Broadoak Grange

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• 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.

The service was in breach of legal regulation in relation to consent to care and treatment.

This service scored 46 (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 because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People had care plans in place which identified most of their care and support needs. However, we found care records did not always provide staff with reliable or current information about how people should be supported. Care plans were not always reviewed and updated following changes in people’s health, mobility needs or involvement from external healthcare professionals. This meant staff could not always be assured they were working from accurate information when delivering care.

We also identified examples of inaccurate and conflicting information within care records. For example, 1 person’s care plan contained contradictory guidance about how they should be supported to mobilise and the equipment required, despite a recent physiotherapy review and recommendations being in place. The provider had failed to ensure the outcome of the assessment had been fully incorporated into the person's care records.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Although recognised assessment tools were used, systems were not always effective in ensuring assessment outcomes and specialist advice were accurately reflected in care planning and practice.

The provider used nationally recognised assessment tools to identify and monitor risks to people's health and wellbeing. These included the MUST (Malnutrition Universal Screening Tool) to assess the risk of malnutrition, Waterlow assessments to identify the risk of pressure ulcer development, and BMI (Body Mass Index) measurements to monitor whether people maintained a healthy weight.

While care plans were generally in place for people identified as being nutritionally at risk, we were not assured these were consistently reviewed, evaluated and updated to reflect changes in people's needs. For example, 1 person's care plan contained inaccurate information regarding how they should be supported with eating and drinking. The care plan stated they used a beaker with a lid, despite their current needs requiring drinks to be given by teaspoon. It also incorrectly recorded their IDDSI (food and drink consistencies suitable for people with swallowing difficulties) level as Level 5 when specialist guidance identified they required Level 4. Staff relying on inaccurate information could place the person at increased risk of choking, aspiration and receiving unsafe care.

We also found examples where specialist healthcare guidance was not consistently reflected in practice. One person had been assessed by the Speech and Language Therapy (SALT) team as requiring Level 1 thickened fluids due to a high risk of choking. The prescribed thickening guidance required drinks to be prepared using a specific fluid volume to ensure a safe consistency. However, records showed varying drink volumes were offered, including amounts that did not align with the prescribed guidance. This meant it was unclear whether drinks were being prepared to the correct consistency or whether staff were consistently following professional recommendations.

People were supported through effective partnership working with other health and social care professionals. Records demonstrated people were referred to relevant healthcare services when required, and staff acted on professional advice to help ensure people's needs were met. However, outcomes from referrals, professional recommendations and changes to people's needs were not always incorporated into care plans. This meant important guidance was not always embedded into day-to-day practice, limiting the provider's ability to demonstrate coordinated care, effective multidisciplinary working and consistent monitoring of people's health outcomes.

Feedback from external professionals was consistently positive regarding staff communication and collaboration. One healthcare professional told us, “Staff are always present, there is always someone around. [Person] is quite challenging and staff are doing their best.” Another commented, “The staff always update me and take me to the [person’s] room and are there if I need anything.” These comments reflected a staff team who knew people well, communicated effectively with professionals, and worked collaboratively to support people.

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 did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

During our inspection, we observed the lunchtime experience. Although people received their meals in a timely manner and kitchen staff worked efficiently to ensure everyone was served, the dining experience was not always conducive to promoting wellbeing, social engagement or enjoyment. People often sat and ate with minimal interaction from staff or others, and there was little encouragement to create a positive and stimulating mealtime environment. This represented a missed opportunity to support people's emotional wellbeing, social relationships and quality of life.

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 andconsistent, or that they met both clinical expectations and the expectations of people themselves.

We found some people spent prolonged periods in their bedrooms with limited opportunities for social interaction and engagement. The provider did not have effective oversight of how people’s wellbeing was monitored where they spent significant periods alone, or whether their emotional and social needs were being consistently met.

The provider was unable to demonstrate how it evaluated outcomes for people who remained in their rooms for extended periods or how it assured itself that people’s individual preferences, interests and wellbeing needs were being promoted. As a result, there was a risk that people could experience loneliness, social isolation and a deterioration in their emotional wellbeing without this being recognised or addressed.

Although healthcare professionals were consulted, the outcomes of referrals and any resulting guidance for staff were not always incorporated into people’s care plans. This meant the provider could not be assured that recommended actions were consistently followed or that people’s health outcomes were effectively monitored.

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

The provider did not ensure consent to care and treatment was obtained and managed in line with the principles of the Mental Capacity Act 2005 (MCA). Care plans contained sections relating to mental capacity; however, these did not provide clear, decision-specific guidance for staff on how people should be supported to make decisions about their care and daily living needs.

Mental capacity assessments were not always robust. In several cases, assessments appeared to have been completed for multiple decisions on the same date and time and did not demonstrate assessors had revisited discussions at a later time to determine whether people could retain information relevant to the decision. Instead, a lack of understanding at the time of the assessment was recorded as an inability to retain information.

Restrictive practices were not always supported by appropriate MCA processes. Bed rails were being used for some people; however, there was no evidence that alternative measures had been considered and explored before their use to ensure they were the least restrictive option.

Mental capacity assessments and best interest decisions to support these interventions were not always in place. In addition, risk assessments did not consistently consider whether equipment used to promote safety, such as wheelchair lap belts, were a restriction and whether further MCA processes were required.

Where people lacked capacity, records did not consistently demonstrate decisions had been made in their best interests. Best interest decision-making documentation was either absent or lacked sufficient detail for significant aspects of people's care and support. Where people had a Lasting Power of Attorney (LPA) in place, records did not consistently demonstrate they had been appropriately consulted or involved in decision-making processes. We also found limited evidence LPAs had been involved in, or informed of, assessments of capacity and best interest decisions where people were assessed as lacking capacity.