Care at Home Group Cheshire East and West

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 the effective key question, identifying both areas of good practice and concern. The overall rating for this key question is good. Feedback from people and staff regarding the scheduling of calls and staff consistency was varied. While some noted recent improvements in working within smaller areas, many expressed concerns about rostering inconsistencies and the challenges of managing travel across large geographical areas to attend calls. People and relatives described staff as kind and respectful of their choices. Care needs were assessed before care commenced; however, many people reported that their care plans were not reviewed regularly, nor were they asked for feedback. Staff also shared experiences of being unaware of changes to care plans until informed by the person during the call.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us their care needs were assessed prior to care calls starting. We were told, “[Staff] did come and do the initial assessment and she was able to do all that was needed in the 30 minute care call”.

The manager confirmed people were assessed prior to care calls beginning. Staff told us they accessed information about people’s care needs on the provider’s electronic care planning system. When changes occurred to people’s care, staff would update the office following conversations with people over those changes.

The provider had a system in place to assess people’s needs and confirmed the care and support they needed. Where relevant, the provider used information from people's local authority assessments to devise their care plans. Managers usually visited the person and where appropriate their relatives, to discuss the care arrangements and their wishes prior to the care commencing.

Peoples care was not always effectively planned or delivered. Overall people expressed concerns over the co-ordination of their care calls. This included feedback over missed and late calls with no update when care staff would be late, or not attending. Comments included, “[Person] pays for his calls and so it feels like a waste of money,” “My relative is supposed to be getting an early morning call, sometimes they would be getting to me midday and then even in the afternoon” and, “A couple of times they've missed a call altogether.” However, another person told us, “They will let me know if there is a delay. They're good at keeping in touch.”

Staff told us scheduling of calls and times were disorganised and planning of rosters were not always effective. We received feedback of some recent improvements; however, this was not consistent to the overall view of staff feedback we received.

The manager had been focusing on improvements in relation people receiving their care calls when expected and in line with their preferences. The provider used an electronic schedule and logging system for care calls. There were some reports of recent improvements. Work had been undertaken by a central team to review rotas, to improve the continuity of staff for people. Systems had been amended to ensure where calls were time specific, and people had preferences, these were adhered to. This needed ongoing improvement. The provider told us they were monitoring and had been responding in a timelier way to any alerts from the system.

Overall people spoke approvingly of staff and care they received. However, some feedback suggested there was a lack of consistency and co-ordination between staff, the office and the scheduling of calls. We were told, “The times of the carers are not good,” adding, “The carers are alright, some are better and some care more than others, but [Person] doesn't get regular carers.” Another person told us, ”The timing of the visits can be all over the place, sometimes too late and sometimes they come to early.” However, we were also told, “I would say it has improved in recent weeks.” CAHG are much better than the last agency. They’ve not missed any calls.”

The manager was working with the local authority to make improvements across the service. Staff gave mixed views of effective working and discussed that further improvements were needed. We were told, “To be honest, they're trying to improve. I believe they can do better. [(Staff]) and [(Staff]) are trying to do this.”

A recent review of quality had been undertaken for the service by a local authority. At the time of the assessment the location was still working with the local authority to make further improvements and embed these into practice.

The provider had processes in place to ensure that relevant information was shared in line with confidentiality and data protection arrangements The provider and manager had been taking action to support the staff team to work together more effectively. This included ensuring staff understood process in place for sharing information and raising any issues or concerns.

People were supported to manage their health and well-being where required. A person told us, “District nurses come on a regular basis and they coordinate it to be here when the carers are also here.”

Staff described how they supported people with different aspects of their daily life. This included aspects of healthy living and lifestyle choices. Where necessary, care staff and the management team liaised with health professionals.

People’s medical needs and the support they required were identified through their needs assessment and care plan. The provider had identified that staff had not always shared issues through their systems to report potential health concerns or issues which may need to be shared elsewhere. Managers were addressing this to remind staff about appropriate reporting processes and record keeping.

Overall people and relatives told us they were unaware of any reviews the provider undertook of their care. Comments included, “No nobody has mentioned any review of [Person] care plan to me” and, “I haven't got a copy of a care plan, and I haven't had any care plan reviews or meetings.” However, we did receive some feedback where people described they felt able to raise issues with care staff and would call the office. We were told, “If I had a little problem, I'd phone the carers or speak to them directly” and, “Yes, they do come and review.”

Staff told us that people would discuss with them any changes of their care. Staff confirmed that they had attended calls unaware of changes of a person care until they have arrived to complete the care call. Following this, they had updated the office staff to make the necessary changes to the care plan. We were told, “All these things show up on the care plan, It's all on the app.”

Initial assessments were completed, and care plans were then devised. However, they had not always been reviewed in line with the provider's processes. There was a process to review people's care plans after 6 weeks and then at 12 months or before if needed. We saw from records that some of the reviews were overdue. The manager advised they were undertaking these and there would be a new process moving forward, for people new to the service. Managers had been focusing on ensuring more frequent calls were made to people to monitor the quality of the service. Surveys had also been carried out and some actions identified required as a result.

Overall people told us that staff were respectful in their care and treated them with dignity. We were told, ”They all respect [Person] dignity and the home” and, “They [Staff] chat to [Person] and explain what they are doing.”

Staff were aware of the Mental Capacity Act and the need for establishing consent. This included describing how they would gain people’s consent prior to providing care tasks.

Staff sought people's consent to their care provision, at the initial assessment stage. Care plans contained guidance for staff to seek consent. Processes were in place to identify any potential restrictions in place and templates available for staff to record any mental capacity assessments and best interest decisions if required. However, some records were contradictory and demonstrated a lack of clarity about a person’s capacity in some cases. For example, one person's medication was stored in a locked box, but their records were unclear if they had consented to this or if a decision had been made in their best interests.