Archived: Bloomsbury House

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

Our rating for this key question remains unchanged at requires improvement. People and their relatives had not always been involved in assessing or reassessing their care needs when there were changes or at a regular review. There was a continued breach of regulation.

Future plans for people when their health deteriorated required improvement to make sure people’s individual wishes were considered in a thoughtful and respectful manner.

There were a range of daily activities taking place at the time of our assessment which people appeared to enjoy.

People and their relatives knew how to raise concerns and felt the provider would deal with any issues promptly.

The provider’s assessment process mostly took account of people’s individual and protected characteristics in line with equality and diversity legislation.

This service scored 61 (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 received the care and support they needed. Relatives explained they were aware of their loved one’s care plans but could not always recall if they or their loved one had contributed to any reassessment of people’s needs. At the time of the assessment site visits, a new electronic care management system was being introduced and care plans were being developed. People had personal objects in their bedrooms.

Staff were able to tell us about people’s likes, dislikes, and what was important to them and they knew people well. However, staff sometimes supported people in an inconsistent way that may not always have met their needs or was in line with the person’s care plan. For example, an inconsistent approach as to whether people were supported to get out of bed on a regular basis and how this was done in a safe manner.

The management team and staff told us they encouraged people who moved in to make their bedrooms personal to them. This included having items such as personal photos and furniture.

We saw that care and support was not consistently person centred and there was an institutionalised approach to supporting people. For example, the use of plastic cups was widespread across the service rather than an approach to drinking utensils which protected people’s dignity, or giving people the opportunity to choose. The lunch-time experience did not take into consideration people may have changed their minds about their meal options. For example, people were not reminded what their choice of meal was, what choices were available and if they still wanted their original choice of meal. However, the provider has since taken action to improve the mealtime experience for people through feedback surveys asking what their personal preferences are. We observed that care plans had not clearly identified where people had been involved in any assessment of their needs.

People and relatives raised no concerns with the continuity of care they received.

The management team told us they had improved working relations with visiting health professionals and believed people were benefitting from that. Staff told us any concerns regarding people’s health were reported promptly to external health professionals when needed.

Stakeholders provided feedback which demonstrated the provider contacted them appropriately for additional health services when required. Stakeholders told us the home was responsive to their feedback and raised no concerns regarding the quality of care provided.

The provider’s assessment process considered people’s protected characteristics, and specific dietary requirements, associated with their individual preferences and beliefs. However, the care plans were not robust and reflective of some people’s current needs to ensure continuity of care.

Relatives told us they would always receive a telephone call from staff or management to let them know if there was any information to share with them concerning their loved ones.

The registered manager told us, before people move into the home, an assessment would be completed to make sure appropriate communication processes were in place. Staff and management understood the importance of communication being made available in a format that people could understand.

The provider had a process in place where accessible information could be made available, when needed.

People and their relatives told us they were asked for their feedback on the care and support they received. People and their relatives told us they felt confident any concerns about the service would be dealt with promptly to rectify any issues.

The registered manager told us they requested feedback from relatives, stakeholders and health professionals. However, they were unable to demonstrate in their answers to us how they were able to demonstrate how people, staff and stakeholders were involved in shaping solutions to make the improvements identified at the last inspection and how this feedback was being measured for impact.

We saw surveys were passed to people, relatives and visiting professionals to gain feedback. This was completed regularly. However, we could not see evidence of how the feedback had brought improvements to the service following the last inspection. There was no evidence to support continued learning from concerns for improvement to the service and how those improvements should be incorporated into daily practice.

People and their family members told us they were able to access the care and support they required as needed. However the assessment team found it was not consistent and there were some shortfalls in the quality of people’s care.

Staff told us, when a person required additional support from a service outside of the home such as GPs, nurses and dieticians, contact numbers were available, and the management team supported with the referral process.

No concerns were raised by visiting professional regarding the service’s processes to ensure people could access the support and treatment they required.

There were processes in place to ensure people could access the care, support and treatment they needed, when they needed it. However, the processes had not always identified when people’s needs had changed and when people might benefit from additional equipment, such as standing aids or use of a hoist.

The home completed referrals to additional health professionals or stakeholders where appropriate. We saw where referrals were made these were recorded in a person’s care records and care plan.

People and their family members did not raise any concerns with us regarding any inequalities experienced within the support they received from staff or the service. People and family members felt able to give their views on the quality of the service being provided and did not feel discriminated against in any way.

Staff told us they respected people’s individual characteristics and gave examples of how they would support people, for example, those living with dementia. However, conversations with staff evidenced a blanket approach to those people who became confused, disorientated or frustrated as a result of their dementia, with staff telling us they would ‘let the person calm down’. Some staff we spoke with could not recall when they last completed their dementia awareness training.

The management team understood the importance of meeting people’s individual preferences and told us they would make sure information was provided in an appropriate format if required, such as an alternative language. However, the assessment team found there was evidence of the service indirectly discriminating under the Equality Act 2010 because, for example, care plans, daily menus were not provided in an accessible format for those people living with dementia to support them to make their own informed choices.

Effective systems were not in place to ensure care plans for people were tailored to ensure they received good quality care related to their protected characteristics.

For example, care plans had identified some people, living with dementia, would become anxious or upset and would need to be reassured. The plans did not contain the detail staff needed to help them understand why people may have had a cause to be upset and what was the best way to support them. This left people at risk of not receiving consistent positive experiences of care.

According to the provider’s training information there was no training provided to their staff on equality, diversity and inclusion.

People were not always involved in future care planning. We saw stakeholders had completed ReSPECT forms without any evidence a best interest decision had been made where the person lacked capacity. A ReSPECT form is a document that records a person's preferences for care and treatment in an emergency or in the event of a significant change in their health.

The management team told us it was difficult to speak with people and/or their relatives about plans for the future but recognised the importance of those conversations. The registered manager explained they would keep trying with people and/or their relatives when it was appropriate.

There was information in place in some people’s care plans relating to decisions about their future arrangements in the event of their death. However, the provider’s audits had failed to clearly identify if the incorrectly completed ReSPECT forms, identified by the assessment team, were the most up to date and valid versions within people’s care records.