Brun Lea Care

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

People's needs were not always comprehensively assessed or translated into effective care planning documentation.

Inspectors found examples where newly admitted people did not have comprehensive care plans and risk assessments in place. One recently admitted person had only a local authority assessment available despite having a range of identified support needs.

Assessments and associated care planning documentation were not always updated following changes in people's health needs, weight, mobility or clinical risks.

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

Care and treatment were not always delivered in line with current evidence-based guidance and professional recommendations. Records reviewed did not consistently reflect professional advice relating to moving and handling, pressure area management, nutrition and safer eating and drinking. This meant staff did not always have access to clear guidance to support safe and effective care.

For example, one person with identified swallowing difficulties did not have clear guidance regarding positioning during mealtimes and there was no SALT assessment available within the care records. People assessed as being at very high risk of pressure damage did not always have appropriate pressure-relieving equipment in place or documented rationale to support decisions regarding pressure care interventions. Moving and handling records were not always current and did not consistently reflect observed practice.

There was evidence of involvement from healthcare professionals, including speech and language therapists, district nurses, diabetic screening services and an Advanced Nurse Practitioner. However, recommendations and assessments were not always reflected within care records or translated into clear guidance for staff, reducing assurance that care was consistently delivered in accordance with best practice and identified needs.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The provider worked with a range of professionals to support people and improve service delivery. Management had engaged external consultancy support to review governance, quality assurance and operational systems. Staff described accessing guidance from healthcare professionals where people's health needs changed.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People had access to health professionals when required and records demonstrated involvement from external healthcare services. Staff were knowledgeable about people's health conditions and support needs. Examples included referrals to speech and language therapy services, district nursing involvement and diabetic screening services.

The activities provided in the home were tailored to support cognitive and physical health. They included engagement with local schools and communities, which supported people’s mental well-being. The activities co-ordinator ensured they supported people’s individual hobbies and interests as well as providing communal events for people to join.

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.

Inspectors identified examples where changes in people's health, wellbeing and risks had not resulted in timely review or documented intervention. For example, significant weight loss had not always been escalated or responded to appropriately, meaning opportunities to identify deterioration and reduce associated risks may have been missed.

Care plans, risk assessments and supporting records were not consistently reviewed and updated when people's needs changed. Inspectors found examples of outdated information, conflicting guidance and incomplete records relating to mobility, pressure care, nutrition and decision-making. This reduced managers ability to effectively monitor outcomes and assure themselves that people were receiving safe and appropriate care.

Auditing and oversight processes had not identified a number of issues found during the inspection, including concerns relating to medicines management, risk assessments, care planning and Mental Capacity Act (2005) documentation. As a result, opportunities to identify trends, address concerns promptly and improve outcomes for people had been missed.

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

People told us staff were polite and always asked for consent before providing any hands-on care. A person told us, “We are well looked after and they ask for consent.”

While MCA assessments, DoLS authorisations and RESPECT documentation were present for some people, records did not always demonstrate how decisions had been made when people lacked capacity or where restrictive practices were in place. Best Interest decision-making records were not consistently available. For example, one person was subject to restrictions relating to smoking, however records did not demonstrate the provider had completed an appropriate assessment of capacity or a Best Interest decision to support the restriction. This meant the provider could not demonstrate that decisions affecting the person's rights and freedoms had been made in accordance with the Mental Capacity Act (2005).

Staff demonstrated a basic understanding of MCA principles and described the importance of supporting people to make choices wherever possible.