Bricklehampton Hall

On this page

• 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 as good. At this assessment the rating has changed to inadequate. This meant services were not planned or delivered in a way that met people’s needs.

We found the provider in breach of 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 were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People’s care and support was not always in line with their choices and preferences. People were not routinely included in the planning or reviewing of their care. Care was task driven and we did not always find staff responding in a person-centred way.

Through the provider failing to have a comprehensive view of risks to people, this did not enable active exploration between the registered manager and individuals on how to reduce further risks.

On the first day of inspection there was a bathing rota meaning that people were only routinely offered opportunities for a bath on specific days. While the registered manager and staff assured us if people wanted a bath this would be carried out, it did not reflect what people told us. One person said they were ‘told they were having a bath’, another person recalled how they refused to have a bath on the day it was offered, with the staff member telling them they would have a bath the following day. Although people told us they were given daily washes by staff this was not as effective as being offered a bath when they wanted. Following the first day of inspection the bathing rota was removed, but we were not assured people would be able to have baths when they chose to. This did not respect people's preferences or reflect person-centred care.

We observed people engaging in singing old songs and also attending a church service held in the service, however not all people were able or supported to engage in these. Outside of these activities we found staff interactions were based on the carrying out of care tasks as opposed to spending quality time engaging with people on an individual basis. This meant people did not always receive person-centred care.

There were some shortfalls in how the provider understood the diverse health and care needs of people in the service, so care was not always effective or promoted continuity.

People did not always experience consistent or positive care. Whilst some people were able to advocate for themselves, others were not and we were not assured of how people’s care was provided.

We observed mixed interactions from staff towards people living at the home. Some staff were positive and engaged with the people they were supporting, while other staff did not always interact with people.

Staff lacked the skills to provide safe and effective care and there was poor management of people’s risks and needs. This did not promote or support a good standard of care for people. People were not engaged in meaningful activities and there were limited opportunities for people to actively engage with their care and with their peers.

Some people’s negative experiences of how staff spoke and interacted with them increased the risk of isolation and did not provide opportunities for integration into the wider service, meaning more people were isolated to their own rooms.

The provider had not considered people’s needs in the layout of the building. There was a lack of signage and many doors did not have any discerning features to make them different from other doors. It did not reflect a service that was providing care and support to people who may have cognitive impairments.

People we spoke with were not always aware of their care plans or risk assessments and there was no evidence of consideration to provide information in a user-friendly format. This meant we were not assured people always had accessible information available to them to be involved in their care, or to make informed decisions and choices over their daily lives.

The provider did not ensure people could share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care. People were not always asked to contribute to care plans and risk assessments.

We received mixed feedback from people about how they should share concerns. One person said care staff were at times ‘intimidating’, another person said they felt ‘bullied to go to bed.’ This indicates an approach from staff that did not take account of listening or involving people in decisions. The registered manager was unable to demonstrate how people’s views were gathered or acted upon.

The provider did not have an open, proactive and positive culture towards safety. They did not listen to concerns about safety. Where safeguarding concerns had been raised by a person in the service the provider had failed to identify or address the concerns. Lessons were not learnt to continually identify and embed good practice.

The provider had not been effective in identifying the areas of improvement in the home environment to reduce the risk of people injuring themselves.

Accidents and incidents were documented however information was not clear or accurate with monitoring forms showing differing accounts of incidents to what was recorded in peoples care records. The clarity in the records needed to effectively detail, review and monitor the frequency of falls and incidents in the service was not there. This meant opportunities to learn lessons from incidents and take action were missed.

Whilst the provider carried out an annual satisfaction survey with relatives and people in the service, this had not been effective in identifying some people's concerns about the care and support they received.

Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

People’s experiences of care and support differed greatly and some of this was due to differing needs. Where people were able to access the activities that took place in the service their experiences appeared positive. However, for people who were not able or who did not have the opportunity to participate in these activities their days consisted of task-based care, with a lack of any meaningful engagement.

Some people had reported being treated without dignity and respect and there were serious concerns about some people’s experiences. The provider did not have an effective system to ensure people had equity in their experiences and outcomes. This meant opportunities to improve people’s experiences and outcomes were missed. This had not been highlighted by the registered manager as a concern until identified during the inspection.

The provider did not have an open, proactive and positive culture towards safety. They did not listen to concerns about safety. Where safeguarding concerns had been raised by a person in the service the provider had failed to identify or address the concerns. Lessons were not learnt to continually identify and embed good practice.

The provider had not been effective in identifying the areas of improvement in the home environment to reduce the risk of people injuring themselves.

Accidents and incidents were documented however information was not clear or accurate with monitoring forms showing differing accounts of incidents to what was recorded in peoples care records. The clarity in the records needed to effectively detail, review and monitor the frequency of falls and incidents in the service was not there. This meant opportunities to learn lessons from incidents and take action were missed.

Whilst the provider carried out an annual satisfaction survey with relatives and people in the service, this had not been effective in identifying some people's concerns about the care and support they received.