Care at Home (Midlands) Ltd

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

This service scored 62 (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. However, we identified the frequency of reviews increased the risk of people receiving ineffective care. For example, the first review after commencement of a person’s care package was 6 months, followed by an annual review. The management team agreed an earlier review was required to provide people an opportunity to feedback earlier on how the care was going and discuss any changes that were required.

People’s care plans that provided staff with guidance about their care and support needs was inconsistent in the level of personalised information, to assist staff in providing person centred care. Whilst some care plans provided details of people’s routines, and preferences in relation to care, others provided less details. For example, oral care support was not always recorded, information about a person’s personal presentation wishes, such as choice of clothing and footwear was often not recorded. It is important guidance for staff is sufficiently detailed and person centred, especially if unfamiliar staff were required to support the person.

People told us they were involved in discussions and decisions about how their care needs were met. Comments included, “It was really important to us, how we felt included in [relations] care plan and we were relieved that this inclusion was encouraged by Care at Home.”

Staff told us how they reviewed people’s care plans before providing care for any updates / changes. Staff felt they had sufficient guidance and told us how by spending time with people, they got to know what was important to them, including routines and preferences.

The provider planned and delivered people’s care and support with them, however the level of information about what was important and mattered to them was inconsistent. We discussed this with the management team who agreed to make improvements to care records to ensure these were sufficiently detailed.

The provider used recognised assessment tools in line with legislation and current evidence-based good practice and standards. The provider worked well with external stakeholders. We were told of examples when occupational therapists and social workers had worked with the provider for a person, and because of the collaboration, this had resulted in a positive outcome.

Feedback from people overall told us they felt staff understood their individual care needs, routines and what was important.

Where support with eating and drinking was required, care plans and risk assessments were in place in relation to needs and risks. This included recommendations from external professionals for example in the management of choke risks. Care plans provided guidance to staff about checking food use by dates before providing food and drinks and offering choices.

An external professional told us how well the provider delivered good care and support and reached out for additional assessment, support and guidance when required. Comments included, “The team are happy to ask for advice and collaborate with outside agencies for guidance and support to promote a seamless service for people and their families.”

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 told us they felt well supported by the management team, including the out of office hours support. Staff also told us how they worked in teams across different geographical areas and how support, communication and teamwork worked well. Comments included, “We have internal communication procedures, overall it all works well, the only negative would be it would be helpful if we send a message for a member of the management team that it’s confirmed it’s been received and passed on to the relevant person.”

In discussion with the management team, examples were given of how they worked with external professionals to support people to achieve positive outcomes. This includes requesting reassessments when people’s needs changed.

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 had guidance about people’s health conditions, this provided staff with useful information, including staff’s responsibility to monitor and report any changes to a person’s health. However, guidance was not personalised to advise staff of how the person’s health condition specifically impacted them. This was discussed with the management team who agreed to follow this up.

People and their relatives were satisfied with the support they received from staff in relation to their health needs. Peoples care records confirmed what action staff had taken when a person's health needs changed. People also told us how staff monitored their health conditions and how they alerted others, such as relatives or external professionals of any changes or concerns. A person said, “I had a bad spell last year, the two carers looked after me very well. The evening one got the paramedics out.” A relative said, “We had a period when [relation] was not well, they [staff] were very quick to make sure I was alerted.”

Staff gave examples of people’s long term health conditions such as diabetes and catheter care, and what they needed to be aware of to effectively care for the person and when to report concerns.

The provider had systems and processes that monitored people’s care and support. This included a review of people’s care records to ensure staff were meeting people’s assessed needs as expected. These reviews showed where shortfalls had been identified, this was followed up with staff to ensure improvements were made.

The provider sought people’s experience of the service to ensure the outcomes of their care were positive and their expectations were being met. This was via an annual satisfaction survey, a 6 month telephone review and an annual face to face review meeting. However, we were not fully assured due to the frequency of these monitoring procedures that they were sufficiently effective. We discussed this with the provider who implemented a 2 week review following the commencement of a care package.

We received mixed feedback about people’s experience of the provider seeking their views of the service they received. Whilst some people could recall being involved initially in their assessment and having had a review and a quality assurance questionnaire, others could not. At least 6 people who had all used the service for at least 12 months could not recall having been asked to provide feedback about the service they received. We discussed this with the provider who followed this up with people.

Staff were confident people received consistent care and told us how they monitored and took actions to improve people’s outcomes. An example was given how a person’s mobility needs changed, and a referral was made to an occupational therapist for an assessment which resulted in a new mobility equipment being provided.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. For example, staff completed daily care records that confirmed what care and support they had provided. We reviewed a person’s daily records that showed how staff were managing the person’s money by giving them a daily allowance. The management team told us the person had mental capacity and had consented to this. However, the person’s daily care records showed that they were not always satisfied with this arrangement. We asked the management team for care records to confirm when and how this arrangement had been agreed and how was it reviewed. The management team were unable to provide this. Comments included, “This arrangement has been in place for years, it’s how it is, the social worker knows.”

People and their relatives felt their needs and wishes were taken into account when their care was planned and delivered. They spoke about their involvement in the initial assessment of their needs before their care started. Staff had received training in the MCA and DoLS and had access to the provider’s policies. Staff demonstrated an understanding of the principles of the MCA. Comments included, “If someone did refuse care, I would try talk to the client and try to find out why they were refusing care. Consent is a must if I don't have consent, I cannot complete tasks such as personal care."