Northamptonshire Domiciliary Care Agency

On this page

• 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 Requires Improvement. At this assessment the rating has changed to Good.

This meant people’s needs were met through good organisation and delivery.

This service scored 64 (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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

The interactions we observed between staff and people during the assessment were personalised and reflected a person-centred approach to support.

Staff demonstrated a good understanding of people’s likes, dislikes, interests and preferences and used this knowledge to shape daily routines, activities and engagement. This helped to ensure support was provided in a way that reflected what mattered to people and promoted positive outcomes.

People’s homes were personalised and reflected their individual personalities and interests. For example, one person had pictures of their favourite football player displayed in their bedroom.

We reviewed care records and found care notes were completed and provided details of events, activities and significant interactions. There were also ‘About Me’ documents in place which included information about important people in a person’s life, significant events, their strengths, interests and likes and dislikes. This information helped staff understand people as individuals and provide more personalised support.

The registered manager spoke positively about their ambition to further strengthen person-centred practice and told us about plans to introduce a more formal person-centred planning approach. They were passionate about ensuring people remained at the centre of decisions about their care and support.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

There had been improvements in the training provided for staff to support people with complex health needs. For example, staff had received condition-specific training in areas such as Prader-Willi Syndrome, epilepsy and diabetes, helping them to better understand people’s individual needs and provide appropriate support. This contributed to the continuity of care people received and supported staff to respond appropriately to changes in people’s health and wellbeing.

The service continued to use some agency staff. However, we saw evidence that agency workers received an induction to the service, and the registered manager told us they aimed to use regular agency staff wherever possible to promote continuity and consistency of support. Agency staff we spoke with demonstrated a good knowledge of the people they were supporting and understood their day-to-day needs and preferences. The registered manager also told us agency usage had reduced and shared plans to further decrease reliance on agency workers.

Feedback from relatives about the provider’s ability to meet some complex health needs and the use of agency staff was mixed. A relative told us, “They are a good generalist service but not specialised in [name of medical condition]. Mencap deny that there is a problem. They say specific training has been provided.”

While improvements had been made, we found further work was required to assure relatives that all staff, had the necessary knowledge and competency to consistently support people with complex health needs.

The provider had taken steps to ensure information was available in formats people could understand. We saw a range of easy read materials covering topics such as complaints, reviews and outcomes, helping people to access information and be involved in decisions about their support.

The provider had introduced a newsletter to share positive news and developments across the Northamptonshire services, and the registered manager told us there were plans to continue these on a regular basis. We also saw that key changes within the leadership team had been communicated to relatives, although not all families could recall receiving this information.

Staff were supported to communicate with people in ways that met their individual needs. For example, where people used Makaton as part of their communication, the provider had arranged training for staff. During the assessment we observed a staff member appropriately using Makaton to support communication with a person, demonstrating efforts to make information and interactions more accessible.

However, feedback from relatives about communication was mixed. While there was evidence of information being shared, some relatives told us communication was not always consistent. Comments included, “I’m only ever given incomplete information”, “They don’t phone me, I have to phone them”, and “Communication is poor.” This indicated further work was required to improve the consistency and effectiveness of communication with relatives and ensure they received timely and complete information.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

The provider had systems in place to seek and respond to feedback from people, relatives and others. A complaints and compliments policy was available and, when people joined the service, they were provided with an ‘Our Better Together’ information pack. This aimed to help the provider understand what people wanted from their support and explain how families and friends would be involved in helping people achieve the outcomes that were important to them.

The provider had sought feedback from people using the service and had achieved a positive response rate to its recent survey. Although the survey identified some areas for development, feedback indicated people using the service felt safe.

The provider had also undertaken a survey of relatives, although engagement levels were low, limiting the amount of feedback available to inform service development.

Staff told us people were becoming more involved in the recruitment of new staff, helping to ensure their views were considered when appointing people to support them.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

Records we reviewed showed people were supported to access healthcare services and attend regular health appointments when required. Staff understood people’s health needs and worked to ensure they could access the support and treatment they needed. This helped to reduce the risk of barriers to accessing healthcare.

Arrangements were in place to support people during emergencies and unexpected events. We saw the provider had a business continuity plan, and staff were able to explain how to access these through the emergency information kept within the service. This helped to ensure staff had access to key information and guidance if normal service delivery was disrupted.

The provider also had an on-call system in place, supported by local and national escalation processes. Staff told us improvements had been made to the support available outside normal working hours and said they now felt assured they would receive a response when contacting the on-call service. These arrangements helped to ensure staff could access advice and support when needed and contributed to people receiving consistent support.

Leaders and staff demonstrated an awareness of the barriers that people with a learning disability and other health conditions can experience when accessing opportunities and achieving positive outcomes. Staff were able to describe how support was adapted to meet people’s individual needs and help reduce some of these barriers, promoting greater inclusion and participation in everyday life.

The provider told us about a partnership between Mencap and Omaze which was focused on improving health equality for people with a learning disability. Leaders described how the project would explore areas where targeted improvements could make a meaningful difference to people’s lives, including work relating to delegated healthcare tasks. This demonstrated a commitment to further developing practice and addressing inequalities experienced by people using the service.

We found some improvements had been made since our last inspection in relation to people’s access to outdoor spaces. For example, people had been supported to develop and maintain their gardens and work had taken place to improve accessibility. This meant some people who had previously been unable to fully access their gardens were now able to make greater use of these areas.

The provider was supporting people to consider and plan for their future wishes where they were ready and willing to do so. We saw evidence that end-of-life care planning was being discussed with people and that goals had been established to support individuals to explore and record their wishes and preferences. This demonstrated an increased focus on ensuring people were involved in decisions about their future care and support.

Prior to the assessment, we received positive feedback about the support staff had provided to a person receiving end-of-life care. This was reinforced by feedback received during the assessment from another external professional, who spoke positively about the care and support provided.

The provider had processes in place to reflect on and learn from people’s deaths. All deaths were subject to an internal mortality review, overseen by the provider’s quality team, to help identify learning, recognise good practice and support service improvement. The provider also routinely notified the Learning from Lives and Deaths, People with a Learning Disability and Autistic People (LeDeR) programme to contribute to wider learning.

The provider recognised that end of life planning remained an area for further development. Leaders told us work was already underway to strengthen conversations about future wishes and to support the development of more comprehensive end of life care plans.