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 requires improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Assessments did not always provide a complete or accurate picture of individuals’ current circumstances. Following the previous inspection, the management team had undertaken a full review of people’s assessments; however, these remained a work in progress and did not always reflect the most up‑to‑date information about people’s health, risks or support needs.

Risk‑based assessment tools such as MUST and Waterlow were in place but were not consistently updated when people’s needs changed, including after hospital readmission or when mobility needs increased. This limited the service’s ability to identify early signs of deterioration or respond promptly when risks increased. Leaders began addressing this during the assessment by updating documentation, assigning monitoring responsibilities and introducing a ‘Weight Champion’ role to strengthen oversight.

Assessments captured some information about people’s preferences and social needs; however, these were not routinely developed into meaningful plans that supported staff to promote engagement or reduce isolation. Observations showed that several people received limited stimulation throughout the day, yet this was not identified through assessments or addressed within planning.

People and relatives were involved in assessments where appropriate, and leaders had begun revising documentation to improve clarity, accuracy and consistency. However, further improvements were needed to ensure assessments were holistic, person‑centred and reflective of people’s most up‑to‑date needs, so that care and support could reliably promote people’s safety, wellbeing and independence.

Staff used evidence-based practice good practice and assessment tools to support people’s care but did not always use them effectively. These were not always used to fully review and make changes to care plans when people’s needs had potentially changed.

For example, some people were assessed as being at risk of developing pressure sores and of dehydration. Staff were using Waterlow and MUST tools to support assessments but had not always ensured that these were used to reassess people’s needs when needs when they potentially changed, or if they had been readmitted from hospital. Waterlow is widely used risk assessment tool to support decisions around preventative care with people at risk of developing pressure ulcers. MUST (Malnutrition Universal Screening Tool) is screening tool used in care homes to assess, identify, and manage malnutrition (undernutrition) or obesity in residents. We raised this with the leadership team who addressed this.

Staff, teams and visiting professionals worked together to support people’s health and wellbeing. Staff told us that district nurses, paramedic practitioners and other community health professionals visited the service regularly, and communication with these services was usually led by the senior care team or manager.

Health professionals confirmed the service was responsive to their advice and engaged positively during joint reviews. They reported that leaders acted on recommendations, which contributed to improved continuity of care and safer decision‑making.

Within the staff team, communication took place through handovers and daily contact between care workers and senior staff. Staff described handovers as important for sharing updates and discussing incidents or changes in people’s needs. They told us teamwork was generally positive, and they supported one another well during busy periods.

People were not always encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing, and so they could not always maximise their independence, choice and control.

For example, people did not have choices of food on the menus. Although the kitchen staff could provide supplementary alternatives, people did not have a choice of main courses to eat. One person said, “It’s passable. There’s no choice.” One relative said, “They do ask (loved one) if there’s a choice, but it’s mainly one thing.” Some people told us they liked the food on offer.

Assessments and support of people’s health needs had improved. The manager and consultants had reviewed each person’s care plans and made referrals to health specialists to ensure that health needs were being effectively supported. For example, referrals to speech and language therapists had been made to support people who had difficulty swallowing.

The management team had begun to strengthen systems to monitor and improve outcomes for people, although these were not yet applied consistently, and were not yet sufficiently embedded to demonstrate consistent and sustained oversight across all areas of care.

Staff used assessment tools such as MUST and Waterlow to monitor risks relating to nutrition and skin integrity; however, these were not always updated when people’s needs changed or following hospital readmission, meaning opportunities to identify emerging risks were sometimes missed. Leaders addressed this during the assessment and ensured dates and monitoring responsibilities were being added, including the appointment of a Weight Champion to oversee MUST and Waterlow processes.

Although systems to track people’s outcomes were developing, they were not yet robust. Records showed inconsistency in documenting follow up actions when risks were identified, particularly in relation to skin integrity and early signs of change in health. Leaders acknowledged these gaps and began implementing clearer escalation pathways and improvements to documentation to ensure staff understood what action was required and when.

There was evidence of improving oversight of people’s health needs. Leaders and external professionals reviewed people’s care records, and referrals were made for specialist support where needed. Staff and health practitioners confirmed that the service responded appropriately to concerns, including referring requests for support to GPs, community nurses or paramedic practitioners. This supported improved continuity of care and contributed to better recognition of health concerns.

Staff told people about their rights around consent and respected these when delivering care and treatment.

Where people did not have the capacity to make certain decisions, appropriate assessments had been carried out. The leadership team included those involved in their care, such as family members or health professionals, so that decisions could be made in their best interests.

The management team had made appropriate applications for Deprivation of Liberty Safeguards (DoLS). They ensured that these safeguards were tracked and monitored to ensure decisions remained valid. Some DoLS had conditions attached and these had been met. The consultancy team had completed a review of the recording of best interest decisions. These had been clearly recorded for most decisions, although they continued to liaise with families to ensure that decisions were appropriately recorded. One professional said, “The manager always makes herself available to the BIA/Social Worker when it comes to completing the DoLS Authorisation assessment. She is able to answer any questions with regards to any of the questions that are asked especially around restrictions and medications but the necessary assessments/care plans from Brockenhurst, such as the Best Interests Assessments, seem to be a work in progress.”