Careuk247 Home Care Cambridgeshire

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• 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 good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always identified and met.

The service was in breach of legal regulation in relation to person centred care at the service.

This service scored 57 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Improvements were needed to make sure people consistently received person-centred care. Clear and accurate care plans were not in place, this meant records did not reflect people's up-to-date needs, wishes and goals. Furthermore, we found care plans were not always developed to meet people’s communication needs, such as where their first language is not English, or where they would benefit from easy read or pictorial formats. Whilst the registered manager did act during the assessment, this was specifically for the care plans we reviewed, and so we cannot be confident that this has been reviewed and actioned for all people in a meaningful way.

We found when people’s care arrangements changed, this did not always result in a structured review of their individual needs and preferences. For example, 1 person regularly received support from the agency during daytime hours. The provider agreed to deliver additional overnight support; however, this change had not prompted a formal reassessment of the person’s needs, routine, or potential risks. As a result, there was no evidence the overnight care had been planned in a person-centred way or that guidance had been updated to reflect the person’s needs during this provision.

People and their relatives gave mixed feedback about their involvement in care planning and decisions about care, this included their gender preference of staff. Some felt involved and listened to, while others were less aware of how care plans were developed or reviewed. One relative told us, “[Person] is not happy with male carers giving personal care – and has male carers coming in to do that. [Person] won’t have a shower or a bath with the male carers – so is not getting washed properly.” We shared feedback directly with the registered manager regarding people’s feedback around gender preference of staff for their action and review.

Where people felt their care plan was reflective of their needs, they told us staff did not always refer to it. For example, 1 person told us, “[Staff] should read my notes, they never look at my care plan.”

Whilst the provider responded to the concerns identified during the assessment, we could not be assured that improvements had been fully embedded or that effective oversight arrangements were in place to sustain these changes and reduce the risk of recurrence.

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.

Consistency of care staff was important to people and contributed to positive care experiences. However, some people told us they were not always informed when a different carer would be attending their visit. For example, 1 person told us, “I used to get a regular carer, but I get lots of different one’s now. I have to tell them all what to do.” Another person said, “The carers do change a lot, I’d prefer more regular carers coming in. I never know who is coming. There is no rota.” One person’s relative told us, “The new [staff] are not introduced before they come for the first time. They just turn up. They don’t know what to do, and they haven’t shadowed anybody.”

We shared this feedback with the registered manager who said they would be reviewing staff allocations. The registered manager told us people were offered a rota when they started receiving care from the agency and said this would be reviewed again with all people.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Improvements were needed to ensure information was always provided in a format that met people's individual communication needs. This included considering the needs of people whose first language was not English, as well as those who may benefit from easy read, translated or pictorial information. For example, where newsletters or other written information were distributed, the provider should ensure these are accessible to all people receiving support, including those who require information in a different format to understand and engage with it effectively.

We received mixed feedback from people and their relatives about access to records. Some had access to the providers electronic system, others did not know it existed. We shared this feedback with the registered manager who said this was offered to people, and their relatives, where appropriate, when starting with the agency. They said this would be reviewed again with all people.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result. People and their relatives told us they were confident to speak to staff in the office as needed, and they had a contact for outside of office hours. For example, 1 person said, “I have good communication with the office, they are pretty good.”

The service sought feedback from people and their relatives to help understand their experiences of care and identify areas for improvement. People and their relatives knew how to contact the office and raise any concerns and told us they felt comfortable doing so when needed.

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

The provider had taken steps to promote equitable access to services. The office was based in an accessible location, helping to ensure people, relatives and professionals could access support when needed. Staff had also completed equality, diversity and inclusion training, which helped promote awareness of people's individual backgrounds, needs and protected characteristics.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The provider demonstrated a commitment to treating people fairly and respecting their individual needs, backgrounds and circumstances. Staff demonstrated an awareness of equality, diversity and inclusion and understood the importance of providing support that respected people's backgrounds, beliefs, preferences and protected characteristics.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Improvements were needed to ensure people were consistently given opportunities to discuss and record their future care wishes. Care records did not always demonstrate conversations had taken place about people's preferences for future care and support, particularly where their needs or circumstances had changed.

In addition, where people had made advance decisions about their care, such as Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions, this information was not always clearly referenced within care plans. This reduced assurance that people's wishes were fully reflected in care records and readily available to guide staff in the delivery of care and support.