St Bridget's - Care Home Physical Disabilities

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 and support achieved good outcomes and promoted a good quality of life based on best available evidence.

At our last inspection 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. We identified a breach of the legal regulations.

This service scored 50 (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 was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Before people came to live at the home, either the registered manager or deputy manager would meet with them and their families, to understand people’s histories and discover their preferences. An assessment of their needs, and whether these could be met, would be completed. People and their families could visit the home and meet with staff. Care plans were drawn up and reviewed monthly, but not always effectively. Staffing levels were adjusted based on how many hours’ support people required. People’s communication needs were acknowledged and catered for. For example, some people could communicate verbally, and others used assistive technology. One person told us they had everything they needed and added, “It’s all very good.”

The provider did not always plan and deliver people’s care with them.

We were not provided with any evidence to show how people were involved in planning their care. We did, however, meet with relatives who were included and consulted with about their family member’s care and support needs.

Monthly clinical meetings were held at which any new interventions relating to people’s care were shared and discussed. Various assessment tools were in use such as Waterlow and the Malnutrition Universal Screening Tool (MUST). These tools addressed and assessed different aspects of people’s wellbeing. Waterlow assesses the risk of people developing pressure ulcers, whilst MUST assesses the risk of malnutrition. The registered manager said, “We try and adhere to Right support, right care, right culture, but being a large organisation that can be a problem. We try and support 1:1 with people with a learning disability. We’re in the middle of changing digital platforms for our care planning.”

The provider did not always work well across teams and services to support people. They did not always share accurate or contemporaneous information about people when they moved between services.

When people were admitted to hospital, information went with them so healthcare professionals could have information about the person they would be caring for. Hospital passports provide essential information about a person’s healthcare needs, communication preferences and personal preferences. This document ensures people’s needs are understood and met during a hospital stay or appointment. The hospital passports we reviewed contained information about people’s diagnosis, health conditions and dietary needs, and religious beliefs. However, none of the passports included people’s likes, dislikes or preferences; they were not person-centred.

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.

Although people had access to a range of healthcare services, this did not always translate into their care being effective as the provider had not ensured risks relating to people’s health were always known and understood by staff.

Where people required a modified diet, they were first assessed by speech and language therapists who provided advice and recommendations. Kitchen staff understood people’s dietary needs and prompts were recorded and displayed in the kitchen. People’s preferences were acknowledged. For example, one person had capacity and decided they did not want the recommended pureed diet, so their food was very moist and cut into small pieces to mitigate the risk of choking.

A relative told us, “[Family member] had to go into hospital and staff were very good because they saw he was unwell and picked up on it very early. Staff were good because they transferred his [Percutaneous Endoscopic Gastrostomy] PEG feeds from home to Worthing Hospital as the hospital did not have the right PEG feed.”

An on-site physiotherapist worked part-time at the home. They told us, “It’s a free for all, and people self-refer and just pop in. I keep a register, so if there are people who don’t come who might benefit, we try to encourage them to come.”

Wheelchair services visited the home every 3 months to service equipment, urgent repairs could be completed more quickly. Paramedic practitioners from the local surgery visited weekly or people could visit their GP in person.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met clinical expectations and the expectations of people themselves.

Although people’s care and support needs were reviewed, the monitoring of people’s healthcare needs was not effective, as risk assessments were inaccurate and unsafe. For example, assessments in relation to choking, and management of seizures, put people at risk of harm.

Residents’ meetings provided opportunities for people to express their views. We saw the management team engaging with people throughout our visits to the home. One person expressed concerns about a particular activity they participated in and told the registered manager they no longer wanted to do this. A conversation about alternative ways this person wished to spend their time were discussed. This person also wanted to think about whether they still wished to live at the home, and a review of their needs and preferences was being arranged with their social worker.

The provider told people about their rights around consent and respected these when delivering care.

People were routinely asked for their consent by staff before personal care was delivered. People communicated this in a variety of ways, for example, verbally or with the aid of assistive technology. Staff knew people well and understood when people were happy to be supported or wished to wait and for staff to come back later.

Where required, capacity assessments relating to people’s ability to make specific decisions had been completed. The service worked within the principles of the Mental Capacity Act 2005 (MCA) and if needed, appropriate legal authorisations had been applied for to deprive a person of their liberty under Deprivation of Liberty Safeguards (DoLS). Some DoLS had conditions attached. For example, if a person was prescribed psychotropic medication, these needed to be regularly reviewed by their GP or consultant to ensure they remained appropriate.

People could be supported with an advocate if they wished. We were told no-one needed this type of support currently, but this could be easily accessed if required.