Archived: East Anglia Domiciliary Care Branch

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – This means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained the same. This meant people did not always feel well-supported, cared for or treated with dignity and respect. The provider was previously in breach of legal regulations in relation to person centred care and dignity and respect. Improvements were not found at this assessment, and the provider remained in breach of these regulations.

This service scored 40 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

When visiting services we witnessed staff interactions with people were kind, compassionate and they appeared to know them well. Relatives overall felt staff were kind, caring and respectful especially if they had worked at the service for a while and had got to know the people who lived there. However, we identified records which were not written in a respectful way but used derogatory terms, such as, ‘[they] will sulk if [they] doesn’t get [their] own way’, ‘Habit of wandering off at car boots’, and records which refer to people ‘not getting their own way’.

People were not always treated as individuals who were in control and involved in planning their care, support, strengths and goals. We found some people who lived together did things together and we were not assured this was their choice. A relative told us, ‘I'm not sure if [person] gets much individual choice. [They] usually does things as a 2 with the other person, or even as a 4 with the other 2 from the other [home]. I'm not sure if [they] get to choose what food [they] want. I think mostly they do it all in a group’. People were not asked about their preferences for male or female carers and this was not identified in their recorded preferences, which meant people were cared for by both male and female staff.

The provider did not always promote people’s independence to develop skills and set goals to help give them choice and control over their own lives. One of the areas relatives identified which stopped people’s independence in some homes was the impact of new staff and using agency workers who could not drive to take people out to do the things they liked to do. Some also felt staff would support a person by doing things for them rather than encouraging them to learn to do more things for themselves. We also found some homes did work with people to develop their independence. At one home some people had lost their confidence to go outside due to the Covid pandemic, and they were working with them to build this once again so they could enjoy activities they used to. Another home had purchased a specially adapted kettle which meant people could make their own drinks unaided by staff.

Staff did not always respond to people’s needs in the moment or act as they wished to minimise any distress. We received mixed feedback from relatives, not all felt staff were always able to anticipate people’s needs and respond to signs of discomfort and distress, due to some people not having very good or any verbal communication and acting in ways staff were unable to predict or identify a reason why. We did not believe all staff had the skills and training to meet people’s needs when distressed. We spoke to a staff member who said they had witnessed verbal aggression and when we asked how they might de-escalate this, they said they would not shout back. Staff were not regularly completing antecedent behaviour and consequence (ABC) forms, which is an observational tool that helps understand the cause of behaviour, for people who exhibited distressed behaviour. When completed, these were not being reviewed to identify triggers and better ways to work with people to support them at times of distress. In some homes, especially for everyday needs, where there had been consistent staff, they knew people and could respond to their needs and requirements.

The provider did not always care and promote the wellbeing of their staff by ensuring they were well supported and trained so they could provide good person-centred care. There had been a lot of changes of staff within most homes with new service leads and new staff being recruited. There had been times of high agency staff use. This had all put pressure on the workforce. We had a mixed response from staff. Some felt they had not been supported well but others did. Supervision had not been happening consistently for all staff. Some new staff we spoke to were unclear on processes such as incident management or making safeguarding referrals and where to find information. Other staff had felt supported. They said, ‘Everything is in order. We are lucky with [service lead], they are very clear with instructions, and we have a stable team with hardly any use of agency.’