Archived: East Anglia Domiciliary Care Branch

On this page

• 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 meets people’s needs. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people’s needs were not always met through good organisation or delivery. The provider was previously in breach of legal regulations in relation to person centred care. Improvements were not found at this assessment, and the provider remained in breach of these regulations.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s care plans contained some details about people’s preferences, likes and dislikes. However, this was not consistent and for some support needs, care plans did not exist or needed more detail to help guide staff how to support people. For example, some people were living with specific health needs, such as use of a catheter, however there was limited information about how this impacted their lives and what staff could do to support them with this. For this person there was no catheter care plan. The catheter leaked which had caused blistering to their legs. The care records said there was a technique to help stop the catheter leaking but this was not documented in the records, nor was the use of a medicated cream prescribed for their legs.

We spoke to some staff who had a good understanding of how people wanted to be supported and how their needs should be met. However, this was not consistent. Some staff, especially those who were new to the service, were not always aware of the risks and why support was in place. For example, 1 person had choked in the past but we spoke to a new staff member who told us they were not at risk of choking and they just liked to eat a lot. Another staff member told us they did not have time to look at the care plan so relied on the handover and asking other staff. They did not think anybody had any particular risks. However, there were people in their service who had risks of choking and took food from anywhere they could find it, the mitigation for which is staff had to be in the vicinity of at all times, however, this member of staff did not seem aware of this. Other risks for people in their service included risk of falls and assault or confrontation with other people.

The diverse needs of some of the people cared for were only partially understood. In particular, people who needed support with how they managed and communicated the way they felt when they were distressed. Their needs were not being continually assessed and reviewed to ensure care and support was provided in a way to support them manage distressing situations. There were gaps in staff training, and a lack of guidance to staff to help them meet people’s needs with regards to positive behaviour support. Due to staffing vacancies and use of agency workers there had been a lack of continuity of staff in a number of homes which had impacted on the care and support provided to people as staff did not know them very well.

The provider did not always supply information in formats tailored to meet individual needs. People’s care plans had a template for easy read. However, the records were not always clear on how people should be provided with information or how they communicated especially if it was by other means than verbal. For example, pictures or by signing. One person’s communication care plan stated they used a mixture of speech and signs to communicate. It advised only using pictures when they were required as they could become fixated on them. But did not state what pictures and when they would be required or what type of signing they used. The e-learning on communication was not mandatory for staff. There was no training provided on alternative forms of communication such as Makaton (a type of sign language). At some homes where people used Makaton staff were not trained but there were books which had signs in for them to learn. Some staff used their initiative to communicate with people by using pictures on a laptop as they did not have flash cards to help with meal choice.

The provider did not make it easy for people or their relatives to share feedback and ideas, or raise complaints about their care, treatment and support. People and their relatives were not involved in updates to care plans and care plan reviews were not taking place. There were no processes in place for people to access advocates and a lack of awareness by staff that people could be offered this support to allow them to have a voice. The complaints process was not robust. We identified a complaint by a relative which was not on the complaints log, which did not detail any complaints at all. There was no system for capturing informal or verbal complaints or concerns and ensuring these were addressed. Not all homes had meetings of the people who lived there and there were no regular meetings with relatives.

Most people could access the care and support from health care professionals when they needed. However, we did have concerns about lack of monitoring for certain health conditions and making referrals for such things as constipation. Most homes had good relationships with their GP surgeries to ensure people received medical support. However, not everyone with complex needs could access care and support they required in a way that worked for them to make the visits less stressful. One person went to a GP appointment and refused to go in or to leave the surgery to go home. There was no review of what had happened, why and how staff could prepare the person next time, so it was more successful.

It was not always clear how people were supported to have their desired experiences and outcomes. Most people did not have goals and or any ambitions recorded in their care plans. The goals we identified did not have any updates on progress or were not still being worked upon. It was unclear for a lot of people what outcomes they had achieved since starting to live at the homes. This made it more difficult to see if people were being supported to have good experiences or achieve their desired outcomes. When we spoke to the manager they said equity of experiences, outcomes and access is an area they needed to work on.

However, we found examples where staff had worked with health care professionals for a person to achieve a better life for them. This person had been cared for in bed for a number of years so staff worked with their GP and occupational therapist to put support in place so they could be out of bed in an adapted chair and had started going outside again, which gave them a better quality of life.

People were not supported to plan, or for decisions made in their best interests, for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. However, for some people relatives had made arrangements in advance for funeral planning.