Brockenhurst

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 good. At this assessment 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.

The service was in breach of legal regulation in relation to person-centred care.

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 make sure people’s care and treatment was effective because they did not check and fully consider people’s health, care, wellbeing and communication needs with them.

Assessments were not completed consistently and sometimes provided confusing and contradictory information. One person’s care record indicated they had Parkinson’s disease however this was not accurate, they had Parkinsonian symptoms but not the disease. Their care plan included details of mental health needs but gave no guidance for staff in how to support them or what signs or symptoms might indicate a change in their mental health needs. There was contradictory information regarding the person having risks of choking and requiring a modified diet and supervision when eating. Their care record included they had chosen not to follow SaLT advice however there was conflicting information about the person’s capacity to make this decision and a lack of guidance for staff in what to do if the person had an incident of choking.

The use of some assessment tools to identify and assess the level of people’s needs was not effective and tools were not always completed. For example, a person was receiving all care in bed however an assessment tool used to assess their skin integrity had not been amended following this change in needs. Their care plan indicated they needed support to change position regularly but did not provide details about how often this should happen.

Assessments lacked detail about people’s emotional and social needs. There were no clear plans in place with how to support people to avoid social isolation and boredom. We observed people were not being supported with activities to provide stimulation and some people were at risk of social isolation.

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

The provider was not consistently following good practice recommendations for comprehensive falls management. There were multiple examples where people had fallen but no measures were taken to reduce the risks and more falls occurred. For example, one person had 9 falls recorded within a three month period. There was a failure to review care to identify how individual risk factors could be resolved, improved or managed to reduce the risk of further falls. After the first two falls were recorded, no actions were taken to reduce risks of further falls and the person continued to have another 7 falls. This put them at increased risk of serious injury. One person was known to have glaucoma and dementia, both of which were risk factors that could increase their risk of falls but they were not assessed as being at risk of falls and no measures were in place to reduce the risk.

People were living with dementia and some people were at risk of becoming distressed. Assessments and care plans did not always provide clear guidance for staff about how to support people if they became distressed. One person was observed to be showing signs of distress, staff were kind and offered reassurance, but they did not employ clear strategies or techniques when supporting the person. Records for the person included a number of incidents where they had become agitated and distressed. There was a lack of analysis to identify patterns or possible triggers. There was no clear guidance or strategies for staff in how to support the person effectively and in the way they preferred. This did not support a person-centred approach in line with good practice guidance for dementia care.

The provider did not always work well across teams and services to support people. They did not always ensure their assessment of people’s needs was up to date to provide clear planning when moving between different services.

The provider did not ensure that people’s needs were always regularly reviewed, assessed and their care plans were updated, including when their needs changed. This meant staff did not always have the information they needed to provide safe and effective care. Following feedback at this inspection the provider told us they had given notice to people who would have to move to another service because they were no longer able to meet their needs. The provider’s systems had failed to identify, review and manage risks, including when people’s needs changed. This meant the provider’s systems did not always support a planned approach to managing changes in people’s needs, including when they were required to move on from the service.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control.

People told us they did not have choice about their food at mealtimes. One person said, “I don’t know what we are having today and we don’t get a choice.” There was no information available to inform people about the lunchtime meal. People said they did not know what they would be offered. One person said, “We don’t get a choice, but the food is nice, it’s home cooked.” We observed not everyone was enjoying their meal and some people were saying to staff that they didn’t like the food they had been offered. The staff member said, “Just eat it up and please, drink the juice.” They did not acknowledge people’s complaints and did not offer any alternatives. This did not support people to have choice and control over their diet.

The provider did not always routinely monitor people’s care and treatment to continuously improve it.

The provider’s system for reviewing care included a monthly summary of the person’s care taken from daily records and any incidents that had occurred. The summary did not result in activity to improve outcomes such as a review of risks or changes to care plans. For example, a monthly summary for a person who was assessed as being at high risk of falls included details of them bringing a suitcase of their belongings down the stairs. This had not resulted in a reassessment of the risks for this person when using the stairs or any changes to support them on the stairs.

One person had been diagnosed as pre-diabetic. Their blood sugars were regularly monitored however there was no risk assessment or care plan in place to provide staff with guidance about the level of risk or how to support this health need. Their nutrition and hydration care plan did not mention risks associated with being pre-diabetic but did note concerns about the person’s food intake. Kitchen staff told us this person was receiving low sugar alternatives or smaller portions of cakes because they were listed as being diabetic. This did not provide assurance that staff understood the individual needs and preferences for this person or that their nutritional needs were being met.

Some people’s health needs had improved since coming to live at Brockenhurst. Staff monitored people’s weight regularly. One person had been malnourished and in poor health due to self neglect, staff described how they had worked with the person to improve their self care and to eat healthily on a regular basis. This meant there had been improvements in the person’s general health and well being.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People told us staff checked with them before providing care and sought their consent. Some people were assessed as lacking capacity to make specific decisions. The provider had recorded when decisions had been made in people’s best interests. The provider had made appropriate applications for Deprivation of Liberty Safeguards (DoLS). Some DoLS authorisations had conditions attached and the provider had complied with these. For example, where a condition required a medicine to be monitored regularly the provider had contacted the Community Psychiatric Nurse (CPN) who had reviewed and reduced the medicine.