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 requires improvement. At this assessment the rating has remained requires improvement. This meant people’s needs were not always met. The provider was previously in breach of the legal regulation in relation to person centred care. While some improvements were found at this assessment, and the provider remained in breach of this regulation.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

Observations of some staff interactions with people did not lend itself to person centred care and did not reflect the choices and preferences they were informing staff of. Feedback of peoples involvement in care planning was mixed with some people and relatives saying they were involved, others not.

The leadership team had made improvements in the planning of people’s support, with a revision of all people’s care plans capturing their physical, mental, and emotional needs, but acknowledged that these were a work in progress, in order to fully reflect people’s care and support needs. Social needs had been explored to an extent, although the lack of engagement and activities for people meant that social needs were not being fully met.

Staff knowledge of people’s needs was good. One professional said, “I have found the staff to be very knowledgeable about all the residents – their backgrounds, their ongoing physical or mental health issues, their likes or dislikes and many other aspects of their personalities. I feel this has enabled the staff to care for each resident in the most appropriate way, taking a holistic approach that is tailored to each individual.”

Staff understood people’s diverse health and care needs and worked effectively with local services to ensure care was joined-up, flexible, and promoted choice and continuity.

There was evidence of improved and positive partnership working with community healthcare professionals, including GPs, Tissue Viability Nurses, pharmacists and clinical practitioners, for example. One professional said, “I find the staff are approachable and when I raise concerns, they are responsive to this. They are willing to learn.”

The management team had made improvements in identifying and supporting people’s communication needs, but did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The environment was not dementia friendly, with little signage to aid orientation. The providers PIR Provider Information Return (a mandatory information submission that all registered adult social care providers must complete for the CQC) stated that they had installed larger dementia friendly clocks for people with dementia, although the clock in the dining room had stopped which could cause confusion for people. There was a menu rota for people in the dining room, however the print was small and it was not displayed in an accessible format.

The management team had reviewed each person’s communication needs within people’s care plans. These provided guidance to support staff communicate and understand people’s views and wishes. Flash cards were observed being used to assist people make choices. Staff showed an understanding of how to communicate with people. One staff member described supporting one person, “A lot of it would be body language, facial expressions. She is non-verbal. In the morning when you’re going to give her personal care, you’d say, I’m just going to wash your face, and she will smile at you. Or I am going to wash your body, and she will smile at you, so to me that’s ok. I have experience with people with pain and who are non-verbal, in bed, end of life.”

Leaders did not always have formal processes in place for people to share feedback and ideas.

The management team had not planned or undertaken regular meetings to allow people and their relatives to discuss issues and provide feedback. Leaders told us that, although they had planned for these to be regularly undertaken, they had not yet been implemented. Three family members could not recall being asked for their views or of receiving surveys from staff to feedback about the standard of care. Leaders told us that they had not held residents’ meetings yet and planned for these to be regularly undertaken.

People and relatives told us that although they felt comfortable raising concerns. The provider had a complaints process in place, although it was confirmed that they had not received any formal complaints since the previous inspection. People told us they would feel comfortable making a complaint and that it would be addressed appropriately.

People could access care, treatment and support when they need to and in a way that worked for them, which promoted equality, removed barriers or delays and protected their rights.

People were able to access healthcare, treatment and support when they needed it. Leaders had made improvements in ensuring people had access to external support and timely referrals had been made for specialist support. People could regularly access local health support when they required it.

People were given support to overcome barriers to ensure equal access through consistent approach to meeting people’s individual communication needs.

People’s care, treatment and support promoted equality, removed barriers or delays and protected their rights.

There were policies in place and in line with current best practice guidance around equality and discrimination. People felt that their experiences of discrimination and inequality are listened to and acted on. Leaders and staff are alert to discrimination and inequality that could disadvantage different groups of people using their services, whether from wider society, organisational processes and culture or from individuals.

People with mobility issues were supported equally to ensure they experienced. Changes had been made to the environment including stairway access and improvements that meant people with mobility needs could access areas of the service safely.

People’s decisions and what mattered to them were not always captured effectively through personalised care plans.

Some people’s care plans showed that end of life wishes, preferences and needs had not been identified with them, with care planning stating that these would be explored further. Leaders told us that, “End-of-life care planning across the service was in the process of being developed and embedded within the new care planning documentation.”

People who may be approaching the end of their life were identified. This information was shared with other services and staff, care plans developed and the person was supported on an end-of-life pathway. Leaders told us, “The plan included relevant clinical guidance and information available to staff at the time. As the person did not have any living relatives, family members or close representatives to consult with, staff recorded preferences based on their knowledge of the person and their usual wishes and routines.” One relative told us about the advanced planning for their loved one, “They know. It was all planned when I was still able to speak to her and since then they’ve asked if it’s still the same. It’s been reviewed.”