Integral Focus Support and Care Services

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 as good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (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.

Initial care and needs assessments were detailed and person-centred. They covered key areas such as communication, eating and drinking, sensory needs and social interaction. Together with information from referral documents, these assessments formed the basis of people’s care plans, which clearly set out their support requirements.

Care plans were reviewed every 6 months or more frequently if there was a significant event or illness for example if a person experienced a fall or required time in hospital. People and their loved ones were present for each review process.

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.

The provider was able to provide evidence-based care and treatment. Policies were in line with national good practice and care was given in a person-centred way. This was in line with the people’s wishes, and they were involved in their assessment of need.

The registered manager planned and delivered people’s care and treatment with them, including what was important and mattered to them. People were able to choose how they wanted their care and support provided. The registered manager made sure they were involved and were given choices. People could choose whether they wanted male or female carers and when was the most convenient time for carers to call. Staff responded to people’s needs and respected their wishes. Most people were independent with most aspects of daily tasks for example, taking a bath or shower however staff still needed to be close to keep people safe. Some people felt more comfortable with staff close and others wanted some privacy and this was respected within the confines of safety.

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.

Staff had access to the information they needed to appropriately assess, plan and deliver people’s care and support. A staff member told us, “We have the care plans and risk assessment, so I know what I need to do.”

The registered manager had established positive working relationships with other health and social care professionals. People’s needs were met by a joined-up approach to support. When people needed specialist support from for example, occupational therapists or the speech and language team (SALT), this was arranged by the service.

Care records enabled staff to communicate well with each other and ensure continuity of care.

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.

Staff monitored people’s health and wellbeing through day-to-day interactions and regular care reviews, escalating any concerns promptly. Care plans contained clear information about people’s health conditions and how staff should promote and support their health and wellbeing.

Staff supported people to eat and drink according to their preferences and needs. Relatives confirmed their loved ones received appropriate support with nutrition and hydration.

Staff received training in how to meet and appropriately manage people’s health care needs and conditions, for example moving and handling, and first aid.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The provider had systems for monitoring the care provided. Daily records were kept of what support was provided on each care calls, and these were reviewed by the registered manager. In addition, the registered manager remained actively involved in people’s care, regularly visiting people to monitor progress and ensure agreed outcomes were achieved.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People and relative told us they were involved in planning their care and support and were able to share their preferences for how they wished to receive care. Comments included, “Yes, we have a care plan.” Staff we spoke with said they always sought consent before providing care. They said people were encouraged to make their own choices and decisions about their care.

Systems were in place to obtain people’s consent before providing care and support. The service had a Mental Capacity Act (MCA) policy, and staff had received training on the MCA.

MCA assessments had been completed to determine whether people had the capacity to make specific decisions. Where a person was assessed as lacking capacity, best-interest decisions were made by appropriate professionals and, where relevant, the person’s representatives, such as relatives.

Records of best-interest decisions were available for all the care plans reviewed. These records clearly identified who had been involved in the decision-making process and included the date of the meeting. This provided evidence that decisions had been appropriately considered and documented.