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 assessment we rated this key question requires improvement. At this assessment the rating has remained the same.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to seeking consent from people for their care and treatment.

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.

The provider did have systems in place to ensure everyone had a care plan and their risks assessment. However, some care plans were not updated with changes to people’s need. Additionally, we found no evidence some people’s health needs had been discussed with them.

We saw evidence that some people’s care and treatment was discussed and reviewed regularly with them. However, some people’s health conditions were not addressed in their care documentation. This meant there were gaps in guidance for staff to help them understand some people’s care needs. Care documentation did have some guidance about effective communication strategies for each individual. People’s care plans were reviewed regularly. Some relatives told us they felt the staff team knew their loved ones well. One relative expressed concerns about how familiar agency staff were with their loved one’s needs. They told us, “The agency staff can be a problem because they don’t know [my loved one’s] ways and needs in the same way.” Staff told us agency staff would usually be working with experienced staff who could offer extra support about how people wanted to be cared for.

The provider did not always plan and deliver people’s care and treatment in line with legislation and current evidence-based good practice.

Policies and procedures to guide staff when people had falls or sustained injuries referenced tools staff should use to help them assess people’s needs. However, staff were not familiar with these tools and had not received any training in how to use them. These included NEWS2 (National Early Warning Score 2) which is a standardized medical scoring tool staff can use to identify if a person’s condition is deteriorating.

We also saw although people had fluid targets, it was not clear to staff when fluids needed to be monitored consistently to check for hydration risk.

Overall people told us they were happy with the quality of the food they ate. They told us they generally enjoyed the meals and could have snacks and fresh fruit as dessert. We saw people living with dementia were being asked about meal preferences the day before. We saw options were mainly discussed verbally, although photographs of meals were also available. Best practice for people living with dementia is to offer them plated options at the time they wish to eat. Asking people living with dementia to make decisions the day before can increase food waste as they may be less likely to want the option they chose after significant delay. Staff told us however, and we also saw, people being offered alternatives when they were not eating or did not want their food. We also noted people were not offered a choice of drinks and were simply given 1 flavour of squash. We did not see people being asked what they wanted to drink. The kitchen staff explained how they developed the menu. They also told us about how they ensured people’s choices and preferences were considered in meal planning.

The provider endeavoured to work well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. However, the assessment of needs was not always accurate and lacked specific details.

We found examples of care records which had not been updated. For example, 1 person’s care plan stated they were taking a medication which had been discontinued. We found a person who was at risk from a specific health condition had equipment to help them reduce the risk. However, there was no guidance about often it should be used for it to be effective. Failure to ensure care records reflect people’s current care needs leaves them at risk of inappropriate care and support.

We saw staff handover procedures were in place to share key information about people’s health needs. Staff told us they felt communication in the staff team was very good. We saw records of repositioning for a person who was spending a lot of time being cared for in bed. The records showed they were being supported well to protect them from the risk of pressure wounds with regular repositioning. Staff were communicating with each other about positioning to ensure the person was supported to limit the risk of pain and discomfort.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people consistently to reduce their future needs for care and support.

Records of falls were not always very detailed. For example, they did not always include information about what the person was trying to do at the time of the fall. This information could be key to helping the person reduce further risk to themselves. Analysis of falls can only be effective if the information being reviewed is sufficiently detailed and accurate. We found analysis of falls was not effective in identifying themes and trends which could help people reduce their risk of falls.

We did see people had been supported to heal well from pressure wound injuries. However, 1 person spoke about an aspect of the support they received from staff to manage risks to their health which was making them unhappy and affecting their sleep. We raised this with the registered manager, who spoke to them about this and took steps to address it quickly.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and

consistent, or that they met both clinical expectations and the expectations of people themselves.

Analysis and review of falls had failed to consistently support people to reduce risk and improve their outcomes. There was a lack of clear processes for identifying and responding to deterioration in people’s health. The staff team, especially agency staff, did not always have the correct knowledge and information to support people. This meant people’s outcomes may vary depending upon how observant and responsive individual staff were.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

The provider did not ensure the management team understood how to effectively assess and record people’s mental capacity to make decisions. We did not see evidence people’s consent to move into the home and accept care and treatment were obtained consistently. There was little evidence people’s capacity to consent to restrictions to their activities and liberties were considered. When people lacked capacity to make decisions for themselves, mental capacity assessments had not been recorded in most cases. When decisions were made on a person’s behalf, there was little evidence this had been assessed as the least restrictive option. There was little evidence the decision was in line with the person’s own wishes, beliefs and preferences. People’s ability to consent was not consistently reviewed in line with the Mental Capacity Act 2005. This left people at risk of inappropriate care and unnecessary restriction.