Care at Home Group Cheshire West and Wirral

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

We assessed 6 quality statements under this key question. Our rating for this key question has improved to good. Overall, the provider had systems in place to help staff to deliver care to people in line with legislation and good practice standards. Since our previous inspection, the provider had taken action to improve how the service worked together and with others to support people, including ensuring all staff training and supervision was undertaken in line with policy. People’s needs were assessed and their care plans were built around their needs. Care plans contained information to help staff understand the person, including their support and health needs. Processes were in place to ensure people's rights and wishes were respected.

This service scored 71 (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 feedback indicated their needs were assessed and care plans were built around their needs. Risk assessments were also completed, and these were kept under review, so that changes to people’s needs could be supported. People said, “They came and asked what we wanted. [Name] came and did an assessment, told us about the company” and “I’ve asked for a cleaner, so they are looking into that for me.”

Staff feedback showed they could access information about people’s support needs. The registered manager told us strength-based assessments were provided from commissioners, which helped them to undertake effective assessments and create plans with people.

Systems were in place to asses people’s care and support needs prior to the care being provided. People were involved in their assessment. Assessments and care plans were available to staff through an app. People could access their information if they wished, which could be made available if alternative formats if requried. The provider used various assessment tools to assess certain risks, such as the risk of skin breakdown or malnutrition. Care plans contained information to help staff understand the person, such as their life history, hobbies, their likes and dislikes, and things that were important to them.

People’s views were mixed about the delivery of care, this related to the timings of care calls and meeting people's preferences. Some people commented that certain staff appeared to lack appropriate knowledge and skills to provide effective care. Comments included, “There’s too many staff for them to know her well and they don’t seem to have had the right amount of training” ; “She appreciates them being friendly but I can’t say they do anything well.” People also gave positive feedback, they said, “They're [carers] very good and very nice. I get on with them all” and “I have no complaints whatsoever.”

Staff told us they followed guidance provided through people’s care plans to deliver care. Staff kept a record of the care and support provided to people. They told us they received training which enabled them to provide care in line with best practice. Staff responsible for training told us they were further developing elements of staff training.

Overall, the provider had systems in place to help staff to deliver care to people in line with legislation and good practice standards. Assessments and care plans supported staff to deliver care in line with their preferences. They had access to information via an app, which could be updated if the person’s needs changed. The provider was now focusing on ensuring all staff supervisions and annual refresher training had been completed to ensure staff were up to date with best practice guidance when supporting people. Training was being further reviewed and developed.

Feedback varied about the way the staff team worked together, this related to the staff changes and the timings of care calls. However, feedback suggested the new manager was making progress and taking action to address some of the previous concerns raised. Comments included, “They come later or don’t have any staff” and “There are more positives than negatives. The carers are really good.”

Managers told us that assessments received from commissioners had improved which helped them to undertake a more effective assessment and develop care plan for people. They told us they worked closely with people's GP's and other health professionals. Managers were focusing more closely on monitoring and responding to any alerts or issues highlighted through the electronic systems.

The local authority informed us they had been monitoring and supporting the service in recent months, they had seen improvements in the service being offered and a reduction in the number of complaints and other issues.

The provider had taken action to improve how the service worked together and with others to support people. The provider was focused on reviewing people’s care schedules and staffing to ensure these met people’s preferences more effectively. Certain tasks were now undertaken centrally such as recruitment and scheduling. Staff had access to a pool car.

People were supported to manage their health and wellbeing. Where necessary staff liaised with healthcare staff and other professionals to support people’s well- being.

Staff told us they reported any concerns about people’s health needs to the relevant people, such as district nurses. Care plans included information about supporting people’s health needs. Staff gave us examples of where they had worked with occupational therapists and physiotherapists to support people’s mobility needs. Any concerns about medication administration were referred to the GP or pharmacy.

Systems were in place to help staff to support people to keep well. Their health needs were included within their assessments and care plans. These included information about how to support people with any risks related to their health. The service kept records of the care and support provided and when health professionals had been contacted or advice given.

Some people were unclear as to whether the provider undertook routine reviews of their care. Comments included, “I don’t think we have a care plan but there’s a book. I don’t know who would do a review” and “I’ve had the provider come out with staff but not had a review of discussion about the care plan.” However, other feedback indicated people felt able to raise any issues and that staff monitored their support. They said, “They listen to me and take my words on; they try their very best and I have seen improvements” and “They are constantly reviewing things.”

Staff monitored and recorded information about people care needs and the care they provided. They told us they would raise or report any concerns should they need to. Staff gave us examples where they had identified issues and shared them with managers for further review. A staff member said, “You can raise a concern about a person through the app.”

The provider had made improvements to ensure systems in place to monitor outcomes for people were fully embedded. Care plans were reviewed and amended if people’s needs changed. There was a system in place to monitor when reviews had been carried out. Calls to people to seek feedback were undertaken on a monthly basis. Annual surveys were also undertaken.

Overall, people told us staff respected their rights and sought consent to provide care. They said, “Yes, I’m able to tell them what I need”; “They don’t do anything they’re not supposed to do, they are friendly” and “They’re respectful and kind.”

Staff were aware of the importance of seeking consent to provide care and respecting people’s wishes. They told us, “The first thing you do, you have to gain consent” and “Every day I will introduce myself. Will explain what I'm going to do. Ask their permission for any personal care, as they have a right to refuse”. Staff recorded where people's relatives held Lasting Power of Attorney and ensured these were registered if in use. The registered manager understood their duty to protect people’s rights and obtain consent where possible.

Processes were in place to ensure people's rights and wishes were respected. The provider had introduced a consent to care form which staff discussed with the person, during the assessment stage, prior to any care being provided. of the assessment process. Within the assessment process, staff considered if there were any potential restrictions in place and if so whether the person was able to consent to these. There were capacity assessments available for use, if staff had concerns about a person's capacity to make a decision. Staff undertook training and completed a workbook in relation to The Mental Capacity Act 2005. In one case, there was some contradictory information, as a person's assessment stated they did not have capacity to decide on their health and wellbeing, but they had signed a consent form. The registered manager reviewed this and confirmed this had been an administrative error. They also completed a capacity assessment to clarify and amended the records accordingly.