A1 Quality Homecare Limited Eastbourne

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

People’s needs were robustly assessed before they started using the service, this allowed a detailed care plan to be written which centred around the person’s needs and wishes. Staff worked well with other agencies to ensure people were safe in their own homes. People were supported to live healthier lifestyles. For example, people were supported to get out for a walk when they wished. People told us that staff completed tasks that they wanted them to and asked for consent before undertaking these.

This service scored 75 (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 needs were assessed before they began using the service. This enabled a care plan to be developed which was appropriate to them and addressed their care needs. A person told us, “Yes, we had meetings beforehand, it was identified in hospital that I needed care and then was discharged, and someone came to do an assessment and they recorded all of this. It was very efficient.”

Staff carried out a thorough pre-assessment using a pre-assessment tool which covered all aspects of people’s support needs. Staff told us that on receipt of paperwork they arranged a home visit together with a family member or loved one and that assessments took up to 2 hours to complete. Care staff told us that they had regular people that they supported and that they got to know them well and so could detect any changes in their support needs quickly. A member of staff said, “Get to know people well, good bonding with next of kin so any concerns then become obvious.” Another added, “If someone degenerates we have a monitoring system, have emergency meetings. We get called in to the office sometimes.”

Care plans were described as ‘living documents’, being added to whenever there were changes in support needed. Risk assessments were completed in accordance with individual needs and were reviewed regularly. Following the initial review and assessment the paperwork was re-submitted to the local authority either accepting or declining the person, according to the training and skills currently possessed by staff. The registered manager told us that new training to cover new support needs, could be put in place within a week so as not to delay support unnecessarily. All support plans were signed by people and their families to confirm consent to the support being provided.

People and their relatives received a good standard of care in line with legislation. They were involved in shaping their care plan which encompassed measures to ensure good practice. For example, food and fluid charts were used to monitor nutrition and dehydration for people who needed this support.

Managers told us how the pre-assessment process covered specific nutrition and hydration needs for people. Care plans contained details for example of people’s likes, dislikes, allergies and personal preferences for when and how they enjoyed their meals. Some people required particular diets due to health needs for example, diabetes. We saw that additional information had recently been put into care plans relating to food and drink and people’s cultural differences. We spoke to staff about nutrition and hydration, one said, “In every care plan re allergies. Always have to look at support plan before giving food and then give options.”

Care plans had details of the calls to be completed by staff, their duration and exact times. As well as risk assessments there were notes in place relating to day to day activities and tasks relevant to people. For example, some people enjoyed and benefitted from simple daily exercises such as stretching. Each person’s plan was person centred and based on what was known about the person and any changes that were needed as time progressed.

People spoke positively about how staff work together, and alongside other service. Relatives also confirmed that staff worked with other services, such as adult social services, to ensure people received appropriate care. A relative told us, “We did attend a meeting prior to them starting, the social worker was there. They made other referrals too.”

The registered manager told us about information sharing protocols and processes with other professionals involve din people’s support. There were written protocols in place. Most information was passed through telephone calls or e-mails with records of each being placed on care plans as ‘professionals contact.’ The registered manager told us that outcomes from conversations with other professionals were discussed with people and any actions that were needed for example, employing an occupational therapist, were documented with written consent from people and their loved ones.

Staff worked effectively with partner agencies to ensure people’s needs were met. Professionals told us that staff communicated with them well and alerted them when people’s needs had changed or needed review. One professional told us, “Any conversations are informative, and they have a really good overview of the people they support.” Another added, “They always respond very quickly, really good communication.”

The registered manager was a member of local and country wide managers forums to share best practice. Any positive practice or procedures that were highlighted were shared with other partners as appropriate. Care plans showed pathways that had been followed for example, an assessment for a hoist to be introduced. The plan showed the initial reasons, the actions of the occupational therapist, the professionals responsible for safety checks and then any ongoing safety reviews.

People were supported to live healthier lives and encouraged to access health services should they need them. Staff had worked alongside people to promote healthier living. For example, a carer had supported someone to prepare healthier meals which they enjoyed. Other people had been supported to do more exercise which had a positive impact on their lives. A person told us, “They escort me for short walks which is lovely, that started a few months ago. It’s good for me to get out.”

Staff told us they encouraged people to lead as healthy a life as possible. They supported them with healthy diets and with maintaining movement through being as independent as possible. This was achieved without compromising people’s safety. Staff told us that family members would usually make appointments for their loved ones for example, GP, dentist and chiropodists. However, for people living alone who needed extra support to make and keep health and social appointments, staff stepped in to help.

Risk assessments were in place to support staff in a crisis but also to help them support people in their daily lives, according to their specific needs. For example, some people lived with a PEG feed. These were mostly managed by relatives but guidance was included for staff to ensure the correct dietary needs were met. Some people lived with epilepsy and fact sheets were included in care plans showing how best to support people in the event of a fit, who to call in and emergency and levels of support expected from family members. These measures were in place to support people in living healthier lives.

People were given the opportunity to give feedback. Some people told us they had not had a review however they added that there was no need for this as nothing had changed in their needs. People were confident in giving feedback either via staff or the office. A person told us, “A few weeks ago, I had a chat to give feedback, which was all positive.” Another added, “They send out questionnaires and they do ask is everything alright”.

A member of the management team told us they were responsible for co-ordinating and scheduling spot checks. Most staff members received a spot check each week. This allowed managers to make sure people were in receipt of the best care and that staff were adhering to best practice. The registered manager told us that if there were apparent shortfalls with staff practice then further training would be immediately scheduled.

The registered manager carried out their own mock CQC inspections based on our 5 key questions. Records were kept of these mock inspections which indicated areas for improvement. An action plan had been drawn up to address any issues found. Separate to this the registered manager carried out periodic quality monitoring processes. This looked closely at processes and procedures to make sure they were fit for purpose. Recent improvements made included extending the staff induction period to allow for more training to be delivered and a more efficient process being introduced to manage to re-ordering of people’s medicines.

People’s consent was sought, and any support needs people had around this were documented in their care plans. People spoke positively about staff regularly seeking their consent before undertaking tasks within their homes. A relative told us, “Staff are very polite and kind. They always ask [person] if he is alright, or if there is anything else he needs. They make sure he is fine”.

Staff were aware of the importance of consent. Some people needed support with decision making and staff told us of how they approached people who needed this support. A member of staff said, “One client always says no to a wash. I do other things, sit them up in their chair and then suggest a wash. Most times they then agree.” Another added, “Conversations, talk, make them feel comfortable. If a no, always repeat back.” Some staff used ways of making people feel comfortable by singing or dancing. Another told us, “A person always refused personal care. I discovered there was something they liked and I found this design on flannels and towels. When I introduced these they were then happy to consent to a wash.” Staff provided choices to people to heil them with decisions. A staff member told us, “Choices are always given to everyone, we give the possibility of choice. We ask what they want to eat and show choices, also with clothes.” A senior staff member told us that people’s capacity formed an important part of the initial assessment process and that loved ones were always present during those conversations. Staff had been trained in the application of the mental capacity act.

Each care plan had had a page covering people’s mental health. This included the levels of support provided by family and loved ones and details of best interest meetings held to support people who needed help with some decisions. The minutes from these meetings were attached and clearly showed that the person, their family, staff from the service and other relevant professionals were present. Decision specific mental capacity assessments were in place where needed. Details of relatives holding power of attorney were included and respect forms, giving details where known, of advanced decisions made about future care needs, were included.