivered appropriate training, including input from a dietitian, specialists in dementia care, and faith ministers.

Staff worked closely with external healthcare professionals to make sure people’s care reflected up-to-date guidance, recommendations, and the registered manager monitored care delivery against the agreed plans through spot checks and audits.

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 were supported by consistent staff who understood their needs and were able to pick up any changes to health quickly. Staff made referrals to other health professionals. Relatives highlighted communication as a strength and told us any changes or concerns were promptly shared with them.

A person said, “I am well informed as to what activities have occurred during each call through the online portal that I have access to”.

A relative said “Communication is good as I have installed a white board and I leave messages for the carers as well as they will leave me messages, and it works well." And another relative told us, “The carers work well as a team with the district nurses and other health professionals, and their record keeping is good so they can inform the clinicians of any changes in health or mood.”

Staff worked collaboratively and supported one another well. They described a strong sense of teamwork and reported feeling valued and listened to. Newer staff felt welcomed through induction and shadowing, allowing them to build relationships with people at a pace that felt safe.

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.

Staff understood that people's independence could be rebuilt and worked to reduce the support people needed rather than to maintain it. One person who required two staff at each visit regained mobility and confidence through consistent encouragement with everyday tasks and exercises, and their care reduced from twice a day to a single daily visit . Another person moved from double-handed live-in care to three visits a day as their health, strength and confidence improved. In both cases the change was led by what the person wanted to achieve.

The provider removed practical barriers to healthcare, arranging for eye tests and hearing assessments to be carried out in people's own homes through a partnership with community providers, so people who could not easily travel still received the checks they needed.

Staff monitored people's health closely, recognised early signs of deterioration and escalated promptly to GPs and other professionals. People and relatives described improvements in appetite, mobility, confidence and social contact. People did not simply remain stable but achieved measurably better health and independence than when their care began.

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.

The provider routinely monitored people’s care to improve it continuously and used what it found to drive measurably better outcomes. Outcomes were positive, consistent, and met both clinical expectations and people’s own expectations.

The provider developed its own falls, choking dysphagia/texture-modified diets diabetes protocols, drawing on national guidance and refined them through learning from their internal audits

The provider used monitoring information to adapt individual care over time. Through ongoing assessment, the team identified that one person was becoming socially isolated and that his emotional wellbeing was declining and revised his care package to focus on emotional security, dignity and social connection. As a result, he built trusting relationships with staff, socialised more and communicated openly when struggling showing how monitoring translated directly into better outcomes.

People achieved positive health and wellbeing outcomes, supported by a consistent team matched to each person and partnership working with specialist health agencies that embedded clinical guidance into day-to-day care.

Continuous monitoring meant deterioration was caught early and care was redesigned around the person rather than left to drift, so people stayed well for longer and experienced fewer avoidable setbacks.

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

People told us they were involved in decisions about their care and support, and their consent was always sought. They told us they made their own decisions to refuse care and staff respected this. One person said, “The staff never assume before undertaking any tasks they are very polite and always ask consent.” Another person said, “They [staff] ask me first, I mean they ask for my consent. They wait patiently for me to reply whether I wanted there help that day.”

Staff let their managers know when care was refused in case this posed any risk to the person and the care plan could be reviewed. Staff provided people with the information they needed to make informed choices and respected those decisions. Where there were concerns about whether people may not be able to make a specific decision, staff carried out mental capacity assessments. Assessments were decision specific.

The provider involved people’s advocates, relatives, staff who knew them well, and health professionals to protect the person's best interests when making decisions. Staff described the training they received to ensure they understood the importance of seeking consent and involving people in decisions, and the service tested staff knowledge in this area.