Right at Home Chippenham

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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 reviewed 6 quality statements in this key question.

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 prior to any service being agreed. People and relatives told us they were involved in assessments. One person told us, “Right at Home did all the paperwork and risk assessments in my home. They came out and talked to us, and my [relatives] were involved.”

The registered manager told us assessments were completed so they could assess people’s needs and determine if a care package could be provided safely. The registered manager told us, “We do a full assessment, medical history, outcomes people want to achieve and answer any questions they may have. We go through terms and conditions and have a consent to care document people sign for us to provide care. We talk to them about preferred timings, what they want us to do. We also have a 1-page profile document which records what people think is important for us to know about them.”

The provider had an electronic care planning system with templates available for staff to follow when assessing people’s needs. This made sure all areas of needs were assessed and recorded. Management teams reviewed all care records on a regular basis, making sure any changes of people’s needs were recorded. The provider had systems to make sure people’s care was reviewed after the initial 2 weeks and then again at 6 weeks. This helped to make sure the care plan was right for the person.

People and relatives told us they were involved in their assessments and care planning. If people needed any help and support for nutrition and hydration, staff were able to provide this. People’s nutritional needs were recorded in their care plans.

The registered manager told us they were provided with regular communication from their national office to update them with any changes to legislation or policy. The registered manager had also signed up for bulletins and newsletters from industry professionals to hear about national updates and changes.

People’s nutritional needs were assessed before they started with the service. Any support needed to eat and drink was recorded in people’s care plans. Staff received training on food hygiene so they could support people with light meal preparation. The registered manager told us they tried to make sure whoever did the initial assessment completed the first visit to people. This enabled them to check the care plan was providing staff with the correct guidance. Staff recorded what they did on their visits in people’s care notes. Records seen demonstrated staff were providing the care and support recorded in people’s care plans.

People had care and support that met their needs. Staff worked closely with healthcare professionals and worked well as a team.

The registered manager and staff told us there was good team working at the service. This included office teams working well together and with care workers out on visits. Staff told us there was good communication amongst the steam and they effectively used a confidential electronic app to share information. Comments from the staff included, “There is definitely good teamwork and communication is good. We get together at team meetings” and “Yes, it is a good team. There is an open office, I love that [registered manager] is with us, in the office for support.”

Professionals we contacted did not share any concerns about this quality statement.

Staff had a regular newsletter from the office team and were provided with monthly team meetings. This made sure staff were kept up to date with any changes to people’s needs. Staff used an electronic communication application on their phones to communicate with each other.

People were encouraged to manage their health needs where possible with support from staff. One person told us, “They [staff] understand what I’m normally like and tell me if they are worried about me.” The person went on to share with us an experience of the staff contacting the GP for them regarding a health issue. One relative told us, “The staff understand [persons] dementia very well and other health issues.”

Staff told us if people needed to see healthcare professionals, referrals were usually made by office staff. The registered manager told us, “We ask for updates from community nurses and check how often they are visiting people. Community nurses are also pretty good at contacting us when needed. We talk with staff about early warning signs and any concerns or changes in behaviour, any appearance of being unwell, then staff report to us.”

We found people’s care records demonstrated staff were involving healthcare professionals where needed. Referrals were made in a timely way and people were provided with support where needed to attend appointments. There was guidance in people’s care plans for health-related conditions. For example, staff had access to links for signs of a stroke and what action to take in response.

People and relatives told us people had the support they needed from staff to monitor any health conditions.

Staff gave us examples of monitoring they were carrying out for people. Staff told us if people were at risk of being malnourished or dehydrated, they would record their food and fluid intake. Staff told us if people were at risk of pressure damage, staff would record any repositioning and condition of people’s skin.

Staff had access to timely information they needed using the providers electronic systems. This enabled staff to check what monitoring had been completed and when they needed to take action. The registered manager told us they often started packages of care for people needing rehabilitation following a stay in hospital. For example, staff supported people to complete exercises recommended by physiotherapists and improve their mobility. People’s outcomes were regularly monitored, and updates shared with physiotherapists. The registered manager shared success stories of how they had supported people to regain independence and no longer be reliant on care from staff.

People and relatives did not share any concerns about this quality statement. People were asked to sign a consent to care document prior to any care package being started.

The registered manager told us this quality statement had been a focus for them since our last inspection as staff had told us they had not received training. The registered manager told us staff had been provided with training on the Mental Capacity Act 2005 (MCA) and it had been discussed in staff supervisions and meetings. Staff we spoke with understood the principles of the MCA and could tell us how it applied to their day-to-day work. One member of staff told us, “There are 5 principles of the MCA, not restricting people, letting people make their own choices, always assuming person has capacity, letting them make unwise choices. If they lack capacity always working in their best interest. This is a big part of my job.”

People’s care plans demonstrated people had consented to their support plans and care delivery. Where people lacked capacity, an assessment had taken place and decisions made in people’s best interest. We found staff had involved others in people’s assessments where appropriate. For example, GPs, family members and dementia specialists had been involved in decision making for people who lacked capacity.