Domiciliary Care Experts

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 of this key question, we rated this key question good. At this assessment the rating has changed to requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to consent to care and treatment and person-centred care.

This service scored 42 (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. Whilst assessments had been completed before people accessed the service, these were not always reviewed and updated in a timely manner when people’s needs changed. People gave us mixed views as to whether they had been involved in planning and assessing their care and support needs. A person told us even though they had been assessed as requiring 16 hours of support a week, which was paid for by the local authority, they only received 15 hours per week. Staff working with the person confirmed this.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. A person told us about a care plan they received which was inaccurate and stated it was completed by someone who had already left the organisation. They felt the provider and management team had copied and pasted the care and support plan and had not involved them in the process. They had lost confidence in the organisation as a result of this. A staff member responsible for creating and amending care plans confirmed that this had not yet been resolved.

A relative said, “I was involved in setting up her care plan and it is regularly reviewed, yearly I think, although the last one was reviewed without us being there.” A person told us, “I was involved with setting up my care plan but there was not much of a dialogue with this company. When I have been with other agencies it has always been regularly reviewed but with this agency it has been reviewed once in 2 years.”

People’s care plans showed the times they would like their care and support. The call monitoring data reviewed as part of the assessment, showed a variation of times that people actually got their care and support.

When people had support with preparing and cooking food, the food provided was purchased by relatives and cooked by staff. People were making food choices. People said, “They do meals and they do wash their hands and wear gloves, and I choose what I have” and “They do my meals and my wife chooses for me, and they do wash their hands first. I am not a vegetarian so eat anything really.” A relative said, “She can’t make choices for herself, but I do know they give her a varied diet, and they ensure she drinks enough as well.”

The provider did not always work 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. The provider told us that they shared information about health concerns with relevant healthcare professionals and with relatives. We observed this taking place during the assessment when a person was suffering from a mental health crisis.

Staff told us communication was not always effective which meant the care was not always coordinated. The provider told us they communicated through email, telephone, secure messaging and through the electronic care planning system. A staff member told us, “When there are changes they (management) might send an email, it is not an efficient way of communicating as I can’t refer to emails always when I am in the persons home. It would be better on the app. The app just states tasks to do and the person’s address. So, it just states personal care. At 1 (person’s home) it says to do their catheter, but the client does not have a catheter. If you are a new staff to that person you have to ask where is your catheter. Some tasks are not relevant to some clients, we report changes, sometimes they can see people need a review, but it takes time for them to come and review them. Sometimes they do, sometimes they visit with the OT’s (occupational therapists).”

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.

Records showed that staff had not always received training to support people with their specific health or lifelong conditions, including epilepsy. Only 4 staff had completed eating and drinking training. There was no skin integrity training listed despite staff supporting people with their skin care. Arelative told us names of staff who supported their loved one who was an autistic person, only 1 of the 4 staff named had attended autism training.A staff member told us, “They have now introduced Oliver McGowan training, so I am happy about that.” (This had been introduced as mandatory training after we carried out our onsite assessment activity.)

A relative told us they had met with the management team to discuss additional training for staff to meet their loved one’s health needs. They said, “This has not yet happened, with no update on when it will.”

Staff could tell us how they would access additional support from healthcare professionals to help people manage their health, should they be required. The management team gave us examples of when they had made contact with people’s GP or the district nursing service when people had become unwell. A staff member said, “If a client is unwell, I would call the office and they would call relatives. I would call an ambulance.” Another staff member told us, “Today I emptied the night bag and the urine was low, the client said they had been drinking and we found it was bypassing. I called the district nurse and they came.”

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. Some people’s care records stated that their fluid input, urine output or frequency and type of bowel motions should be monitored. There was no evidence this had been taking place; documentation was not available to evidence that the management team routinely checked this, which left people at risk of harm. When people or their relatives had requested improved care and treatment, they had not always experienced this. A relative said, “My relative has had regular carers from day one. My relative really got on with [staff member] but he only comes rarely now, it is so upsetting as my relative got on so well with him. The company change carers on a whim and my relative has complex needs and gets upset by this change especially when the carers do not attempt to bond with my relative, it makes my relative not trust them as they do not know the carer.”

The provider did not tell people about their rights around consent or respect these when delivering care and treatment. The provider had not always ensured that consent was obtained by the relevant person and in conjunction with the Mental Capacity Act 2005. For example, consent records were signed by people’s relatives. There was no evidence to demonstrate that the provider had checked relatives’ legal entitlement to do this. There were no copies of lasting power of attorney for health and welfare people’s records. Office based staff advised us if one had been obtained it would be in the file. They confirmed they had not seen any supporting documentation.

There was a lack of mental capacity assessments and best interest meeting records to demonstrate that the provider was adhering to the principles of the Mental Capacity Act and the code of practice.

Staff told us they supported people to make their own choices and decisions. Staff told us, “I give 3 options and show them to help them choose. Some people like to eat cheese and crackers every day, but I still give them the options. Also, the same with drinks, I know what their favourite is but will always offer”, “I like people to choose the colour of their socks or shirt” and “Most clients can talk and make decisions, some can’t make decisions on their own and have help to do this from their families. I offer choices of clothing, sometimes help someone walk to the wardrobe so they can choose colours.”