Bryony 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

Responsive – this means we looked for evidence that the provider met people’s needs.

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

This meant people’s needs were not always met.

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 not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Although the level of detail in some people’s care plans had improved since our assessment, to tailor these to individual needs and personalise care, further improvement was still needed. For example, some care plans had not been updated to reflect changes in people’s care needs. Although staff we spoke with knew people’s needs well, the service did sometimes have to rely on agency staff who knew people less well. Updated care records provide important information and guidance for all staff ensuring they do not have to rely on their memory for the details of people’s care needs. The management team told us they found the electronic care planning system they were using difficult to update and detail person-centred care needs. They had sourced an alternative system and were in the process of transferring information to the new system at the time of our assessment.

We received mixed views from relatives of people living at the service about their involvement in the review of care plans. Some told us they had been involved in reviews of their loved one’s care. One relative said, “We have gone through the care plan with staff.” Others told us they had been involved in the initial plan but not been involved in any updates or reviews. One relative told us as next of kin they had never seen their loved one’s care plan. Involving relatives in care planning is especially important for people who are not able to easily communicate their own needs. Relatives who know them well can help to ensure their wishes, needs and preferences are upheld and represented well in their care plans. Failing to consistently involve relatives in care planning risks missing important details about people’s needs and wishes.

There was a lack of evidence for many people, that their consent was consistently sought or considered. This meant their care was often not planned and built around their consent and their wishes. There was also a lack of evidence some people were fully supported to make decisions about their care. This meant people’s individual needs and wishes were not always at the centre of the care they received.

Around the home we saw most people’s rooms were personalised in some way to reflect their tastes. Some people told us they had brought in items such as photographs to help their room feel their own. We did note 1 person’s room was bare and devoid of personalisation. We raised this with the registered manager who said they would speak with family and encourage personalised items to be brought in. Some people’s bedroom doors had their names on them, others did not. Personalisation of doors can be an important way to help people feel the room is their own. It can also help to orient people living with dementia in a building where many doors look the same.

There were some shortfalls in how the provider understood the diverse health and care needs of people, so care was not always joined-up, flexible or supportive of choice and continuity.

A failure to consistently understand when to seek advice from medical professionals, meant care was not always timely or adequate to meet people’s needs.

We did receive positive feedback from most people about the care and support they received from their local GP surgery. People were supported to attend external medical appointments when needed. Some health professionals came to visit people at the home if they could not attend in the community.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

We were not presented with any evidence of documentation that was provided or available for people with visual impairment. One person whose first language was not English, frequently chose to speak in their first language. However, we saw no evidence of documentation provided or made available to this person in their first language. We saw no evidence of information provided in easy-read formats for people living with dementia or learning disability. This left people at risk of not being fully informed about their rights and choices in the home. We raised this with the registered manager who told us they had made efforts to provide documents in the various formats people may need.

We did see signage around the home to help people living with dementia find their way around. We also saw information to help people orient themselves to time of year, month and day.

We saw evidence of systems in place to invite people and their loved ones to share feedback and ideas, or raise complaints about their care, treatment and support. However, it was not always clear how feedback was leading to improved and personalised care.

Meetings for people and relatives were held which did provide opportunities for those in attendance to give feedback. However, it was not always clear how feedback was sought from people who may struggle to communicate their needs verbally.

Throughout the home we did not see easy to understand information about how people and relatives could raise concerns or complaints. We did not see evidence of an easy-read version of the provider’s complaints procedure. This meant there was a risk of people being unsure about their rights to complain or raise concerns.

It was not always clear whether people had been involved in decisions about their care. In many cases people’s mental capacity to make decisions had not been assessed which showed people were not always fully supported to make decisions which affected them.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

We saw delays in people receiving the medical care they needed. We saw call bell response times were not effectively monitored and addressed to ensure people were receiving timely assistance, care and support. The provider had not always ensured possible communication barriers had been fully assessed and mitigated.

Equipment was in place to help people physically move around their home when they wanted to. This equipment was checked and maintained to ensure it was safe and suitable for people to use.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

We were not assured people’s care always promoted equality and protected their rights. For example, where people had been added to a list of those who staff were to support to go to bed or get up earlier than others, the rationale for this and respective person’s wishes had not been clearly documented. People who may struggle to recount the circumstances of an unwitnessed fall were at more risk of receiving delayed medical care in the event of being injured. The communication barriers faced by people with limited or fluctuating mental capacity and living with dementia had not been fully understood and mitigated.

The provider had failed to ensure staff completed the legally-required training to help ensure they could support people with learning disabilities. This left people with learning disabilities at risk of not having their needs fully understood.

People were supported to plan for future care including care at the end of their life.

People had ReSPECT forms in place (Recommended Summary Plan for Emergency Care and Treatment). These were personalised plans to guide professionals about what clinical care, treatment and resuscitation preferences people had. They can be used if a person cannot speak for themselves in an emergency. The electronic care record system in use included basics about these decisions on a summary page so it could be found easily by staff in an emergency.