Bricklehampton Hall

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 inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The provider was in breach of the legal regulations relating to person-centred care.

This service scored 29 (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’s care and treatment was effective with the people they were supporting because they did not check and discuss people’s health, care and wellbeing needs with them.

Assessed needs were not always reflected in the care people received and in how they planned the numbers of staff needed to deliver care to meet those needs.

People’s care records contained detailed information about needs, however there was no overview of the consistency with which staff were meeting those needs. People told us they received bruising from staff at times when being supported to mobilise or move. One person had a documented injury from a hoist strap, while another incident form we reviewed described an instance where a hoist almost tipped over with a person in it. These examples indicate staff may not have been following appropriate manual handling techniques which placed people at risk of avoidable harm and injury. We were not assured the provider had taken action to immediately address these issues.

A number of people had indications on their body maps (which are taken by staff to see if there are marks or injuries) of unexplained bruising. There was no clear plan from the provider to identify or address the reasons for these injuries. We took action to ensure where required safeguarding referrals were made to the local authority.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

Care and treatment was not always delivered in a way that was best practice or evidence based. For example, we were shown a nursing procedures and advisory book. Nurses told us they used this to help inform them of current nursing practice, however the procedures and information were out of date as this book was 17 years old and has been updated 3 times in the intervening period. There was not up to date information reflecting current best practice available for reference in the service. This may mean that out of date nursing practices could be used.

Where incidents or concerns had been raised regarding how staff were carrying out care tasks there was no evidence to support a management focus on ensuring care was evidence based. The poor experiences of people with manual handling, the failure to ensure medicines were given in line with prescribed instructions and staff providing people with incorrectly prepared fluids did not provide us with the assurances around consistent delivery of evidence-based care and treatment practices.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Relatives told us people were supported to access health professionals when required, and we could see in people’s care records where this had taken place. People told us they were able to see the doctor if they felt they needed it. Feedback form health and social care professionals was positive and they felt the provider worked well with them.

However, the internal staff team were not always effective in sharing important information regarding people’s needs. Daily handover meetings didn’t always contain the detail needed to be effective, falls and incidents were not always documented or evidenced as being discussed. This meant that factors contributing to potential risk of injury or health deterioration were not shared between staff leaving people at risk of further harm.

We were not assured there was oversight of people’s care needs, and what steps were required to ensure communication was effective amongst staff to identify signs of deterioration and prevent people from being exposed to the risk of harm.

The provider did not always support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. When people had been involved in incidents poor quality documentation meant the opportunity to learn and make changes to reduce incidents occurring again were missed. This meant opportunities to improve outcomes for people did not occur. There was no evidence people were encouraged to be involved in planning their care, however some relatives told us they felt involved.

The provider did not routinely monitor people’s care and treatment to improve outcomes. They did not always ensure people’s experiences were positive and consistent. Where people required monitoring for nutrition and hydration intake, records were not always evidencing this was happening. For example, 1 person’s care plan stated fluids were to be offered every 2 hours. We found however gaps of 12 hours documented between when fluids were being offered or taken by the person This meant the registered manager could not be assured people were always receiving appropriate levels of fluid and being supported to avoid the risk of dehydration and harm.

Falls, accidents and incidents were not accurately documented and records contained conflicting information regarding the frequency of incidents. There was no effective oversight or monitoring of what was occurring regarding the daily outcomes for people.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

Staff had received training in mental capacity and consent. There were systems and processes to ensure that where people lacked capacity to make certain decisions applications for Deprivation of Liberty Safeguards (DoLS) had been made. Whilst staff we spoke with understood the principles of capacity and consent, people’s experiences demonstrated that this was not always considered. Staff did not always take the time to act on people’s wishes with some people receiving poor experiences around their personal care needs being met in a timely way.

One person’s records had contradictory information regarding their end of life wishes. It stated they had requested to be resuscitated if required, yet other records stated they were not for resuscitation. This meant in the event of a situation where a person should be resuscitated, they may not be. This did not demonstrate that the persons wishes had been fully considered. We were not assured the registered manager had oversight to ensure people always received care in line with their preferences and wishes.