Hands on Healthcare Solutions

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• 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

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Outstanding.

People were exceptionally well supported to make sure they were at the centre of their care and support. Staff fully supported people to understand their care and worked in partnership with them and health professionals to respond to any changes in people’s needs.

This service scored 93 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs. For example, respecting people’s wishes at the end of their life. One person was an avid gamer, and the provider assigned a staff member who also shared the same passion of gaming, who not only assisted with the persons daily care but also engaged in gaming sessions. This allowed the person to continue enjoying the activity that had brought them joy, even as their condition progressed.

People told us that staff often went over and above to support them and felt their care was personalised to them, 1 person told us, “If I could have wished for the way my care was going to be provided, it would be just like this. I get the care I want and its how I want it. Its all about me and what’s best for me and if I'm happy. I am so lucky.” One person was supported with extra support to travel to attend a family members funeral which was not part of staff duties. This ensured the person had the necessary support for this difficult event. Staff also supported 1 person to renew their bus pass, assisted them with registering a noise complaint, helped with bank account issues and assisted them with obtaining a provisional driving licence. These areas of support were outside the scope of the original care plan but were provided as part of the providers commitment to ensuring people had access to essential services and enhancing their quality of life.
 

To accommodate a person’s individual's needs, the provider made adjustments to their home environment, such as ensuring all mobility aids were in place and that the layout of their living space was safe and accessible. They also provided flexible care times to accommodate the persons individual routine, ensuring that visits were scheduled at times that suited their needs and allowed for extra time if required. This ensured people’s care was tailored to their individual needs and reflected their preferences and wishes. People were empowered to actively engage in their care planning and staff encouraged them to express their views and preferences. For example, staff provided accessible communication methods, including verbal communication, written instructions, and visual aids, to ensure everyone could participate fully.
 

The provider placed a strong emphasis on ensuring that people understood their health need and the various care options available to them, including associated risks and benefits. For example, where a person with chronic obstructive pulmonary disease (COPD) required care and support, the provider ensured they were fully informed about the care options available to them, such as the use of inhalers or oxygen therapy. Staff explained the benefits of these, such as improved lung function and quality of life, as well as any risks, such as potential side effects or challenges with adherence.

Staff said the registered manager and the management team were excellent role models who actively sought and acted on the views of people. Promoting independence, health promotion and safe risk taking were fundamental aspects of the ethos of care and support at all levels. The feedback, culture, and attitude of all the staff was that nothing was too much trouble; and everyone involved was willing to go above and beyond expectations to ensure people could have enriched and fulfilled lives.
 

People’s care plans were specifically tailored to reflect their unique physical, mental, emotional, and social needs, including those related to protected characteristics under the Equality Act. Staff worked collaboratively with people, their family members, carers, friends, and relevant healthcare professionals to develop a comprehensive care plan that addressed all aspects of their needs and preferences, while also respecting their values, culture, and identity. In addition, for individuals who may have difficulties understanding or retaining information, the provider introduced a daily routine chart with clear and easy-to-understand visual cues to help the person manage their activities independently. This adjustment allowed the individual to feel more in control of their day, promoting independence and dignity.

The provider had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. For example, we found that 1 person had a complex care need. All staff members involved in the persons care had received specialised training under the supervision of a nurse specialist. This comprehensive training ensured the team was equipped with the knowledge and skills necessary to provide safe and high-quality care for the person. The team worked collaboratively with different health professionals in the persons care which meant staff were able to respond quickly to any changes in the persons care ensuring timely interventions and minimising health risks. As a result, the person had experienced improved overall health stability, better mobility, and a reduced risk of complications, all of which had significantly enhanced their quality of life.

People and relatives told us they were fully involved in the care provided. One person told us, “The staff always ask me, every day if I’m happy. I believe they would bend over backwards to make sure I get the best care they can give me. Its superb. I never thought it would be this good. It was my lucky day when they came into life. My life has improved a lot.”
 

All staff members completed training specific to people’s needs. For example, records showed that staff had training to understand and manage epileptic seizures effectively. As a direct result of the staffs comprehensive training in seizure management, they had been able to make significant positive outcomes for people who experienced seizures as part of their health condition. Detailed seizure documentation also allowed staff to track patterns in people’s seizures, which were shared with people’s healthcare team. For 1 person this had enabled more tailored treatment planning, resulting in better overall management of their condition and fewer hospital visits.

