My Carer

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 63 (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, well-being and communication with them.

Assessments of people's needs were completed before they started using the service to determine whether their care needs could be met. People and, where appropriate, their relatives were involved in the assessment process to help them make informed decisions about their care. One relative told us, "Two people came from the service to do an assessment." Care plans were developed from these assessments and reviewed regularly.

Staff had guidance on people's routines, preferences and the support they required. However, some care records contained limited, missing or outdated information, which reduced assurance that care plans consistently reflected people's current needs and provided staff with comprehensive guidance. The impact of these concerns was reduced as staff demonstrated a detailed understanding of people's needs and were able to describe the support individuals required. Ongoing communication with people and their relatives helped staff remain aware of changes in needs, supporting the delivery of personalised care while records were being updated.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People's needs had been assessed, and care plans were reviewed regularly. However, care records did not always demonstrate that care was planned and delivered in line with current professional guidance and best practice. For example, care plans for people with complex healthcare needs did not consistently contain detailed guidance to support staff with specialist tasks, including percutaneous endoscopic gastrostomy (PEG)care (A percutaneous endoscopic gastrostomy (PEG) is a medical procedure used to place a feeding tube directly into the stomach through the skin), catheter care and the management of associated infection risks.

Where people were at risk of choking or required modified diets, records did not always contain sufficient information to reflect professional recommendations or provide staff with clear guidance on managing risks and responding to emergencies. Similarly, care records relating to severe allergies and the use of emergency medicines did not consistently provide staff with the information needed to recognise deterioration and respond appropriately.

These omissions reduced assurance that all staff could consistently deliver care in accordance with current evidence-based guidance and professional recommendations. However, staff demonstrated a good understanding of the people they supported and were able to describe how they met people's needs in practice, which helped mitigate the immediate impact of these concerns.

Following our feedback, the registered manager acknowledged the issues identified and took steps to review care documentation to ensure professional guidance and best practice recommendations were more clearly reflected in people's care records.

The provider worked well across teams and services to support people. They helped ensure people only needed to tell their story once by sharing assessments of needs and relevant information when people moved between services.

Processes were in place to ensure information about people’s needs, preferences and any changes to their care were shared effectively amongst staff through the digital homecare management platform. The service used an electronic call monitoring system to record staff attendance and the support provided during each visit. This helped ensure people received their planned care and enabled oversight of visit delivery. Where visits were not being managed as expected, the provider responded promptly by arranging replacement support and contacting staff to establish the reason for non-attendance.

People and relatives consistently told us staff arrived on time and that having regular carers promoted continuity and consistency of care. One person told us, “[Staff member] is never late and never makes me feel rushed.” A relative said, “There are 2 regular carers, this stability and continuity really help, and [person] looks forward to them coming. The carers are timely, efficient and never rush off, always finding time for a chat and a laugh with [person]. I think the fact that we have stable, consistent carers really helps with understanding, recognition and trust.”

Feedback from professionals consistently highlighted the service’s effective communication and positive working relationships. One professional told us, “Communication with their workers was always open and constructive. They worked well alongside other services, shared information appropriately, and were proactive in contributing to safe and coordinated care.” Another professional said, “My Carer works collaboratively with health and social care professionals to ensure safe and effective care.”

Staff worked with a range of health and social care professionals to support joined-up care and help people achieve positive outcomes. This helped ensure information was shared appropriately, risks were managed effectively and people received coordinated support which met their needs.

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.

People were supported to access healthcare services when required. The provider worked in partnership with other services, including GPs, pharmacies and local authority teams, to help ensure people received effective and timely care. Professionals consistently told us staff understood people's individual needs and delivered personalised care. Comments included, “Staff had a strong understanding of the person's needs and delivered care in a genuinely person-centred way, taking into account both their mental health and overall wellbeing” and “Staff show a good understanding of the people they support and take a personalised approach to care."

Staff had a good understanding of people's individual needs and preferences and were committed to ensuring these were met. They supported people to maintain their independence and encouraged them to make choices about their care and daily lives. Staff worked with people to achieve positive outcomes and promote their wellbeing.

Professionals told us staff responded appropriately to people's changing needs and worked proactively with other agencies to support their health and wellbeing. One professional said, "I found the service to be consistently professional, supportive, and clearly committed to the person they were working with." They added, "The person's quality of life noticeably improved as a result of the care and support they provided."

