Bespoke Care & Support 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 requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (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.

People were not fully protected from the risk of receiving care based on outdated information because updates in care plans were not clearly dated. Although initial assessments were completed, the absence of dates on changes meant we could not be assured staff were using accurate, current guidance. This limited confidence that care reflected people’s most recent needs and preferences.

The provider assessed people’s needs before delivering care, and care plans included relevant personal and health information. However, because updates were not dated, we could not be confident the information was accurate or up to date.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Nationally recognised tools were not used to help inform care planning and outcomes for people. Where people had already been identified as being at increased risk of skin breakdown, Waterlow scores (a calculation which helps care providers estimate the risk of a person experiencing a pressure sore) had not been completed, which meant staff could not always understand people’s specific needs to enable them to deliver the best possible care.

However, most people and relatives told us they felt staff were competent to deliver care.

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 completed detailed care notes during each care call to ensure the next staff member supporting that person had the information required. This included whether they had eaten well or not, or if there were any other concerns. Staff used electronic records to communicate information with each other. Staff could speak with the leadership team by calling the office. The service had a field supervisor who supported staff, which included onsite visits, if required.

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. The registered manager told us referrals were made to health and social care professionals and confirmed they worked closely with the district nursing team. Staff, people and relatives gave examples of how people were supported to make choices including what meals they would like and how they would like their personal care provided. Care tasks showed some people were supported to engage in exercise programmes provided by professionals.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Provider audits showed there was ongoing monitoring of call times and duration to support people’s safety. However, staff told us they often had very limited time between visits, did not usually get breaks, and sometimes finished their shifts later than planned.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. Staff understood the need to gain consent before carrying out care and treatment. One told us, “Having capacity is to make your own decision until proven otherwise.” Records showed gaps in mental capacity training which the leadership team were aware of and planned to action promptly. Care plans included information about any relatives who held power of attorney for the people they were supporting. This allowed staff to contact the power of attorney should they require any action or decisions to be made in relation to a person’s health or finances.