One Step South 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 “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 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. There were robust assessments of people’s needs to ensure the provider could support them safely, with staff working closely with people throughout the process to understand the outcomes they wanted from their care and to ensure they felt safe and supported throughout transition. There were regular reviews of people’s care to ensure the provider understood people’s up to date physical, emotional and social needs and were able to support these accordingly. Staff ensured where possible, people or their representatives were closely involved in this process to ensure their voice was heard and at the centre of any care plans. For example, one person communicated using gestures and a tablet device, and staff had recently sat down with them to review their care plan together to ensure it reflected their current needs and wishes. A relative we spoke to also confirmed there were regular reviews of their loved one’s care stating “Yes, sometimes they call me and I listen in on the phone. The last review was in the last year. They listen to my opinion.”

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. People received care that was driven by regular engagement with specialist services to ensure it was evidence based and continued to meet people’s needs. People had care plans and risk assessments that we found in the majority of cases had sufficient clear detail, including what signs to looks out for that a person’s health was deteriorating and at what point to contact health services if they were concerned. Staff were equipped with the knowledge and training to be able to provide evidence-based care, for example, one person had started taking weight loss injections and staff were having specialist training from health services on how to administer these injections safely. Staff could clearly state what side effects they would look for, and at what point they may need to take further action if they were not improving.

Leaders and staff had a strong knowledge of best practice guidance for services supporting people with a learning disability or who were autistic. For example, staff were using easy read guidance covering “Stopping over medication of people with a learning disability and autistic people” (STOMP). This is a national programme designed to support people in managing their mental health through holistic methods rather than medication. They had reviewed this guidance with the people they support, to review alongside healthcare professionals how they could support them in reducing their medication if clinically appropriate to do so.

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. There was a strong consistent team of staff who knew the needs of people very well, and worked collaboratively to ensure people received the care and treatment they needed. This was especially important for certain individuals who were at greater likelihood of becoming distressed and needed a consistent team who they felt comfortable with and knew well. “One relative told us “Staff are brilliant. The last 9 months have been amazing and they have a staff team who are consistent and know their needs well. When my relative is heightened staff pick up on this, or (person name) now feels comfortable telling them. They treat and talk to them like an adult”. Professionals who worked with the service reflected that the service worked well with them to ensure people received joined up support. One stakeholder told us, “I have to say that I have no concerns around their practice or dedication to the service users. The team have been responsive and supportive of all our processes and have exhibited excellent knowledge of the person I work with and 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. There was a strong focus on promoting healthier choices through the service, which included using easy read communications to involve and empower people to be involved in discussions around their health, such as for people entering the menopause or around the importance of cancer screening. Where people needed support to attend health appointments and advocate for them staff would support them in doing so. One relative told us, “My relative has a dentist locally, it’s a specialist clinic for people with learning and other disabilities. Staff support our relative in attending this regularly”.

There were robust health action plans setting out an agreed plan between people and their key worker on how the service would support their health needs. One person had recently expressed a desire to lose weight and take part in more exercise and staff had agreed a plan with them of how they would do that. Another person had lost a significant amount of weight through a healthy eating plan which was designed in partnership with his staff team, which had helped them alleviate anxiety about their weight which had caused them significant distress. They now had greater self confidence and were being supported to stay active to help them remain in control of their own health and wellbeing.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. There were clear and robust systems in place for reviewing people’s care, which included regular meetings or reviews where people were able to discuss the outcome they wanted from their care, and any changes that needed to be made to ensure these were being met. Where people had complex conditions such as diabetes, risk of dehydration or malnutrition, epilepsy or constipation there were clear documents in place to monitor these conditions which were closely being followed by staff and checked by management. For example, where people were becoming distressed, this was being recorded through antecedent behaviour (ABC) charts, which were used to explore contributory factors and where appropriate make referrals to specialist mental health services for advice.

The provider told people about their rights around consent respected these when delivering care and treatment, but decisions made on people’s behalf in a minority of cases were not clearly recorded. Where people lacked the capacity to make decisions for themselves, the provider worked closely with their representatives and other professionals to ensure any decisions made were in their best interest and that care was being provided in the least restrictive manner. These decisions were regularly reviewed to ensure they remained in people’s best interest. However, while we assured the provider was proactively conducting assessments of people’s mental capacity, we found records in a minority of cases lacked specific detail on how they had judged a person not to have capacity and why a particular decision was in their best interest. Following the inspection, the provider took action to review the specific decisions we identified to ensure were appropriately recorded.

Staff had a strong understanding of the principles of the Mental Capacity Act and people’s right to make unwise decisions. One staff member stated, “Our role here is to give people as much autonomy as possible. We want to support positive risk taking whilst giving people the information they need to make these decisions, such as supporting people in making their own shopping lists or managing their finances. People absolutely have a right to make unwise choices.”