Bryony House

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.

At our last inspection we rated this key question good. At this inspection the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not always receive effective care and support based on assessments of their personal and individual needs. For example, where people had known conditions associated with the care, like poor skin integrity or anxiety, these were not effectively assessed. There was a lack of guidance in some peoples care plans on how to effectively support people or how to recognise if further support was needed. For example, when someone was living with diabetes, there was no guidance for staff on how to recognise changes in their condition or what to do. Relatives who spoke with us told us they had not been involved in any care planning or assessment of their family member’s needs. However, some people did have some assessments including a risk of falls, but this was inconsistently applied throughout those living at Bryony House.

People’s care and support was not always planned or delivered in consultation or agreement with them. Assessments regarding skin integrity, diet and nutrition, anxiety, risk of falls and mobility were inconsistently assessed. Some people had assessments which met their needs whilst others did not. We saw 1 person had been at Bryony House for several weeks yet their assessments of care directing staff on how to engage and support them had not been completed. A member of the management team told us they go on the notes from social services but acknowledged this was not sufficient to effectively plan or deliver the person’s care. This put people at the risk of receiving inconsistent support from staff who lacked direction by the management team.

People did not always receive joined up care and support as the provider did not always work well across teams and services to support people. One person’s medicines had run out. The management team failed to identify these stocks were running short and when they ran out, they failed to effectively work with prescribers and dispensers to locate or acquire additional medicines to ensure the person’s continued wellbeing. Not everyone had a hospital passport. This is important information on what mattered to the person which could be passed to other healthcare partners. In some instances, vital information relating to the person had not been assessed and could not therefore effectively be passed on, especially in an emergency. This compromised people’s experiences of receiving consistent care.

People were not always supported to manage their health and wellbeing effectively by the provider. People were not always promptly referred to additional services if required. One relative told us they had to push the management team several times to get their family member referred for additional help. They believed this was unnecessary and the management team should have been more proactive in supporting their relative.

People’s care and support was not consistently or routinely monitored to continuously improve it. The provider did not always ensure people’s outcomes were positive. There was a lack of managerial oversight regarding people’ health outcomes. For example, the provider did not consistently review daily notes to ensure changes to people’s health were identified early on and assess if additional support was needed. Where someone’s anxiety levels changed, there was a lack of managerial oversight to ensure staff were acting appropriately and providing support which mirrored best practice. Where 1 person’s skin had broken down and required the support of a district nurse, the management team failed to review their care and support plans or risk assessments. They did not routinely monitor the progress of healing or decline to ensure the treatment effectively met the person’s needs. Albeit the clinical care of this person was managed by a district nurse the management team had not updated their plans of care to effectively reflect this.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. People were not always supported to maximise their independence choice or control. We saw 1 person’s care notes stated they had mild cognitive impairment. We were told by a member of the management team this person could catch a bus and go to the bank. Later they told us they would prevent the person from leaving Bryony House as it would not be safe for them to do so. However, they had not completed a formal assessment of this person’s decision making or applied the deprivation of liberty safeguards effectively to safeguard the persons rights. We saw another person was given their medicines covertly but the best practice guidance had not been followed to ensure this was in the persons best interests and the least restrictive outcome for them. Another person was told by a staff member they could not go to the toilet until they had had their tablets. This was inappropriate and restricted the person from making decisions and was a controlling behaviour displayed by a staff member. These issues put people at the risk of having their rights eroded or abused. However, in other instances capacity assessments regarding specific decisions including where the person was to reside, had been completed. If necessary, appropriate applications to restrict their liberty had been applied for.