Brockenhurst

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• 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 good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

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

This service scored 50 (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 were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Peoples’ needs for social interaction and stimulation were not being consistently met. Some people were at risk of social isolation and were spending all day in their rooms, others were spending time in communal areas but there was a lack of activities to provide stimulation or interest. People told us they were bored and had nothing to do to pass the time. Our observations were that staff were not always interacting with people unless they were providing care. One person said, “Staff are kind, but they never sit with us or have a chat.” One staff member was observed to be singing and the person they were supporting was clearly enjoying this and appeared to be at ease. Some people were sitting together and were clearly enjoying each other’s company as there was a nice atmosphere, chatting and laughing. However, not everyone was able to join in. We noted in one lounge area the television was not on and there were no activities taking place. We asked one person if they liked the television and they said, “Yes, but it’s off.” Staff were not facilitating any activities or supporting social engagement. There were no items of interest, books, magazines or games around to provide stimulation for people.

A person who was spending their time in their bedroom said this was their choice, they said, “There’s nothing to do anyway.”

Another person was observed sitting in the dining area during the morning, they were alone at a table with nothing to do. A visiting professional spoke with them as they went through the dining area and the person responded happily with a broad smile. Their care plan indicated they enjoyed books but there were no books around for them to look at. Staff walked past them but did not ask if they were okay or needed anything. After 75 minutes the inspector asked a staff member to offer the person a drink as they had not had any interaction with staff during that time.

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

Some people were receiving care in bed due to a change in their needs. Their care plans had not been amended to include guidance for staff in how to support them to move. Staff told us they supported people to move with the use of a hoist and sling or glide sheet to change position in bed. However, staff gave different accounts of how this happened and were not clear about when two staff were required to support people. There was no risk assessment or care plan in place to provide guidance for staff in how to do this safely or in the way the person preferred. We observed how a staff member working on their own, failed to move one person into a safe position. This did not support safe or person-centred care.

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

Staff were not always providing effective support for people with communication needs. One person was noted to be very hard of hearing and their care plan included the use of a communication board. However, we saw staff did not use the board with the person. Another person’s care plan included they wore spectacles, but the person did not have them on or near them. Care plans did not provide personalised details to guide staff with people’s communication needs. For example, a person had very limited communication due to their dementia. Their care plan identified they could understand and answer short questions, but no other tools had been considered to aid communication such as the use of pictures, symbols or objects of reference. People were not provided with a menu to know what was on offer at mealtimes, staff did not consider providing pictures, photos or showing people the food before serving it. This did not support people with dementia to communicate their preferences regarding the food on offer.

Staff did not demonstrate an understanding of Accessible Information Standards (AIS) and records did not meet the requirements of AIS, such as flagging when a person needed support to communicate.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

The provider told us they had a complaints process in place, but they had not received any complaints in the last year. Records for one person included reference to a complaint their relative had made about a member of staff. This was not recorded within the provider’s complaints process and there was no record of how the complaint was investigated or resolved.

People and their relatives said they would talk to staff if they were unhappy about anything. We observed there was a poster providing information about the complaints process on the wall. Staff told us they would report any concerns to the registered person.

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

The provider had not always made referrals to health and care professionals to support people’s needs. The provider said they had decided people should be on a modified diet when they were having trouble with eating. They had not referred people to the Speech and Language Therapist for an assessment to determine the level of risk and the most appropriate type of food modification for their needs.

Other referrals were made consistently including for people who required support with their mental health needs. Where people were falling on a regular basis they had been referred to the falls assessment team for advice.

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.

Some people told us they were unhappy with the care provided at Brockenhurst. One person said, “I am very unhappy here,” they described feelings of isolation and boredom. Some people were able to go out with staff and we saw photographs of recent trips, however there were no clear plans or arrangements for other people to have trips out. Some people had advanced dementia and were receiving care in bed, there were no activity plans for them to provide enrichment to their quality of life.

Assessments and care plans provided some details about people’s equality characteristics, preferences and needs but did not confirm how these needs would be met. For example, a person’s care plan noted their faith and that they enjoyed singing hymns. However, there was no clear plan for how the person’s religious needs would be supported.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People and their relatives were supported to plan for end of life care. The provider worked with the GP to ensure that anticipatory medicines were in place in case a person’s needs changed rapidly. One relative spoke highly of the end of life care that had been provided to their loved one. They explained how staff had been especially kind and had included them in decisions about the care provided. They told us, “I will miss coming here, the staff have been a wonderful support to me and provided incredible care.”