Live in Care

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 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.

The service had systems in place to assess people’s care and support needs before beginning the care package. The registered manager told us they visit the client in person to gather as much information as possible including medical background, health conditions, medicines, daily routines, meal preferences, allergies, and potential risks. During this process, observations were also carried out in relation to cognitive abilities, mobility and the environment.

There was a system in place to review people’s care needs. The registered manager told us; “At the moment, our reviews are every 6 months in person. We visit every 6 months without fail, but we also visit when care needs change. So, for example, if they've [people] had an admission to a hospital or we've had significant new equipment, we've recently had a [ person] that's had a hoist put in. It might be that we've got changes in house conditions. The carer may request a review. But throughout, we're taking calls from carers, we're auditing logs, we're speaking to clients and family. So, with the real time care planning, we're updating the care plans a lot more often than every 6 months, probably every month.” Records we reviewed evidenced this practice.

Feedback from people and their relatives confirmed this. Comments included “ [The assessment] It was three years ago and arranged for me when I came out of hospital. The manager sat down with me and the family and we had a detailed discussion about how to support me to live safely in my own home. The conclusion was that a live-in carer would be the best way to help me retain my independence.” and “We sat down with them and had a long chat about what we wanted, and how best to support my husband. It gets tweaked from time to time when the manager rings (usually weekly).”

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.

Information and risks about people’s nutrition and hydration were documented, where necessary, to enable staff to support people’s needs and their requirements effectively. For example, when needed, staff supported people to contact speech and language therapists to make sure they had appropriate meals and fluid.

The registered manager provided us with an example about how they implemented best practice guidance in relation to oral care to support a client. They talked to us about how they used some guidance in care planning to implement person centred care, focusing on goals, preferences, aspirations and outcomes.

The registered manager had plans in place to look at thematic reviews related to falls management with a view to implement some of that guidance into their practice.

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.

Processes were in place to ensure staff received appropriate information about people in a timely manner. There was a handover system in place when staff changed within a care package. Staff worked well together and with other professionals and records evidenced the multi-disciplinary teams working partnership the service was involved in for various people. They quickly and appropriately referred people to health and social care professionals to promote good outcomes for them.

One person told us; “They have built good links with the staff at our GP surgery which helps if there’s ever a mix up with prescriptions. It also helps if we need to see a doctor, or a nurse.”

A health and social care professional who worked with the service told us; “The Live in Care service’s coordination and communication with all parties was very effective and resulted in the prompt resolution and reduction of risks.”

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 vigilant about observing changes in people’s health. Any concerns were raised with the office team and people were supported to access health professionals as needed.

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.

Care documentation contained information about people’s expected outcomes. These were used to monitor and review care.

People and their relatives told us; “I get a call from the manager every week. If anything changes, I let her know but most of the time my carer has already reported any changes.” and “The original care plan has been revised several times and describes how best to support him.”

We talked to people and their relatives about the most important outcomes for them from being supported by the service. Comments included; “To be able to enjoy my life.” and “That my husband can stay at home, that he retains some links to the community through the care team.”

The registered manager told us that outcomes were discussed with the person. They talked with the person about their desired outcomes and how they could achieve these.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment, however some improvements were needed in relation to how this was recorded in people’s care documentation.

The service had a system in place to gain consent for people in relation to their care, however, improvements were needed to ensure that records clearly documented how decision-specific consent was obtained, and how people’s capacity to make decisions, for example about medicines administration was assessed and recorded in accordance with legislation and guidance. Improvements were also needed to ensure that the reason why some people could not physically sign their own consent forms was captured.

People were supported appropriately under the Mental Capacity Act (MCA). The registered manager had a good understanding of the principles of Deprivation of Liberty Safeguards (DOLS) and provided us with some examples of when they worked with local authorities and other professionals in relation to concerns about restrictions in people’s homes. Where restrictive measures were used to minimise risk to people’s safety, for example the use of bed rails or rising recliners, risk assessments were in place and records were made of people’s consent to this.

Care documentation contained information related to people’s Lasting power of attorney (LPA).

People did not share any concerns in relation to their consent being sought. Comments included “We know each other so well after three years that that is really no longer an issue. She never ‘takes liberties’ though.” and “Well, things are now routine, but they never fail to make clear what they’re going to do.”

The registered manager told us that once a person decided to start a care package with the service, they would be asked to sign consent forms, for example, consent to care and consent for the service to contact medical professionals.

The registered manager explained when they carried out the assessment of a perspective client, that gave them the opportunity to assess people’s ability to consent by incorporating the principles of the Mental Capacity Act assessment in this process.

Staff we spoke with were aware of the principles of the Mental Capacity Act and knew what action to take if they had concerns in relation to people’s capacity to consent. Staff told us that everyone was deemed to have capacity to make decisions unless otherwise proven and were aware of the concept of decision specific mental capacity.