My Homecare Crowborough

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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. The registered manager or another member of the management team carried out thorough pre-assessment on people before starting a care package. The process involved reviewing paperwork provided from other professionals followed by meetings in people’s homes and assessing all support needs. The person and relatives or advocates were fully involved in this process and this was confirmed by people we spoke with. One relative told us, “A pre-assessment was completed. Initially by hospital where they had been for 7 months and then (registered manager) came round, it was thorough and the care started that same day. Regularly reviewed.” In most cases people were matched with staff to make sure the most effect support was provided. After the initial assessment the registered manager would make calls to the person after a few days to make sure the calls were being completed and were helpful. There was an official review after 6 weeks and then regular reviews thereafter. A ‘Client Quality Assurance Check’ was completed at reviews and provided a comprehensive list of questions for people and their relatives.

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. Care call times were agreed with people to fit in with their daily routines and preferences. Sometimes times were adjusted to enable people to attend medical or social appointments. Professionals contributed to people’s care plans where specialist advice was needed and to assist carers’ in their daily support for people. Reports and notes were included from occupational therapists, district nurses and speech and language therapists. All of this information was accessible to staff through their mobile phone application, to which they added their own notes with the most up to date information about people and their current needs.

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. Care plans, risk assessments and other key documents were completed and maintained by the service so that the most recent updates and information were clear to carers and other professionals having involvement with people. Each care plan had a summary page outlining key information about people, their current health, historical medical information and key personal and professional points of contact. This document helped inform other professionals when people moved between services or attended appointments. The registered manager reported a positive relationship with other professionals involved in people’s care and this was similarly reported back to us by professionals. One told us, “(Registered manager) are quick to inform me of any concerns and respond in timely manner to me. I find them incredibly hard working, respectful and a pleasure to work with. This is true example of the importance of joint working for the benefit of those most in need.” Another added, “We provide carers care plans for them with advice about repositioning and skin care to help prevent pressure ulcers and they are generally good at following our advice. They are prompt at alerting us to concerns they have about their clients and attend professional meetings as requested.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. Some people were supported with their nutrition and hydration needs although many were supported by family members. Staff told us they gave people a choice of meals and encouraged people to eat healthy, nutritious meals. They also told us that if people refused their meals and there were concerns about weight loss that they would immediately call their supervisors for guidance. Not everyone we spoke with were happy about the food that staff produced for them. One person told us, “The care I receive is safe but I would like the carers to have a better understanding in my preferred food.” Another added, “Due to cultural differences, some carers are unfamiliar with preparing meals in the way I prefer.” Others were more positive with one saying, “The food is prepared to my liking.” Nutrition and hydration care plans were in place but they needed more detail about people’s preferences, likes and dislikes to inform staff.

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. In the event of a clinical need the service would implement medically approved measures to monitor people’s needs. For example, the use of malnutrition universal screening tool (MUST), which measured people’s nutritional intake and identified those at risk of malnutrition. Food and fluid intake charts were also available and staff trained in their completion if they were needed. Similarly, pressure sores were graded and monitored, important for some people who spent most of their time due to frailty and general health conditions, in bed. Any changes were monitored by managers and relevant professionals called upon for support if needed.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. No staff at the service had received training in the completion of mental capacity assessments. There was a reliance on partner agencies who, where needed, had completed assessments prior to people starting to be supported by the service. However, most people being supported had capacity or were directly supported by family members with any complex decision making. Care plans had a section relating to consent to receiving support and these had been completed. In some case mental capacity assessments had been completed by the service, following guidelines and these were fit for purpose. The lack of staff training however resulted in some cases not being reviewed as frequently as needed. This matter was discussed with the registered manager who acknowledged the need for training and undertook to put this in place for some staff. Staff did understand the need for gaining consent from people before carrying out tasks or activities with them. Staff had been trained in dementia awareness and were able to tell us about variable capacity and how they approached people. A member of staff said, “With some people need to be direct. ‘Come on (name of person), it’s that time of the week again.(relates to bathing.)’ Sometimes they say no so leave it and try later but never force. We have high quality standards, we look at people’s preferences. People even with dementia too have the choice, for example choice of clothes.”