People and their families were at the heart of decisions about their care and were actively involved in the care planning process to ensure that all decisions were made based on their preferences, values, and goals. For example, staff worked with 1 person who had a long-term condition, involving family and carers to co-produce a flexible care plan that could adapt to their fluctuating health needs. The care plan was regularly reviewed and adjusted based on how the person felt on a day-to-day basis, and their family were continuously involved in the decision-making process. This ensured their views, concerns, and preferences were always taken into account.

The service worked with others to ensure people received appropriate care and support from everyone involved in their care. Healthcare professionals told us the service worked well with them and there was a joined up approach to ensuring the needs of people were met.

Regular review meetings were held with people, family members and staff involved in their care provision, to assess the effectiveness of the care plan and make any necessary changes. These meetings provided an opportunity for everyone involved to discuss the progress of care, address any challenges, and suggest improvements. This ongoing dialogue ensured that peoples care remained person-centred, responsive to the individual's evolving needs, and focused on enhancing their overall experience.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. For example, accessible communication methods, including verbal communication, written instructions, and visual aids were used to ensure everyone could participate fully in discussions about their care and support. For people with a sensory impairment care plans and instructions were presented in a readable font size and format, using simple, clear language. If necessary, the provider arranged for a family member or trusted individual to assist with communication to ensure the person’s needs were fully understood.

Where people had difficulties retaining or understanding information, staff took extra time to explain the care plan step-by-step, using pictures or symbols where appropriate. Complex information was broken down into smaller, more manageable sections to ensure the person clearly understood their care and felt comfortable making decisions about their care and support.

Information was provided in different formats to make it easier to understand. For example, in easy-read formats or pictorial guides. People’s family members were also involved in discussions, especially if the person needed extra support in understanding their care. In addition, if a person had difficulty reading or understanding written instructions, people could be provided with a voice recording to explain the information or arrange for a home visit from a healthcare professional.

One person who lived with a family member experienced a challenging situation when due to ill health they were left at home alone, feeling vulnerable. Staff contacted the emergency duty team for social work support and successfully arranged waking night support to ensure the person was not alone during this time of need. This support was put in place until their family member returned home, ensuring the person had the companionship and assistance they required to feel secure and well-cared for. As a result, the person was able to maintain their sense of security and emotional well-being during a period of significant stress.

When feedback was received, people and their families were informed of the actions the provider was taking to address their concerns. For example, if a person provided feedback about the quality of care, the provider investigated the issue and reached out to people, to explain the steps they had taken. Whether it was additional training for staff, changes to scheduling, or improved communication protocols, people were people were kept in the loop. This demonstrated the providers commitment to transparency and assured people that their concerns were being taken seriously.

Whenever improvements were required, the provider actively involved people and their family in shaping the solution. The provider worked collaboratively with people to find the best approach. This could involve discussions on training for staff, changes in care routines, or modifying certain practices to better suit the needs of the person. This collaborative approach helped ensure that solutions were both effective and appropriate. After improvements were made, the provider continued to gather feedback to assess the effectiveness of those changes. This allowed the provider to adjust the solution if needed and ensured they were continually meeting the expectations of people using the service.
 

The provider made sure that people could access the care, support and treatment they needed when they needed it.

One person who lived with a family member experienced a challenging situation when due to ill health they were left at home alone, feeling vulnerable. Staff contacted the emergency duty team for social work support and successfully arranged waking night support to ensure the person was not alone during this time of need. This support was put in place until their family member returned home, ensuring the person had the companionship and assistance they required to feel secure and well-cared for. As a result, the person was able to maintain their sense of security and emotional well-being during a period of significant stress.

Staff were committed to ensuring that everyone received the care and treatment that was most appropriate for their needs, and the provider made reasonable adjustments to ensure equity of access to services. For example, 1 person with a physical disability who required assistance with personal care and mobility had staff who were experienced working with people who had similar needs, ensuring they felt safe and supported.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. A relative said, “The staff are always asking for our feedback. We speak often, there are always phone calls, we complete questionnaires, and it is just on going all the time. As I have said before, they really do listen to us, and we work as a team, all working towards the best care for my [family member]. Its exceptional.”

