Optimal Care Plus

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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

We reviewed all 7 quality statements under this key question: person-centred care, care provision, integration and continuity, providing information, listening to and involving people, equity in access, equity in experience and outcomes and planning for the future. People were supported to make decisions about their own care and support. Staff treated people as individuals, providing a person-centred approach. People had access to external health care professionals to ensure their health needs were met. Where possible, staff supported people to plan and document their end of life wishes.

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 and relatives were happy with the service provided. They told us they were actively involved in their care planning to ensure information was current and up to date and reviewed regularly to promote good outcomes.

The registered manager and staff told us care plans were personalised. Staff demonstrated a good awareness of people’s individual support needs and preferences. A staff member told us, “It is about providing individualised care to a person. So just because 1 person has something for example, diabetes and you know their routine, does not make it the same for all diabetics. It is about individualised care for that person.”

People/relatives told us staff treated them as individuals and care staff who regularly supported them were familiar with their needs, preferences and daily routines. A relative told us, “We have the same team which is a main carer and an additional staff and if there is a new one then the new one comes with the carer we know and introduces them. I’m confident staff have the right training as they seem to know everything on how to care for person’s individual and complex needs.”

Staff were familiar with the personalised care, daily routines and preferences of the people they supported.

We requested information from partners however, we received no information in response to our request.

The registered manager was in the process of using 2 electronic care planning systems to improve communication with people, staff and allow care notes to be accessible to people and/or their relative/representative.

People, their relatives and staff were provided with information that it is accessible, safe and secure and supports their rights and choices.

The registered manager and staff we spoke with told us information for people could be supplied in the persons preferred format as and when required.

Systems were in place which enabled people to either receive information about the service or have their information in accessible formats should they so wish. For example, people with a vision impairment may wish for their care plans to be printed in a larger font to ensure their information is accessible to them.

Not all people/relatives we spoke with were aware of the process of how to raise a complaint if they needed to, however were confident should any issues arise, they would be dealt with. Comments included, “If we need to speak then I tend to ring up which seems to work quite well but I don’t know of any procedure to follow,” and, “The office is easy to contact and usually they answer and reply straight away but no, we haven’t had any questionnaires.”

All staff we spoke with were confident should they raise any concerns they would be responded to and dealt with in a timely manner. Staff told us they had the opportunity to share their thoughts and views through staff meetings, 1-1 discussion with their line managers, spot checks and through staff feedback questionnaires.

The registered manager had a complaints overview in place, and we found these had been responded to and any follow up actions taken as a result. The registered manager told us they carried out telephone monitoring calls to people every 3 months and were in the process of developing an electronic survey for staff, sent out via email or a link in a text message on their mobile phone to complete. Submission would go straight to them enabling them to obtain more responses.

People could access the care, support and treatment when they needed it.

Staff understood people had the right to receive the care and support that met their specific individual needs.

We requested information from partners however, we received no information in response to our request.

People were able to access care, treatment and support when they needed to and in a way that worked for them.

People we spoke with were positive about the care and support they were receiving. People/relatives told us they were supported by Optimal Care Plus should they require access to external services. Details of people’s cultural and religious needs were recorded and respected by staff.

Staff understood people had a right to be treated equally and fairly, to receive care and support which met their needs.

Staff had received training in equality and diversity. The care records we reviewed demonstrated people were able to access services when required.

We saw people’s future wishes had been discussed where appropriate and documented in their care plan. Some people had a do not resuscitate order (DNAR) in place.

Staff told us they had received training around end of life care and were confident in their knowledge and understanding of how to provide care and support to people who were nearing the end of their life. Comments included, “The training we have is about being careful and ensuring people’s final wishes are respected and to also be sensitive to family members,” and, “Good end of life care is about providing care and being sensitive to the person’s condition and needs, as well as providing support to their family members. It is important to listen to the wishes and concerns of the person carefully and follow them with the support of family and other healthcare professionals.”

Staff had received death, dying and bereavement training. People’s care plans documented their future wishes and how they would like to be supported at the end of their life where appropriate. People’s care plans documented any specialist support groups, palliative care teams and involvement from district nursing teams.