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Case Study : Mrs. H.

Care Pathway

Mrs H had a fall and fractured her femur. She was admitted to hospital, had an operation and was soon ready to be discharged; the hospital gave her two options of which were to return home with the support of carers or to go to a rehabilitation unit.

Mrs H wished to return home. The discharge team worked alongside the local authority to source care for Mrs H. After reviewing the information on Mrs H’s needs, Mega Care were appointed to provide her with two calls a day – 30 minutes in the morning and 30 minutes in the evening.


After being sourced to provide Mrs H’s care, the Clinical Supervisor contacted Mrs H to arrange an initial assessment. The assessment was booked around Mrs H’s wishes and convenience.

It was explained on the telephone to Mrs H that the assessment would be conducted in her own home to enable her to feel more comfortable, and by doing so, it also allows the Clinical Supervisor to get to know her in a more personal way.

In order to gather all the necessary information and to ensure all areas of care were covered, the Clinical Supervisor used the assessment forms. As part of the assessment, the Clinical Supervisor also assessed her home to ensure the health and safety of Mrs H and her carers would remain at the forefront.

The assessment enables Mega Care to get to know the client personally and understand their wishes, preferences, likes and dislikes. It allows for identification of their goals and ways in which we can promote their participation in their life roles and routines.

*Assessments are carried out by a senior member of staff; in Mrs H’s case, the Clinical Supervisor conducted the assessment

On the assessment, Mega Care identified Mrs H’s goals were around improving her self-confidence and promoting her independence in regards to personal care activities.

Specific “Following my fall, I want to gain my self-confidence back to enable me to shower independently”
Measurable “Over the next 6 months, I want to make sure I attend my physiotherapy appointments to enable my mobility to improve”
Achievable “I recognise I may require care on a long-term basis, but I hope to improve my self-confidence to enable me to shower independently, with the supervision of a carer”
Relevant “I have always been a proud and independent person so I believe being able to wash independently again will not only improve my quality of life, but also promote my dignity”

“I would like to achieve this within 6 months but recognise it could be longer depending on external factors”

Once the assessment was completed, Mrs H and the Clinical Supervisor agreed a mutually beneficial start date to commence her care. The Clinical Supervisor explained to Mrs H she needed to have at least a day in order to complete her care folder to ensure the paperwork reflected all of her needs, wishes and goals.

Preparing the Care Folder

Following an initial assessment, Mega Care will complete all the necessary paperwork which will create the care folder. Within this folder, it will have the initial assessment, a client profile, a number of different risk assessments, a tailored care and support plan, a medication administration record (if needed), comment sheets, incident logs and a few relevant policies.

Mega Care adopt a client centred approach at all times which ensures the client is put at the heart of the care provided. To implement this from the beginning of the care process, the assessor will create a personal and tailored care plan which reflects the client’s needs, as well as their wishes, preferences, goals, likes and dislikes.

A support plan is also created alongside this which is a shorter version of the care plan, detailing the client’s needs and requirements for each call. Mega Care expect and encourage our carers to read through the client’s folder on their first visit to ensure they understand what is required of them on each call. After they have read this, we ask them to sign the ‘staff signature’ sheet which is towards the start of the folder; they sign this to say they have read and understood the client’s requirements.

The numbers of the office and the 24/7 on call phone will be left with the client in order for them to contact Mega Care with any questions in-between the assessment date and the start date. Mega Care will continue liaising with the local authority regarding assessment dates and start dates.

Once care has begun, Mega Care will ask the client or their next of kin to read through the care folder to ensure everything is correct. If anything requires changing we will implement this immediately. When the client or next of kin is happy with the care folder, we will ask for their signature on their care plan.

Commencing Care

Care will commence on the date and time agreed on the initial assessment. The carer attending the first call will bring the care folder with them, along with personal protective equipment. They will decide with the client where the best place to keep the folder is and they will inform Mega Care to enable us to inform the other carers attending. Although some clients do not mind if they do not have regular carers, Mega Care do try to keep continuity with the carers attending to enable an effective relationship to be built. We believe care can be delivered more personally if the client and carer(s) have a good relationship.

At the end of each call, the carer will record what has been carried out in the care call on the comment sheets. Within this record it will also include their time of arrival and departure, in addition to their name and signature. If the carer or client has any concerns, we ask the carers to update us via the on-call phone to ensure our clients’ care remains at the forefront of the service.

Mega Care will continue liaising with the local authority throughout the duration of care with any concerns, with the client’s consent. Again, with the client’s consent, Mega Care can also complete referrals to other healthcare professionals such as; Occupational Therapists and General Practitioners.

Throughout service provision, a senior member of the team will review the care folder on a monthly basis to ensure all paperwork is kept up to date. If any paperwork requires updating, this will be completed and implemented imminently. In addition to reviewing the folder monthly, a senior member of the team will also complete a three-monthly client review to ensure they remain happy with the service they are receiving. If there is an area they are not completely happy with, Mega Care will work with the client to resolve the issue.

Mrs H

Following the commencement of Mrs H’s care package and her commitment to attending her physiotherapy appointments, her level of needs significantly reduced. Within her time frame of six months she was able to shower independently with the supervision of a carer, instead of requiring their assistance throughout.

Her carers helped her improve her self-confidence by promoting her independence. Mega Care completed a referral to the Community Occupational Therapy service as they recognised how important showering was to Mrs H. Following this referral, Mrs H was given a bath board which enabled her to get in and out of the bath more safely and independently.

At the start of her care, the carers were assisting her in and out of the shower and with washing. However, as time progressed she began taking the lead with getting in and out of the bath with supervision, washing more independently and eventually was able to feel confident enough to stand in the shower whilst washing. Carers now only supervise her as a means of reassurance, whilst she showers independently.