Clarissa's Home Healthcare Services LTD

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

Leaders told us they provided people and families with information such as telephone numbers for the service, doctor, safeguarding and ambulance service, if they needed extra care and care plans were in the homes. The records did not always provide clear information on how people were to be supported with their communication needs or how support was to be provided if people were unable to communicate discomfort. The service reviewed with people their future planning in relation to end of life wishes and this was documented on the care plans. A review of the records identified conflicting information with regards to ‘Do not attempt cardiopulmonary resuscitation form’ (DNACPR). However, a review of the care notes showed people were involved with their care and support. Care plans made reference to people having access to equipment at home to support their well-being and independence. People commented positively about the carers.

This service scored 71 (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 they had a care plan. Relatives told us, “A care plan was made. I was there when they [agency] came out and [person] signed it herself. They asked what [person] needed. [Person’s] had something like a review with the manager who has sorted it out.” Relatives also told us care plans were made and, “The care plan is in the folder” along with, “The manager and carer came to assess and it was all written down.”

Staff told us they provide person-centred care, putting the clients first and having “honest and open communication.” Staff told us they involve people in the decisions “about current and future care and support” as well as asking them how they are feeling to ensure people are receiving the care they want. Additionally, staff told us about developing partnerships with people with their care and support needs and people receiving care “have the right to voice their opinions and make informed decisions regarding their treatment and support.” Leaders told us they involved people, families, professionals and reviewed what needed to be assessed. Leaders told us they gave people choices, asked them what they liked, involved people and families in the decision making, gave them reassurances and made sure they were comfortable.

People commented positively about the carers. People told us, “[Carer] is really good, [carer] knows what [carer] is doing and [carer] does everything [carer] should do” and “I did have loads of different ones which wasn’t too good but now I have [carer] and [carer] is good.” People also told us, “as a whole the care provided is amazing, the carers ensure our [person] is happy, safe and well.” Relatives commented on the flexibility of the carers consistency of care and joined up working. Relatives told us, “The carers are flexible if needed” and “The carers do attend to [person] physical and emotional needs and are flexible to [person] needs on visits” Relatives also told us, ““They keep [person] safe and most important they keep [person] at home where [person] wants to be.” Additionally, relatives told us, “Continuity of carers which [person] is very appreciative of.” Whilst relatives told us, “Lack of continuity with changes of carers every few days is unsettling”, we were also told “They have been able to provide continuity with a carer, so [person] can build a relationship and trust.”

Staff told us they communicated with people and families to understand more about people and what they liked and disliked. Staff told us they looked at the care plan so they knew what people wanted and the management met with staff “to give information necessary for the client's care.“ Staff told us they worked with professionals such as doctors, nurses and social workers and “professionals are sometimes involved to ensure the best possible outcome for the individual.” Leaders told us they referred to different professionals depending on peoples’ needs and also obtained information on support groups. Leaders told us they supported people with activities, looked at different activities and they asked people if they wanted to be involved.

Partners told us the service was responsive in resolving issues when concerns were raised and whilst it took time for the service to engage in processes to support a person, this was resolved.

The service had a service user guide which outlined their responsibilities in working with professionals. The service worked with professionals to support with people and queries raised.

Relatives told us, “They have a medicines record so that the next carer visit knows what time the medicines were given. I can see the record” and “The carers were fine with us and shared information between them. [Person] records were kept well and shared with other agencies.” Relatives told us the carers worked well together, records of visits are kept and they are kept updated with people’s health needs. Relatives also told us, “I asked for a book and a daily log – I need that to keep up to date with what is happening. They didn’t do it at first but do now, before it was all on their phones and I couldn’t see it”

Staff told us they would write things down, used signs, drawings or showed people the item (eg) choosing between tea and coffee. Staff commented they would ensure hearing aids were fully charged and checked there were enough batteries. Staff told us “The individual communication needs of the clients are known and understood and the information is shared in an accessible format and a way that is understood by them” and it was important to check people had understood the information by “asking questions and evaluating their responses.” Leaders told us they used picture cards, visual cards and also, “Sometimes hearing aids are not worn, so we tend to write what we want to say. We use pen and paper and write it all and then they answer or write back.” Leaders told us they learned how people can understand and when pre-assessments were actioned they discussed with people and families any communication needs. If communication needs were identified such as a sight impairment, leaders told us they offered people large print format, easy read format and specific picture cards were used for morning, lunch and medication. However, a review of the records identified the records did not always provide clear information on how people were to be supported.

The provider had an Accessible Information Standard (AIS) Policy and Procedure. The service user guide refers to making information accessible for people. However, the care records did not always provide clear information in line with their policy on how people were to be supported with their communication needs or how support was to be provided if people were unable to communicate discomfort.

