City Home Care Limited

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• 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 found the provider did not always follow the Mental Capacity Act (2005) in terms of assessing people’s capacity to make specific decisions and obtaining consent for the care they received. This was a breach of consent to care. People's needs were assessed. They were able to express their choices and be involved in planning and reviewing care. We did not assess all the quality statements within this key question, as we did not identify concerns in the areas we judged as being met at our last inspection.

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 using the service and their relatives told us they had been involved in the assessments of their needs and care planning. Their comments included, “My relative was assessed at home and I was there along with a couple of other relatives” and “Yes, they did come out to assess my relative’s care and the office do check occasionally with a phone call that everything is okay.”

Staff indicated they were able to meet people’s needs. Staff knew people well and gave us examples of how they supported people in a person-centred manner. For example, when providing personal care, one staff member told us, “I respect the wishes of the service users by giving them choices and supporting their needs. I always ask for their permission before doing anything and provide them with the space to have privacy. This ensures they feel valued and respected.”

There were processes for the provider to assess people's needs and choices. People’s needs were assessed prior to moving to the service to help ensure the provider could meet the person’s needs. Ongoing reviews of risk assessments and care plans were undertaken so staff had relevant information on how to meet people’s needs. However, there were not always appropriate risk assessments in place to provide sufficient guidance on how to keep people safe.

Overall people and their relatives indicated people’s needs were met including their nutritional and hydration needs.

Staff told us they had undertaken training to understand about best practice. This included training about dementia, safeguarding and whistle blowing. They explained how this had supported good practice in their roles. One staff member told us, '', this very useful as it enhanced my understanding of domiciliary care.” The registered manager told us they worked well with other health and social care professions to maintain people’s health.

The provider had systems in place to ensure people’s care plans included information about people’s health needs, likes and dislikes and how people would like to receive their care. People and their relatives were invited to care reviews.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

People had support to access healthcare services as required. People using the service and their relatives told us staff liaised with others and helped to keep them healthy. For example. one person told us, “They always try to do the best and they do help me with my health condition for example today my physiotherapist is coming to show them some exercises that they can do with me.”

Staff monitored people's healthcare needs. They reported any concerns and the provider made sure people received the appropriate help.

Care plans recorded information about people’s healthcare needs and staff made referrals to professionals according to people’s needs.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People using the service and their relatives told us people were given choices and consented to their care. One relative said, “They know what [person’s] preferences are and seem to give them time.”

Managers and staff confirmed they had undertaken Mental Capacity Act 2005 (MCA) and staff understood that consent was required for individual tasks and needed to be obtained each time care was delivered. Staff comments included, “I respect the wishes of the service users by giving them choices and supporting their needs. I always ask for their permission before doing anything and provide them with the space to have privacy. This ensures they feel valued and respected” and “I always try to ensure clients are happy, by giving them a choice of what they want to eat and by making sure I can support them. As well as giving them privacy when wanted.”

The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. We found the service was not always working within the principles of the MCA. We identified one person had a mental health risk assessment but not a mental capacity assessment regarding decision making and two other people had mental capacity assessments completed but these were not decision specific. Another person’s records was contradictory stating in one place they did not have the mental capacity to make decisions about their care and in another that they did. We raised this with the registered manager so they could make appropriate changes to how they completed mental capacity assessments. However, as it was not always clear people had consent to their care in accordance with the MCA, the provider was in breach of the regulation for consent.