Flamelily Independent Living

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 service met people’s needs. At our last ratings inspection we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met. The service was in breach of the legal regulation in relation to person centred care. People did not always receive person-centred care according to their wishes. Communication needed to be more robust, for example how care is to be delivered and the time of calls. We were concerned that staff had not considered people’s mental capacity when planning their care. Complaints were not always responded to in a timely manner and people did not always feel listened too. People did not always feel they had a choice or preference in who delivered their care. The provider was meeting people’s communication needs. Staff told us how they treated people equally and without discrimination. People at end of their live were treated with dignity and their wishes were respected.

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.

People and their relatives did not always feel people were at the centre when their care was planned or delivered. For example, one relative came home unexpectedly to find staff putting their relative to bed earlier than planned whilst staff were also taking part in a personal call. One relative told us, “I think [person’s name] is safe in their care but sometimes there are issues with communication as they don’t understand, we have to double explain things.” Feedback from relatives also showed that people’s choices and preferences of who was to deliver their care were not always respected. For example, people who had requested no male care staff when being provided with personal care had at times been provided with male staff to provide care. One relative told us, “We were not offered a choice of female/male carers they asked if I would accept 2 male carers and I said ‘no’ but that has happened on 2 or 3 occasions.” Relatives raised concerns that care calls did not always last as long as they should. One relative described how their family members 30 minute call could at times last less than 10 minutes. Records confirmed that staff had not always stayed the full duration of each care visit. We were concerned that this increased the risk that people might be rushed, or tasks left uncompleted which could put people at risk of harm. The provider was aware of these concerns and had an action plan in place to address this.

Staff and management strived to provide person-centred care. A senior member of staff told us, “Absolutely provide person centred care, care plans and task plans are all individual to their needs and preferences.” Staff told us they have access to the care plans by an application on their phone and were kept updated of any changes. However, feedback from senior staff showed they did not always fully understand person centred care. For example, we received some information from a relative who were not happy with the care provided. This showed a mixed response from staff with some staff providing good person centred care and some other staff not being very person centred in the way they provided care. We were concerned that staff had not considered people’s mental capacity when planning their care and it was not always clear if relatives had been involved in supporting decision making where people were unable to make decisions independently. Records showed and leaders confirmed mental capacity assessments and best interest consultations were not always completed in sufficient detail. Following the inspection the provider told us they were working with professionals to ensure these records were completed. Records showed and leaders confirmed staff did not always stay the agreed time. The provider was working with staff to ensure improvements would be made to improve staff staying the duration of allocated care calls.

While some people felt they had at times too many different staff members. Other people were happy with the staff. They were mostly supported by the same staff that got to know them and were able to express their preferences for the staff they liked to support them. One relative told us, “Most weeks we have the same two carers and they are outstanding. They interact with [person’s name] and talk to him and make him comfortable and they always call me if they notice anything not right. They send me a rota on Thursday with the names and times for the carers from Monday to Sunday.”

The service 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 registered manager told us they organised staff to specific geographical areas which helped with continuity for people and for staff travelling. Most staff felt happy with their rotas and knew the people they looked after and their preferences well.

A professional told us the service was always responsive and that they took feedback on board.

Records showed people’s care provision was kept to regular staff where possible and that care plans were reviewed to ensure they were still meeting people’s needs.

People told us they had information in a format they could understand. One relative told us, “Our access to my relatives care plan and records meets our needs entirely.” People and their families told us about an IT application which people could use to access their care plan and review records. They were positive about the application and having access to care records.

People's communication needs were recorded and known by staff supporting them. Staff told us they were aware of people’s communication needs and that people’s care plans included this information. One staff member said, “The care plan says everything we do with him to communicate so it was easy to follow.”

Since 2016 all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard (AIS). The AIS tells organisations what they have to do to help ensure people with a disability or sensory loss, and in some circumstances, their carers, get information in a way they can understand it. It also says that people should get the support they need in relation to communication. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service made it easy for people and their relatives to share feedback and ideas, or raise complaints about their care, treatment and support. One relative told us, “I've never had to complain. I know that if I had any concern though, it would be dealt with quickly and appropriately.” However, not everyone felt listened to as they had not always been told what had changed as a result of raising their concerns.

Staff told us how they managed complaints and recorded these on a complaints log to identify any trends so they can make improvements to the service. One staff member told us, “I will have to let the office or supervisor know immediately. Mostly if I report to the office they will try and go and find out and give feedback to service user.’’ Recently the service had received an increase in concerns about the communication and staff’s knowledge about people’s care. The registered manager clarified after our inspection this was likely due to new people with new packages of care.

The provider had a complaint policy and process to manage any complaints. Records showed most people had been responded to in line with the provider’s policy and people were happy with the outcome. However, we heard from some people that they were not responded to and we found this to be the case. The registered manager told us they were now addressing complaints that had not been dealt with in line with their policy.

The service made sure that people could access the care, support and treatment they needed when they needed it. One relative told us, “The District nurse comes once a week to look after her feet after the carer was concerned and sent a photo through to the GP.” Another relative said, “The District Nurse comes once a week, and the carers are aware of issues and what to look out for.”

The manager was aware of support people needed to access services. This could be services such as GP’s or community nurses visiting people’s homes. Staff told us they have never come across any barriers in accessing care. One staff member told us, “Physiotherapist, GP as well as nurses and social workers. It is a joined up service and everything is done, and all make the effort which is good for the service user to meet their needs.”

Professionals did not share any concerns regarding this quality statement.

Records showed people accessed appropriate health professionals and the service made appropriate referrals when needed.

People and their relatives told us people had not faced any discrimination from staff or management at the service. For example, one relative told us, “There are absolutely no barriers or discrimination to my relative’s care at all. He is always treated fairly, and his rights protected.” One relative said, “They are very good. I didn’t want carers coming in but they have been a tremendous help.” As we reported on in this report some people did not always have choices in the staff member providing care for them in their own home.

Staff told us how they treated people equally and without discrimination. Staff told us they would report any concerns to management.

Records showed mandatory training was in place for equality and diversity for all staff and completed annually. Policies were in place to support this training.

People had been able to share their wishes and preferences for end-of-life care where appropriate. One relative told us, “My relative and our family have been very involved in making future or end of life plans and have had plenty of opportunity to do and record this.”

Staff we spoke with were comfortable providing end of life care as they had received training and had support from healthcare professionals. Staff told us they were supported by management for emotional support during and after providing end of life care.

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. Care plans included information about whether people had a 'Do not attempt cardiopulmonary resuscitation' (DNACPR) decision in place and where this was kept in each person’s home. This meant staff could inform medical professionals of people’s resuscitation wishes if a medical emergency was to occur.