People told us communication should be better but they also told us, “I’ve had 2 feedback forms over time” and “The manager phoned the other day to ask if everything was ok.” Some people had regular carers but had to contact the service to achieve this. People told us they contacted the service to resolve issues timings and lengths of visits. Relatives told us, “[Person] decides what she wants and is happy enough with her care. The carers listen to her if things change and they are OK with that” and “The carers understand how to involve [person], she knows and trusts them.” Relatives felt they were listened to and could access the manager without difficulty and told us, “[Person] is listened to and I’m sure if [person] says that [person] doesn’t want to do something then they won’t force [person] too.”

Staff told us people are provided with feedback forms and people are listened to with regards to their “personal stories, needs, preferences and ideas and act on them.” Staff told us people’s opinions are asked for and problems or areas needing improvement were identified. Staff told us contact details are provided to people should they wish to speak with the management and people were involved in the care planning. Leaders told us they regularly ask people for feedback and action people surveys. Leaders told us they involve the people, ask how they are, if there are any concerns, how the situation could be improved and report to the managers who work with the social workers. Leaders told us they acted on feedback received such as the carers not arriving on time and how food was prepared. Leaders told us they “ask the client, what do you want” and leaders tell the carers to “get to know the client.” Leaders told us they call people and families and ask them directly how the care is and “Act on what they say straight away and have a discussion.”

The service had a quality and quality assurance policy and procedure. The service had completed a recent audit in response to feedback received from people and families which included the feedback received, subsequent actions and letters of apologies sent to people.

People told us about not wanting to have male carers and having different carers. However, people also told us this was resolved. Relatives told us, “[person} care is consistent” and the carers encouraged people to make a cup of tea, part dress, eat and drink independently or watch the TV and read. Relatives commented the carers supported taking people for small walks, with support and if safe and possible. Relatives told us, “Yes, we are listened to especially by the carers,” “we have no complaints or concerns” and if they thought something was wrong, they would contact the manager. Relatives also told us, “At the moment the service is meeting [person] needs very well” and “I feel heard. The care is going well and it’s doing what I can’t do.”

Staff told us they accompanied people to appointments such as the GP and they always try to be on time at people’s premises in order to “provide care for them when they want it.” Staff also told us the care plans gave “all the information I need to understand and what is important to the client” and by involving other people who were a part of people’s lives brought together information and “will usually improve their care and support.” Leaders told us they take people to appointments, the hospital, the GP, action referrals for the chiropodist for people with diabetes. Leaders told us they provide people and families with information such as telephone numbers for the service, doctor, safeguarding and ambulance service, people can call if they need extra care and care plans are in the homes.

A partner told us the service was “responsive” and they “have a staffing structure to support the organisation.” Partners told us the service supported with a plan to ensure the person had food delivered on a regular basis and the care for the person had been consistent.

A review of the care notes showed people were involved with their care and support. Care plans made reference to people having access to equipment at home to support their well-being and independence.

Whilst people told us there had been missed calls, people also told us, “I phone the office and they send someone from the office but that hasn’t happened recently” and also told us the manager, “has come out to give care if they are very busy and he runs the carers round in the car too.” Some relatives said they had been contacted for feedback whilst some said they had not or were unsure. However, relatives told us, “If the District Nurse missed a visit to clean and treat [person] bedsores then the manager came and checked and would give me a call. He sorted things out” and “Both myself and the service monitor the care. Oh yes, they are happy to take my comments.”

Staff told us they reported on changes in people’s health and “We can assure them they do not have to deal with things alone.” Staff told us they supported people “by assisting them in obtaining the necessary treatment or care they require, without any hassle or difficulties” and “Listening to how they are feeling without making judgements and concentrating on their needs.” Staff told us they treated people with dignity, respect, kindness and they “work together with their loved ones.” Leaders told us they listen to people, ask them for their feedback, write it down and then pass this onto the relevant professionals. Leaders told us they involve the professionals to get the help people need such as a social worker, mental health professional, GP chiropodist, optician, dentist and a domiciliary dentist that can come in.

The care plans and pre-assessments showed the service sought information from people to support with the care delivery and if changes were identified, to be raised with the relevant professionals.

Although relatives told us discussions had not been held with the service about the future, relatives also told us the service were aware if a DNR(Do Not Resuscitate) form had been completed.

Staff told us they would tell their manager, work with their manager and “Talking with clients and families in an honest way.” Staff also said they provided “a listening ear” and they listened to people, families, experiences and concerns. Leaders told us when the care planning is actioned, they ask people what their plans are and they involve everyone. Leaders told us these were sensitive issues to discuss and they understood. Leaders told us they with work people, families, professionals and said “we are trying to make sure this client is not going to be neglected and is comfortable at all times.”

The service reviewed with people their future planning in relation to end of life wishes and this was documented on the care plans. However, a review of the records identified conflicting information with regards to ‘Do not attempt cardiopulmonary resuscitation form’ (DNACPR). We were not assured the service had effective oversight.