Northamptonshire Domiciliary Care Agency

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 Inadequate, and the provider was in breach of regulation in relation to safe care and treatment.

At this assessment the rating has changed to Requires Improvement. Enough improvement had been made, and the provider was no longer in breach of regulation.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

Further work was needed to ensure improvements were fully embedded and sustained into working practices.

This service scored 54 (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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them or others.

There had been improvements to care plans since our last assessment. We generally found records contained sufficient information to help staff understand people's needs, manage identified risks and support people safely.

Guidance relating to specific health needs had also been strengthened, including information on diabetes management, catheter care and bowel health. This meant staff had access to more detailed information to support consistent care.

Although care plans often described how information had been gathered, such as through discussions with people, relatives or staff, family members told us they had not been invited to care plan reviews or involved in the development of care plans since our last assessment. For example, a relative told us, “I’ve never been invited to care plan review.” Another relative told us, “No. I can’t remember the last time I went to a care plan review.”

While progress had been made, further work was required to ensure care plans remained person-centred, accurate and subject to regular review. For example, a bowel health care plan we viewed did not reflect the persons current needs or available support from staff.

The provider was not able to demonstrate that an evidence-based tool was consistently being used to assess whether people were at risk of poor nutrition or to determine the actions required to mitigate identified risks.

We found that people who were at risk of experiencing health complications associated with obesity were not always routinely having their weight monitored. This meant opportunities to identify changes in people's health and take timely action may have been missed.

We saw there was some evidence health practitioners, including the GP, were aware people were overweight, and in some instances the provider had worked with partners to educate staff and develop resources in relation to portion sizes. For example, in relation to a person with Prader Willi syndrome. However, oversight of this was not consistent and several families expressed concern the provider was not proactively supporting people with the health complications of obesity.

During the assessment, we provided feedback regarding these concerns. In response, the provider shared a local protocol and information relating to training they were developed to improve staff knowledge and oversight in this area.

Further work was required to ensure care was consistently informed by evidence-based approaches in relation to health-related risks.

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.

Staff across the supported living homes we visited consistently told us that teams worked well together to ensure people received good quality care and support.

Staff demonstrated a good understanding of people’s individual needs and preferences and described positive communication and information sharing within and across teams.

We found improvements had been made to care plans and risk assessments, which now provided clearer guidance for staff. This meant staff were better supported with written information about people’s needs, reducing reliance on individual staff members’ knowledge.

The provider had an established organisational structure with a range of support functions available to local teams. There was evidence of effective collaboration across the wider organisation to support service improvement. For example, staff told us they had received regular support from the provider’s quality and practice development teams, including visits to the services.

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.

People were supported to access healthcare services and staff worked collaboratively with external professionals. For example, records demonstrated involvement from a range of healthcare professionals, including speech and language therapists, opticians and dentists.

There was also evidence that people had medicines reviews and annual health checks to support the monitoring of their health and wellbeing.

However, the provider was not always supporting some people to monitor and address all potential health related concerns.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive andconsistent, or that they met both clinical expectations and the expectations of people themselves.

We found there had been improvements in how people’s goals and outcomes were recorded across the supported living services. Records showed people had identified goals and aspirations, and we saw examples which included planning holidays, making improvements to their homes and obtaining a new mobility vehicle. This demonstrated a greater focus on supporting people to achieve outcomes that were important to them.

However, further work was required to ensure goals were consistently meaningful, personalised and focused on longer-term aspirations beyond day-to-day living. We also found opportunities to strengthen how outcomes were evaluated to demonstrate the impact support had on people’s lives and whether people had achieved the goals they wanted to achieve.

The provider recognised these areas for development and told us about their planned implementation of the Outcomes Star framework. They described this as a positive step towards strengthening how they measure and evidence the difference their support makes to people’s lives.

The provider told us this work would focus on further developing person-centred goal setting and improving how outcomes are monitored and reviewed over time.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Staff and leaders had completed training and demonstrated an understanding of consent. During our assessment, we observed staff seeking people’s permission before providing support and promoting people’s involvement in decisions about their care.

The provider had completed mental capacity assessments and best interest decisions in relation to specific decisions. However, records relating to people’s capacity and consent were not always completed in line with the principles of the Mental Capacity Act 2005.

For example, where mental capacity assessments had been undertaken, there was not always evidence demonstrating how information had been presented in a way the person could understand to support them in making their own decision. We also found examples where information recorded within a mental capacity assessment had been repeated within the associated best interest decision, which did not evidence a best interest decision-making process or meeting had taken place.

The provider acknowledged the areas requiring improvement and told us about the actions they planned to take to strengthen the quality of mental capacity assessments and best interest decisions.