Princess Homecare

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 reviewed 6 quality statements in this key question and identified one breach of the legal regulations. Not all support was based on current evidence-based good practice and standards. Practices were being undertaken without the person’s consent or appropriate systems being followed. People and relatives were complimentary about the staff. They were aware of individual needs and preferences, and enabled people to fulfil their main aim of living in their own home.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us they had used the service for many years, so staff knew exactly what they needed. They said they could always ask if they wanted anything changed and their care plan would be reviewed accordingly.

Leaders told us they would complete an assessment if a new care package was referred to them. We were told they regularly reviewed people’s care and their risk assessments to ensure all remained current. Leaders told us all staff would recognise any changes in a person’s health and report back to them. Staff confirmed this, but told us on reflecting on past events, gaining professional help could have been timelier. They said this would have made a difference to the person’s wellbeing, but we did not see any evidence of this.

Due to people being supported by the service for many years, leaders stored all initial assessments securely. Each person had a care plan, which showed an assessment of their needs. However, the information varied in detail and did not reflect the complexity of need. This meant there was a risk any staff member not so familiar with the person, would not be fully aware of their needs.

People and their relatives were complimentary about the staff and the support provided. They said staff knew their preferences and how they liked their care to be delivered.

There was conflicting feedback from leaders and staff about evidenced based care. Leaders told us they promoted people’s wellbeing and minimised urinary tract infections and constipation through good nutrition and hydration. This included encouraging lots of vegetables and a daily fluid intake over 1000mls. However, staff told us they believed some practice had been directed by leaders and established over time, rather than based on current guidance.

Processes did not demonstrate current evidence-based good practice. This meant people could not be assured they were receiving safe care. Examples of this included the support people received with decision-making, weight management, skin integrity and communication. Leaders told us they attended a provider’s forum to keep their knowledge up to date.

People and their relatives told us the staff worked well together and all knew their needs and what support they required. They said staff would involve other services such as the GP if needed.

Leaders told us staff were always kept informed of any changes to a person’s support. They said staff had an App on their phone for any messages or work-related information they needed to know, and there were regular handovers. Staff told us they communicated well with each other and gained information from relatives and professionals as needed. They said this was particularly important when supporting a person living with dementia.

Partners told us they did not have regular contact with the service. One healthcare professional told us they generally communicated with staff when needing to arrange an appointment with a person. Another professional said they found the provider’s lack of formal systems difficult, so chose not to use the service.

Each person had a care plan, which staff had access to. There were also records of any involved health and social care professionals, and medicine administration records. Other communication systems such as app on staff’s phones, team meetings and handovers were utilised to exchange information.

People and their relatives told us staff would identify if they were not well and would take appropriate action. They said staff helped with meal preparation as this was difficult for them to do. They said they were happy with this provision and had no concerns.

Leaders told us helping people to lead healthier lives was important to them. They said nutrition and diet were essential to maintain health and wellbeing so promoted this with people. Leaders told us people were regularly weighed to ensure their weight was maintained. However, staff told us they agreed healthier lives should be promoted but found the conflict between people’s choice and leader’s expectations of meal provision, difficult to manage.

Processes for supporting people to live healthier lives were not effective. For example, those practices described by leaders and staff were not documented in people’s care plans. This meant consistency could not be assured. The provider’s website demonstrated they could offer dietary advice and support, including tailored nutrition to each individual. However, support with nutrition to maintain healthier lives was not identified in people’s care plans. This meant there was a risk the plan would not be followed, which would jeopardise the outcome for the person.

People and their relatives told us the service enabled them to stay in their own homes, which was their main aim and preference.

Leaders told us they had supported the same people for many years. They said this had enabled people to continue living in their own homes, where they wanted to be. Leaders told us they would take a person shopping, to church or whatever they wanted to do. It was their choice, and they were there for them. Staff told us supporting the same person each time enabled them to give excellent care, based on people’s own choices and individual needs.

Processes were basic and not always effective. For example, each person had a well-being checklist, but the information was limited and not detailed. The checklist did not identify follow up action or monitoring. This did not give a clear portrayal of the person or ensure effective monitoring. There were systems to gain people’s feedback about the service, but these were not consistently used. This did not enable ongoing development and improvement of the service, based on people’s views.

People and their relatives told us they were consulted about their care and involved in developing and reviewing their care plan.

Leaders told us of a practice they had undertaken, without the knowledge or agreement of the person. This was considered to be covert, and not acceptable without the appropriate decision-making processes being followed. They also described weighing a person regularly with equipment they had purchased from the internet without written consent to do so. This was not safe or lawful practice. Staff told us they offered people as much choice as possible during their support. This included when they wanted care interventions undertaken and in what order.

Assessments were poor and not always completed. For example, decisions made in relation to monitoring a person’s weight, a specialised diet, and the use of equipment had not been formally assessed in line with the Mental Capacity Act. This did not ensure decisions were appropriate, the least restrictive and in the person’s best interests. However, capacity assessments had been completed in relation to receiving care and support and sharing of information.