Brockenhurst

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

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.

Staff did not always ensure that people’s dignity and privacy were always upheld.

During our assessment we observed an incident where a staff member persistently encouraged a person to eat, repeatedly telling them to ‘open your mouth’ despite clear signs they did not wish to do so. The person did not respond to the prompts and kept their eyes closed. Another person at the table told the staff member, ‘She doesn’t want to,’ but the staff member continued to encourage the person to eat. This approach did not uphold the individual’s dignity, respect their right to decline food, or reflect person‑centred care. Staff did not adapt their support in response to the person’s verbal and non‑verbal cues or the concerns raised by others present.

We observed where a staff member told a person to ‘keep eating’ because there was food left on their plate, even after the person said they were not keen on the meal. The staff member continued to prompt them despite the person clearly expressing their preference not to continue. This did not reflect a dignified, person‑centred approach or respect the individual’s right to decline food. These approaches did not lend themselves to good practice in terms of autonomy and respect for people’s choices. Providers must ensure that people should be able to make choices about their nutrition and hydration. Following feedback to the leadership team, the matter was reviewed and additional oversight and guidance were introduced for agency staff to reinforce expectations regarding dignity, choice, and person centred care.

We observed an undignified moving and positioning practice where privacy of the person was not maintained. We raised this with the management team who responded by reviewing their moving and positioning practices and equipment. The management team arranged for staff to undertake additional training and observed practice assessments to reinforce expectations around maintaining privacy and dignity while supporting safe moving and handling practices.

We observed most staff interacting with people with kindness and compassion. During our observations, a staff member was seen kneeling beside a service user’s bed holding their hand and offering reassurance. The staff member said, “We are here for you. You are not alone.” One person told us, “They are always warm, calm and caring”. And another person told us, “The staff are nice and now they`re like my friends. I feel comfortable coming here.”

Staff did not always demonstrate a person-centred approach that met people’s needs and preferences.

Care plans did not always reflect people’s personal histories or individuality. The management team said they were in the process of reviewing and updating care plans to ensure they reflected people`s current care needs, preferences and social backgrounds.

Staff demonstrated understanding of the needs and preferences of the people they supported. One staff member described how a person preferred to receive personal care from a female staff and explained how their Catholic faith was respected. They told us the person was supported to practise their religion and receive Holy communion on a weekly basis.

Staff did not always promote people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing. People did not always have access to activities and the local community to promote and support their independence, health and wellbeing.

Opportunities for meaningful activities and social engagement were limited and not always accessible to everyone. Our observations throughout the inspection noted a lack of engagement and activities, while people and staff confirmed this. One person told us, “Sometimes there’s entertainment, but it’s a bit limited. I can`t do it because I can`t get around.” Staff members told us, “We did have a lady who was specifically for activities, but she left 5 or 6 months ago. I hope she’s replaced; people could do with a bit more stimulation. We try and fill the gap.” Another staff member said, “We’re mainly reliant on relatives who take people out. No-one goes out on his own. (Person) will go out with a staff member, but many people don’t go out, they don’t ask.”

The management team acknowledged this as an area of improvement and said they are actively seeking to recruit a dedicated activities coordinator to enhance the provision of inclusive and stimulating activities for people they support.

Staff looked to promote people’s independence when completing personal care. One staff member described how they encouraged independence in relation to personal care. They told us, “I will ask them to try and do it themselves. If they are able to stand by the sink to wash their face or brush their teeth or get dressed.” They added that staff provide assistance when needed. “We help people to put on their socks as some people struggle. We try and keep people as independent as possible.”

People told us they were able to have visits at any time of the day and felt that their loved ones were encouraged to maintain regular contact.

We also observed a staff member offering people their medicines in line with their individual preference and choice. We observed a staff member acknowledging people`s right to refuse medication and treatment while continuing to provide support and encouragement.

People’s needs, views, wishes and comfort were not always anticipated or addressed to avoid any preventable discomfort, concern or distress.

We reviewed records and found inconsistencies in documentation, with limited evidence appropriate follow up actions were taken when risks had been identified. For example, there was insufficient evidence to demonstrate that staff consistently recognised or responded to signs of deterioration in skin integrity or changes to people’s health. The management team acknowledged that staff may not have been fully equipped to identify and respond promptly to emerging risks. Leaders had recently arranged for specific training to enable staff to recognise soft signs of health deterioration and to escalate concerns promptly. The management team also told us they were developing clearer escalation pathways to guide staff in responding to changes in people`s health.

We observed staff responding to people’s needs in the moment and acted to minimise any discomfort, concern or distress. We observed some people resting in communal areas after lunch. We observed staff entering the rooms periodically to check on people and provided reassurance and assistance when needed.

Staff described ways in which they respond to people`s needs. One person explained how flashcards were used to support a person who is unable to verbalise their needs and has a tendency to hold food in their mouth. Staff told us they used visual prompts such as “chew” and “swallow” flashcards during mealtimes to encourage safe eating. Staff told us this approach had helped to reduce the risk of choking.

People did not always receive person-centred care as staff were not always supported to deliver this.

For example, leaders were working hard to change the culture of the service and introduce new ways of working that improved people’s care. Staff told us that many new processes, changes and duties had been introduced, but sometimes these had been difficult to adapt to and consistently apply.

One staff member said, “I have to deal with (listed number of duties). I don’t feel I’ve always got someone with me when I need it.” Another staff member told us, “I’ve been here for many years. It’s always been very old-fashioned. With all the changes, it’s a lot to take in and get used to.”

Staff told us that they felt that changes to their work practices were positive and that they received support from the manager. The management team had recently reviewed their staffing rotas to strengthen management oversight, including at weekends in order to support staff and people using the service. One staff member said, “I think (manager) is doing a good job and we have seen changes. I am happy to go to her with anything. Changes for the good. It’s getting there. There’s a lack of staff sometimes.”