However, information relating to people's health conditions, professional guidance and ongoing support needs was not always clearly documented within care plans. Up-to-date information was not consistently available to guide staff in supporting people with specific health or clinical conditions. Although staff demonstrated a good understanding of people's needs and professionals spoke positively about the care provided, these recording shortfalls reduced assurance that healthcare advice and changing needs would be consistently reflected in care records and available to all staff involved in people's care.

The provider did not always routinely monitor people's care and treatment to drive continuous improvement. They could not always demonstrate how outcomes were reviewed to ensure care remained effective, met people's needs and delivered positive results.

While staff demonstrated a good understanding of people's needs and people spoke positively about the care they received, records did not consistently evidence how care and treatment were monitored, evaluated and updated to ensure positive outcomes were achieved and sustained.For example, care plans did not always demonstrate how professional recommendations relating to nutrition, dysphagia and healthcare needs had been reviewed to determine whether the support provided remained effective and met people's current needs.

People were supported by consistent staff who knew them well and responded to their individual needs. Staff spoke positively about the people they supported and demonstrated a strong commitment to providing good quality care. One staff member told us, “We support different clients, some can walk and some are bed bound. When we arrive, we always ask if people need support with any personal care, and if they need food or medicines.”

The provider sought feedback from people and their relatives through quality assurance processes. However, there was limited evidence to demonstrate how feedback was analysed, used to evaluate people's outcomes, or translated into improvements in care delivery and service development.

Whilst people and professionals generally spoke positively about the service, the provider's recording systems did not consistently demonstrate how information gathered through reviews, observations and feedback was used to monitor the effectiveness of care and support ongoing improvement.

The provider did not always ensure they worked in accordance with the Mental Capacity Act 2005 (MCA) and could not always demonstrate that consent to care and treatment was appropriately obtained and recorded.

Policies and procedures were in place to support compliance with the MCA. However, these were not always effective in practice. The provider did not consistently demonstrate a clear understanding of MCA requirements, including how to assess a person's mental capacity or complete best interest decisions when people lacked capacity to make specific decisions about their care.

Where there were concerns regarding a person's ability to make decisions, the provider had not always completed mental capacity assessments or followed the best interest decision-making process. When we requested evidence of MCA assessments, the provider was unable to provide this. We also found restrictive practices were being used without appropriate MCA considerations. For example, medicines were stored in locked facilities, and bed rails were in use for some people, but the provider had not completed mental capacity assessments or best interest decisions to demonstrate these arrangements were necessary, proportionate and in the person's best interests. This meant the provider could not always demonstrate that decisions relating to people's care, support and restrictions had been made lawfully and in accordance with the MCA 2005 and current best practice guidance.

The provider discussed consent with people during the assessment process and when agreeing care arrangements. However, systems were not always effective in ensuring care was delivered in accordance with the MCA and people's rights were protected. The MCA states people must be assumed to have capacity unless there is reason to believe otherwise. Where people had capacity, records did not consistently demonstrate their consent to care and support had been sought, reviewed and recorded as an ongoing process.

Care records had not been signed by people, although initial care agreements had been signed before support commenced. This reduced assurance that people had been involved in reviewing and agreeing the content of their care plans as their needs changed over time, or that records continued to reflect their wishes and preferences.

We also identified concerns regarding consent for the use of people's photographs. The provider's social media platform contained photographs of people using the service; however, the registered manager was unable to demonstrate consent had been obtained for this purpose. Documentation provided to us referred only to photographs being used within care plans and stated they would not be used for any other purpose. This meant the provider could not demonstrate people had consented to their images being shared on social media or understood how their personal information would be used, creating a risk that their rights, privacy and autonomy were not fully protected.

Staff told us they routinely sought people's consent and offered choices when providing care and support, although this was not always reflected in records. Staff demonstrated a good understanding of the importance of gaining consent and the principles of the MCA. One staff member told us, "Before helping I would ask the person what they would like me to do."

People generally felt staff respected their choices and preferences. One person told us, "[Staff member] doesn't check my consent, they've been coming here for years, they know what needs doing and they just get on with it." This reflected the positive and longstanding relationships staff had developed with people. However, records did not consistently evidence how consent was sought, reviewed and maintained as an ongoing part of care delivery.