BH Residential Care Home

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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. This is the first assessment for this service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. The provider was in breach of legal regulation in relation to nutrition and hydration and record keeping. Systems and processes relating to nutrition and hydration were not always effective. Fluid intake requirements were not clear and food logs varied in quality and accuracy. Guidance for staff on how to ensure people’s health needs were met were not always present or clear. The provider had not always involved people in reviewing their care, to ensure it still met their needs. People told us staff sought their consent before providing care. However, consent forms in care records required improvement. Detailed assessments were completed prior to admission to ensure the home was suitable. The provider worked with staff and wider teams, such as social workers to ensure care was effective and information when people needed to be transition out of the home, for example to hospital, was up to date. People had access to medical professionals as required, with the provider ensuring referrals were submitted promptly.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Assessments were completed prior to people’s admission to ensure the home was suitable and could meet people’s needs. Information gathered during this process was used to begin completion of people’s care plans and risk assessments. Assessments were currently completed by the home manager.

People provided mixed feedback about the food provided during mealtimes, with some telling us the choice and quality of the food needed to be better. Comments included, “The food is pretty poor, mainly frozen rather than fresh”, “The meals are very repetitive” and “I think the food is good and we get plenty of it.” Daily menus were not clearly or accurately displayed during our first 2 site visits. A whiteboard was used to detail the days meals, however, what was written differed to what was provided, and there were no menus on tables. Food logs did not always accurately record what was eaten, especially for a person requiring a modified diet, as they often did not indicate their meals had been pureed. Timings of entries on the food logs did not always tally with when the meal had been eaten, for example, people were recorded as having eaten breakfast in the afternoon, and evening meal in the early hours of the morning. No overall daily fluid intake total had been calculated, so staff had a target to aim for. As such, it was not clear how much people should be drinking and what staff should do if they didn’t reach this amount. Three people whose care records we looked at all required good hydration due to identified issues with their skin integrity, yet their fluid intake fluctuated greatly and never reached the widely recommended daily amount of either 1600 millilitres for women and 2000 millilitres for men.

The provider had systems and processes in place to support the transition of people’s care between different services, for example admission to hospital. The current manager had identified some shortfalls in the quality and quantity of information previously sent with people and had subsequently changed the way information was collated. The hospital transfer document was now completed using the providers electronic care planning system just prior to the person leaving the home. This ensured all information was up to date and accurate. We also noted other examples of how the provider worked with others and shared information, this included correspondence with social workers around people’s admission and discharge.

People were able to access medical professionals as and when required, for example GP’s, district nurses and podiatrists. From reviewing care records, we noted referrals to professionals had been made timely, when any issues had been noted. However, guidance for supporting people to stay well was not always clear. For example, one person with active pressure areas had no guidance or information about pressure relief within their risk assessment or care plan, therefore it was not clear how often this person should be repositioned due to being unable to do this themselves. Another person was losing weight, yet their nutrition assessment did not specifically reference this or state what was being done to help increase their weight.

People and relatives told us they had not been involved in care plan reviews. These are done to ensure people’s care is effective and continues to meet their needs, as well as ensuring information is accurate. From reviewing people’s care records, we noted reviews had been completed more consistently over the last 3 months, though did not detail who had been involved in the process. However, prior to this, completion had been inconsistent. Where care plan reviews had been completed, they had not always been effective in identifying incorrect information or gaps in people’s care plans and risk assessments. At the time of assessment, the provider had no clear systems for monitoring the effectiveness of the care and support provided to people to determine whether improvements where required. Although care plans and assessments covered people’s needs, they did not explore whether people had any specific goals or aspirations they wanted to achieve as part of their care and support.

We found improvements were needed with the capturing and recording of people’s consent. The current manager had also identified this and had begun to change the process used. The previous consent forms were basically a list of people’s care needs, along with what the person was able to do for themselves, for example, “continence – I’m regular and go when I need to use the toilet”. The form also contained a column titled ‘consent’ in which the person was asked to add their initials. It was not clear from this form what the person was consenting to, if they had the capacity to consent and if not whether the best interest process had been followed. We checked whether the service was working within the principles of the Mental Capacity Act (MCA), whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been submitted. However, the lack of a log to capture submission dates, dates of approval, expiry dates, resubmission dates and whether any conditions had been attached to a person’s DoLS, made it difficult to assess and confirm the process had been followed consistently.