Ree Enterprise UK Ltd

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

People’s needs and rights were supported. People’s care and treatment was effective due to their health, care, well-being, and communication needs being assessed with them. People’s care plans were kept up to date with any assessments completed in a timely manner. Staff were aware of people’s preferences and respected these in a person-centred way. People were aware of their rights around care and treatment. Staff have good knowledge of the mental capacity act, including capacity and consent. Staff were aware of how to support someone with fluctuating capacity.

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 were involved in planning their care. All the people we spoke with told us their needs were reviewed regularly. For example, a person we spoke with said, “The office checks on me regularly to check I am getting everything I need.” People told us they had access to their care records if they wished to see them, for example a relative told us there was a care file kept in their family member’s home which they could review and communicate with staff if needed.

Staff knew people’s needs well. Staff knew how to access care records and ensured they referred to healthcare professionals when needed. Staff told us they referred to specialists such as the dietitian and specialist nursing teams when people needed specialist support.

Care plans documented people’s risks and needs. An electronic care planning system was in place. This ensured care records could be updated in a timely manner when people’s needs changed. Care plans we reviewed during this assessment detailed people’s needs and wishes. Moving and handling, continence and personal hygiene care plans were in place to direct staff in how best to support people. A care plan for specialist areas such as how to support a person who required enteral feeding was in place and guided staff in how to support the person safely. Enteral feeding is a method of providing nutrition directly into the gastrointestinal tract and this may used when people are not able to consume their diet orally. National assessment tools were used to understand people’s needs and how best to support them. For example, Waterlow and MUST risk assessments were completed for all people.

People we spoke to were very happy with care and support they received. People told us staff recognised any changes to their health and acted where needed. A relative we spoke with said, “Staff notice changes with my [relative] and will tell me straightaway if I need to contact the Doctor.” People told us they had positive relationships with staff, and they felt confident staff supported them correctly and in line with their wishes.

Staff and managers understood how to implement and deliver evidence-based care. Staff understood the importance of best practice guidance and the impact poor practice had on people. Staff gave us several examples of implementing guidance into the support they provided. For example, a staff member we spoke to told us, “We make sure people are supported with everything to make sure their health gets better, like checking their skin and nutrition and hydration regularly.” The management team discussed people they supported who required specialist support with a catheter and a nephrostomy tube. They told us they implemented guidance from specialist teams to ensure people received the best possible care and support.

Processes in place meant people received evidence-based care and treatment. Training and detailed care plans allowed managers, staff and the provider to monitor people’s needs and outcomes. Monthly reviews meant any emerging risks were highlighted in a timely manner. A monthly analysis of themes and trends were completed. This meant any emerging risks were identified in a timely manner and changes implemented.

People told us staff communicated well which meant they felt the care and support were effective. A person we spoke with told us, “We have all the contact details if we need to get hold of staff. The office staff ring regularly to make sure we are happy.” A relative we spoke with told us they worked in partnership with the staff at the service as they also support their relative with their personal care needs, they said, “Staff arrive and I get things ready, we work well together to make sure my [relative] is safe.

Staff told us they admitted people to the service from various settings such as the hospital. Staff told us they ensured they had all the correct information before providing support to ensure transitions were smooth for people. Staff recognised the importance of a holistic assessment when people first started using the service. Staff told us, “People’s needs are identified by the information provided either from the hospital, social worker assessments and by listening to the requests and wishes communicated by people and their next of kin.” The registered manager told us they ensured communication was effective with partners to ensure people received effective care and support.

Feedback we received from partners was positive. Partners told us, “The service are professional and efficient.” Another partner we spoke to told us, “I have always found them to communicate well with me, they call me promptly if they have any concerns. They implement any changes to care plans as soon as I am able to provide a written plan to follow.”

Processes in place demonstrated staff worked well with other services to ensure people received effective support. Care plans detailed specialist guidance had been implemented. For example, a care plan had been updated to evidence advice from a specialist dietitian had been implemented. The electronic system in place meant these were updated without delay.

People told us staff supported them to access health appointments as needed. People and their relatives told us staff recognised changes to their health needs and supported them to gain access to healthcare professionals. People told us staff encouraged their overall health and well-being by encouraging exercise and socialisation. A relative told us, “They encourage my [relative] to do little things for themselves and make them laugh, they stay the whole day sometimes to provide company for them.”

Staff understood people’s needs and how to support them to access health and social care support if needed. The registered manager gave us several examples of referring to external agencies such as occupational therapists and dietitians. Staff told us they worked effectively with the pharmacy to collect prescriptions for people who could not collect their own. This meant there were no delay in people receiving any medicines or potential treatment.

Records were kept of when health professionals reviewed people, and what advice they gave. For example, we reviewed a care plan directing staff to use specialist equipment to safely support a person. Staff recorded people’s daily wellbeing. This allowed staff to monitor the people’s overall well-being. For example, we reviewed notes where a person’s catheter was not draining well. They encouraged the person to drink and continued to monitor the person to ensure they remained well. They contacted the district nursing team to request a visit to support the person when they did not see an improvement in their clinical presentation. We also reviewed records relating to skin damage. A person was monitored, and a healthcare professional contacted for advice. A body map was completed to identify any potential pressure damage. Staff recorded people’s daily food and fluid intake where they were at risk of malnutrition. Where needed people were referred to a dietitian for dietary supplements. This protected people from the risk of malnutrition.

People were supported to live as independently as possible. People told us staff respected their right to privacy and independence. For example, people were supported to be more independent with their mobility, a person gave us an example where their support calls had been reduced as staff had supported them to become more stable with mobilising and using specialist equipment. This meant their call times had been reduced as a result.

Staff gave us several examples where they had contributed to improving people’s outcomes. Staff understood the impact they had on the people they supported. For example, staff said, “A person I supported was really fed up, they had not left their home for a long time, I supported them to leave the house and we did things such as go to the park and play cricket. It made such an impact on them.” Another staff member told us of a person they supported to regain their mobility by following the physiotherapy exercises and providing gentle encouragement, staff told us this really improved the person’s overall well-being.

Processes in place meant the registered manager and management team had good oversight of people’s care and support. Care plan audits were completed to review and monitor people’s progress. Where concerns were identified action was taken. The electronic system meant when changes were needed messages to the wider staff team were sent immediately. This meant staff had accurate information to support people effectively.

People told us they felt respected and staff always gained consent before providing support. A person told us, “There is no set pattern to my care they ask me what I need and respect my choices.”

Staff understood how to apply the principles of the mental capacity act in practice and ensured consent to care was sought. One staff said, “I gain consent from someone by asking them clearly and making sure the person understands the proposed action, I listen carefully to their response and respect their preferences, I also provide information including risks and benefits for them to make informed decisions.”

People’s rights were respected, and the Mental Capacity Act 2005 (MCA) was followed for people who were deemed to lack capacity to make decisions about their care and treatment. 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. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. When people receive care and treatment in their homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. At the time of this assessment no one was being deprived of their liberty. People’s mental capacity was assessed in line with the MCA. Processes in place meant where a person lacked capacity to make decisions relevant people such as their next of kin were involved in the decision-making process.