The provider sent out feedback forms to all people using the service twice a year. These forms allowed people to express their opinions regarding the care and support they received. In addition to the feedback forms, the provider offered a range of ways for people to provide feedback. For example, people could contact the service directly via phone, email, or through their assigned staff member during scheduled visits. This ensured that people, regardless of their preferred method of communication, had a choice in how they shared their feedback. The provider also offered support to people who may need support in expressing their concerns or completing feedback forms, ensuring inclusivity for all individuals.

By creating a supportive and empathetic environment where complaints were seen as an essential part of improving the service, the provider ensured that people and their families felt confident their concerns would be treated with the respect and care they deserved. For example, a family member raised a concern about a staff members attitude during a visit. The family felt that the staff member was not as patient and respectful as expected. Following an immediate investigation the member of staff was provided additional training and support. The family were kept informed of the steps the provider was taking, and ensured the family were satisfied with the resolution. This level of transparency and follow-up reassured the family that their complaint had been handled with care and taken seriously.

There was a clear, transparent procedure for raising concerns or complaints, which was explained to people during their initial care assessments and was available to them in writing. The provider told us that all feedback was taken seriously and used it to continuously improve the service. When concerns or suggestions were raised, they were acted upon swiftly so that people were able to see tangible improvements as a result of their input. For example, if a person raised a concern about a staff member arriving late for a scheduled visit, immediate actions were taken to investigate the issue. By offering multiple accessible methods for feedback and addressing concerns in a timely and transparent manner, the provider ensured people could actively participate in shaping the care they received. For example, 1 person raised concerns about the inconsistency of staff for their care calls. The provider acknowledged the issue and, in response, introduced a rotating staff team so that a smaller number of staff would be assigned to the person. The person was informed about the implementation of the changes and a few months later, the provider followed up to measure the impact of the change.

In addition to the formal complaint’s procedure, senior staff carried out regular spot checks to monitor the quality of care and gather feedback directly from people and their families. The spot checks allowed the provider to identify any concerns or areas for improvement early and address them promptly. To allow people to raise concerns outside of office hours people were provided with direct office contact numbers and an on-call number, ensuring they could contact the service 24/7. This meant that people and their families could raise concerns at any time, day or night, and receive the support they needed without delay.

People were given exceptional support to plan for important life changes, so they could make informed decisions about their future, including at the end of their life.One person had a life limiting condition and as their condition advanced the person lost the ability to move and, consequently, faced significant challenges with eating and swallowing. This posed a serious risk to the persons nutritional health. To address this, a Percutaneous Endoscopic Gastrostomy (PEG) tube was placed to meet the persons dietary needs to ensure they received the necessary nutrients.
Recognising the complexity of PEG tube care, the provider took a proactive approach by ensuring all staff involved in the persons care competed specialist training prior to the persons discharge from the hospital, equipping the staff our team with the essential skills needed for safe and effective care. By ensuring the staff team were fully trained and able to reduce the burden on the persons family. This allowed the persons nutritional needs to be met consistently, reducing the risk of complications related to the PEG tube.

The staff demonstrated an extremely compassionate awareness and understanding to end of life care. For example, 1 person who was being supported at the end of their life was initially able to communicate with ease. However, as their condition advanced, it severely impacted their ability to speak, creating immense challenges for the person and their family. The staff team quickly developed a unique communication system to support the person’s needs. They used the persons eye movements and visual queuing to facilitate communication, a method that was personalised for them. To ensure consistency, the provider assigned a dedicated team of staff who were familiar with the persons cues, reducing the challenges of having unfamiliar faces who might struggle with their non-verbal communication. Staff recognised the emotional and physical strain on family members so specialised night-time care was put in place when family were unable to assist. This ensured the person was never alone and that they always had experienced staff who understood the persons evolving needs, providing both comfort and security.

End of life care plans were detailed and recorded how people wanted the end of their life to be provided and how they wanted to be supported. End of life care plans were very person centred and included people’s personal wishes and preferences. These had been co-produced with people and families where appropriate to ensure they fully captured everything that was important to the person regarding their end-of-life care support.