Respectful Care

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 met people’s needs.

At our last assessment we rated this key question as good. At this assessment the rating has changed to outstanding. This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 93 (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 was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

The provider had an excellent understanding for the need of very detailed personalised care plans that guide staff on how to deliver care in the exact way a person would like to receive it.

We saw incredibly individualised care plans for both maintaining people’s safety and as well as their wellbeing. Care plans started with an "About Me" section which really gave staff an insight into the person beyond their needs. Each care plan detailed the outcomes each individual wanted to achieve from each area of support. All were written in the first person, and it was evident they were co-produced by the individuals.

For example, plans described which side to dress a person first and the reason why or how they liked their hair to be brushed and put up in a scrunchie that colour coordinated with their outfit for the day.

Management explained, “We have 6 monthly reviews with our clients routinely, but they can request one at any time, staff can also advise that clients may need a review in terms of speaking up for their clients. After reviews we update care plans promptly with any changes.”

Staff said, “I enjoy the continuity of calls but also like to meet new people and because the care plans and everything is accessible it means you’re able to do your job smoothly at every call whether you have been 1 time or 10.” “I think it's important that as support care workers we assess our clients always and document and report to ensure that a person centred care package remains up to date,” “Care plans are filled with information about the individual. This gives the carer an opportunity to find out things the client may forget or not feel comfortable telling them out loud,” and “the plans help us deliver tailored, high-quality care that aligns with each individual’s assessed needs.”

A relative told us “All care planning is a family event.”

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The provider worked with a number of different providers of services as well as health and social care professionals to provide tailored care in accordance with people’s individual needs. The provider had their own mental health first aider who supported people where there was an identified need. For example, we saw evidence of them supporting a person during rehabilitation to become less anxious of returning into the community.

Staff knew how to respond to people whose health deteriorated and how to seek help in an emergency. They described to us how to refer to other healthcare agencies such as Occupational Therapists and the district nursing service.

The provider were exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider established communication needs for all people at initial assessment, for example staff discussed any assistive technology needs and then supported people with these needs. They also provided staff with flash cards to support people whose first language was not English. Care plans provided specific guidance for staff on how best to communicate with people. For example, plans included statements such as “must face [person] all times when speaking” and “make sure glasses are on.” For people who struggled to give written consent the provider’s digital system had a dictaphone concept for those who find verbal consent more comfortable.

The provider was dedicated to support people to access information in ways they could understand. They provided easy read PAL Instrument (Pool Activity Level – a person-centred dementia assessment tool designed to help caregivers understand and support individuals with cognitive impairments) assessments for people living with a dementia diagnosis, each one unique to a person’s condition. For example, one PAL assessment regarding continence wear enabled staff to work with a person to achieve a successful outcome of being able to take a person via a taxi to a day centre. The provider also enabled people to manage their own mobility risks as they provided an easy read falls prevention document to all people who had been assessed to be at risk of falls.

Staff told us, “We have clients who are visually or hearing impaired, so we adapt our way to communicate to the client. Sometimes with facial expressions, visually showing them items, using a white board or pen and paper, or even communication passport. Being patient and listening is extremely important for our clients to receive the best care.”

People and their relatives praised staff’s communication skills. For example, a relative of one person they supported described how they were non-verbal “but the carers still have conversations with them, and they have their own 'language' now, led by the carers.”

The provider was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff always involved people in decisions about their care and told them what had changed as a result.

Information on how to raise a complaint was clearly described in the provider’s “Client Guide” which each person received when they joined the service. Information about the local advocacy services available were also listed in this guide, as well as the local authority, the ombudsman and CQC.

We saw evidence in the providers’ complaint log that any concerns or complaints were taken seriously and investigated with resolutions. We saw emails to complainants from the provider who fed back to all involved and then followed up by the registered manager to ensure people were satisfied with the resolution.

Staff shared how they supported people and how they made a difference to people’s lives when they advocated for them when they felt unable to voice their opinion themselves.

People were able to both formally and informally give feedback on care. Formal routes involved regular client questionnaires. People told us they felt confident to speak up and felt listened to.Relatives said, “Office staff listen and act on the content of the call,” and “the office staff keep me calm if I call about something and I know they will sort out any problems.”

The provider was exceptional at ensuring people could access the care, support and treatment they needed when they needed it.

The provider and staff understood the importance of all people being able to access services. Staff described how they followed legislation to ensure everyone had rights to allow care to be needs led and equality based. Staff excelled to identify when people may have needed additional support from other agencies and supported them to access these. The provider supported staff to access any identified training that meant people using the service could have better experiences, outcomes and get the care, support and treatment when needed. For example, training on how to use feeding tubes to alleviate carer stress and sourcing additional training on specialised equipment to support breathing which allowed a person to remain home.

The provider also supported unpaid carers with any training needs to allow them to safely care for their loved ones when staff were not there. For example, moving and handling training. These needs were identified via unpaid carer support reviews.

The provider recognised that people did not always have their compression hosiery applied in line with requirements, because the external professional who fitted them were often short staffed. So the provider proactively sought to gain authorisation and guidance to enable people to have their compression hosiery applied at the time they receive their personal care by Respectful Care staff.

Staff supported people to access external services without delay. In addition, staff were able to recognise when their own care delivery could be delayed, they proactively rectified this. Staff said, “If you notice that there is insufficient travel time, if you call the office the management team will try and sort the issue out for you.”

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

Goals and outcomes were discussed and documented at initial assessment and revisited on a regular basis. Staff described to us how they supported people when they recognised that a person may want to achieve something, for example, returning into the community or volunteering to attend appointments with them that they were anxious about.

The provider always supported people no matter what their preferences were and actively found ways to go above and beyond to ensure they had equity in experience. For example, a person who may not have been able to safely date via dating apps was supported to attend social events specifically organised for people living with disabilities to meet. Staff explained, “All clients have the rights to equality and respect, and they shall receive this,” and “we have supported a few clients with religious and cultural beliefs, and we have engaged in settings with them, respecting and supporting their beliefs while enabling them to attend, join in where possible as much as possible and following strict religious beliefs such as diets, clothing etc. Providing gentle reminders of these where needed that this is something that was important to them, for example, if we know this and a client develops dementia, we can support them to still uphold their beliefs and religious practices.”

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

At initial assessment advanced decisions were discussed and it was identified if there was a respect form in place. A respect from is a document that details a person’s preferences for care and treatment in an emergency, for example if they are for resuscitation or if they would prefer to not be admitted into hospital.

When the provider supported someone with end-of-life care, there was a plan in place called “A Respectful Request” which detailed their individual preferences for example, who they wanted around them and whether they would like music on.

Staff told us about times when they had supported people as they came towards the end of their life and felt they had made a difference to them at this time. For example, “I supported a person who recently passed away … to remain at home with their wife as this is what they wished to do. I set up a 24-hour package for them and liaised with specialist nurses to source training so staff could support them with their ventilator so they could remain comfortable.”

The provider also had a bereavement care service, who offered free training and support for people and their loved ones. The aim was to ensure those grieving felt supported with compassionate, sensitive and practical care.