Caremark (Harlow & Epping Forest)

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question as required improvement. At this assessment the rating has remained the same. This meant people’s needs were not always met.

This service scored 50 (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 work in partnership with people to assess how to respond to changes in people’s needs. Care plans lacked details in relation to people’s health needs. For example, where people had epilepsy, dysphagia, dementia or Parkinsons there was a lack of detail that described how to personally support that person. However, staff were able to describe how they used sensory touch techniques touch to help them make daily choices. For example, helping people feel the textures of clothing to help them make choices.
We did see examples of people’s preferences, such as what people liked or disliked, for example to call out on arrival or people’s personal care routine. However, where care records showed people could become quite anxious or agitated, there was a lack of additional information to guide staff with how to support someone with meaningful activities or distraction that people may positively respond to and enable them to calm sooner.

Further improvement was required to develop existing links with local health professionals such as district nurses, speech and language therapists and GPs. Staff relied on updates from people or their relatives which meant there were risks key information may not be relayed, and staff were not integrated in those care reviews to ensure continuity. The management team had identified they needed to develop the involvement and engagement across the wider health partnership, and this was an area they would ask the local health board for support with.

The provider gave appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Care plans could be adapted to incorporate larger fonts for easier reading. Staff were aware of adaptive technologies to aid communication.

Staff told us they used effective and different methods for each person to share information with them. One staff member commented, “I talk quite fast so if someone has deafness, I slow my speech and talk clearer and check they heard me. One person can’t see well so I take the clothes to them to feel so they can be part of that choice.”

The provider did not always make it easy for people to share feedback and ideas, however people felt they could raise complaints about their care, treatment and support. Staff involved people in decisions about their care.
The provider told us they used surveys and telephone calls to gain feedback from people about their care and support. They said that senior staff also carried out on site checks where they talked about this face to face with people. However, these checks had not been carried out as frequently as the provider told us they needed to be. Some people’s feedback had not been sought for a significant period. This meant that the formal feedback systems to listen to people’s suggestions was in place but did not effectively capture that feedback for improvement.
People and relatives said their complaints and concerns were listened to and taken on board. People were able to tell us about situations they had experienced and the positive changes that followed their raising of a concern.
 

People did not always receive support that considered peoples human rights. There were examples where people did not always have access to the care, support and treatment they needed. For example, we have found examples where best practice guidance was not in place or referred to in care planning. The primary risk is that people receiving care may suffer due to unsafe practices, such as incomplete care plans leading to improper handling, or failing to meet basic needs like nutrition and hydration.

Staff were supporting people living with various complex health needs, for example with dementia or a sensory impairment. We found the care plans in place did not address how to support people and did not provide any information on how their health need presented for each person or adjustments that staff may need to make to adapt the care or support they provided. This meant that people may receive care that is unfair and results in variable outcomes as care planning does not identify and actively address inequalities.

People were not supported to plan future changes or goals, so they could ensure personalised choices around decisions including at the end of their life were known and documented. Care plans recorded basic future plans that people had, for example, “Promote [persons] independence and dignity throughout personal care activities.” But these statements lacked additional substance and goals to enable people to achieve those. Care plans were not developed for these areas and staff had not had end-of-life discussions with people. People spoken with confirmed these wider discussions and reviews had not occurred. One person said, “I don’t think they do [discuss future plans], they ask about what I need for today, things like a shower or what I’d want for lunch, but not sort of longer-term things, I’m not sure they should be doing that? I don’t recall talking about things like going into hospital or funerals or things.”