Birch Avenue

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.

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.

The provider did not always make sure people’s care and treatment were effective. At the time of our inspection, pre-assessment processes were not consistently robust, and care plans did not always reflect relevant information had been gathered to understand people’s needs, wishes and preferences. Some care plans did not contain important information about a person. We found examples of people’s mobility, continence and dietary information, which didn’t reflect their current needs. Although staff knew people well, care records did not provide staff with up-to-date guidance about people’s needs or wishes. People and relatives told us their input was requested during the assessment process, with a relative telling us, “They asked what [loved-one] liked and disliked when they first arrived.” However, a person at the service told us, “I’ve not been asked for my input around how I want things.” And “I just get told when I’m having a wash.” The manager recognised these concerns and showed us new systems which were in place. However, these required embedding further at the time of our assessment.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. People’s needs were assessed by using recognised tools such as, Waterlow Scale and the Malnutrition Universal Screening Tool (MUST), which helped the service identify risks such as skin breakdown or poor nutritional intake. However, previous months audits showed a high majority of people’s assessments had not been reviewed for a significant amount of time. Therefore, we could not be assured any poor health outcomes for people had been mitigated. Daily logs included general statements about food, nutrition, and personal care, but did not contain meaningful detail. For example, entries for 1 person on a modified diet and at risk of weight-loss stated, ‘poor diet and fluids taken.’ Whilst we found no impact to this person, staff did not always record people's day to day care appropriately, meaning a decline or concern relating to health may not always be recognised and acted upon.

The provider worked well across teams and services to support people. Visiting professionals, GPs and therapists provided information and guidance for staff which was recorded in people’s care records. Staff maintained a record of their visit and outcomes. People told us they had access to external health and social care resources such as dentists and opticians. A relative told us, “[Loved-one] always sees the doctor and also sees a chiropodist every few months.” At the time of our assessment, the service was working closely with the local authority, and we received feedback that the service was actively implementing changes to improve the standard of care at the service. Some professionals told us they had concerns around staff professionalism and moving and handling concerns. However, these had been raised with leaders and responded to in an appropriate manner.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff were generally good at identifying when people became unwell, and records showed medical attention was sought promptly, with appropriate contact made with doctors or out-of-hours services. A new daily ‘walk round’ system, meant leaders were actively requesting updates on people’s health needs. However, there was limited evidence that action was taken to reduce future risks. For example, some records were not always reviewed after a person had fallen or when their needs changed. The service had recently implemented a more thorough auditing system and were in the process of ensuring people’s care records reflected needs, to enable people to live healthier lives at the service. However, these required implementing and embedding into practice.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. Whilst we found no harm to people had occurred, the systems to monitor the effectiveness of people’s care, treatment and support were not robust, and actions to improve outcomes were not consistently taken. For example, actions to update care records for people had been ongoing for several months. Management did not consistently monitor outcomes to assess effectiveness or use the findings to improve and further develop the care provided to people. For example, 1 person who was at risk of falls and weight-loss had not had regular risk assessment reviews for a considerable amount of time, which meant people’s ongoing health needs were not always assessed, risks mitigated or action taken to address any concerns.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. We observed staff and management asking for consent when entering people’s bedrooms or providing care and medication. Staff told us about people’s capacity and how they were able to refuse or give consent for specific decisions. Where people lacked capacity, assessments had been completed with people’s representatives and healthcare professionals, and best interest decisions made.