Bearwardcote Hall Residential Home

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 good. At this assessment the rating has changed to requires improvement. This meant there was an increased risk that people’s needs could not be met.

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

Care plans included some information about people’s life histories, preferences, and routines. However, they were not always updated to reflect changes in physical, mental, emotional and social needs, including those related to protected characteristics under the Equality Act 2010.

People who use services and those close to them were nor regularly involved in planning and making shared decisions about their care and treatment, so we could not be assured it was centred around people and their needs.

We could not be assured that people received the most appropriate care and treatment or that reasonable adjustments were made where necessary. This was because, when people lacked capacity, there was no documented evidence of mental capacity assessments or best interest decisions to guide how their care should be delivered.

Opportunities for meaningful and individualised activities were limited. No activity planner was visible, so people could not see what was available. . The limited availability and predictability of activities restricted people’s choice and reduced opportunities for engagement.

People’s choice and independence around meals were limited. Food options were written in chalk on a blackboard in the dining room, which was difficult to read, particularly for people with visual impairments. No alternative menus were available at the tables, which reduced people’s ability to make fully informed choices, although staff did verbally ask people what they wanted.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible and supportive of choice or continuity.

Care plans did not consistently reflect the support provided by relatives, which could affect a full understanding of people’s needs. Staff induction training was completed in a single day, presenting a potential risk of insufficient knowledge retention and understanding. Feedback regarding communication and information sharing with relatives was mixed, indicating inconsistent practices in keeping relatives informed. Continuity of care was observed, supported by low staff turnover and no reliance on agency staff, which contributed to consistency for people. Records demonstrated that eligibility and funding arrangements were in place, and no concerns were identified regarding communication with people, relatives or integrated care boards about funding requests.

The service had policies in place for the Accessible Information Standard (AIS) and GDPR, and pre-assessment paperwork and care plans considered residents’ communication needs. However, inconsistencies were identified in staff training and induction, as staff had not received sufficient guidance on meeting people’s communication needs or complying with GDPR requirements. We noted some concerns regarding GDPR during our site visit; for example, sensitive information about people’s care was left in communal areas where it was accessible to others. Information available to residents and relatives was limited. Some measures were in place to support communication, such as toilet signage, information about the weather, month, and season, and a blackboard displaying the day’s meal choices, but these were not always clearly written or easily accessible.

The service had a complaints policy and recording system. However, our review of the complaints log showed that staff had not always investigated complaints thoroughly in line with the provider’s policy and safeguarding procedures. Staff sometimes failed to escalate safeguarding risks, and the actions taken did not always match the seriousness of the incident, or complaint. The service did not audit complaints or review themes to drive learning and improvement.

Staff did not always conduct investigations in accordance with best practice guidance or internal policies. The service did not consistently develop improvement plans, and when they did, they did not always implement or review actions effectively.

Staff held some resident meetings and carried out surveys, but analysis of feedback was limited, and they took minimal action in response to suggestions or concerns. While the service recorded feedback forms, it did not consistently use processes such as, suggestion boxes or electronic surveys to promote regular feedback. Overall, although staff maintained an up-to-date complaints policy, they did not consistently ensure people’s views were heard, addressed, and acted upon.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

Care plans partially considered people’s individual needs and reasonable adjustments to support equal access to services. Staff recorded some information about people’s communication needs; however, not all care plans contained up to date information about people’s mobility or sensory needs. This limited assurance that everyone accessed care and support in a way that met their personal requirements.

Emergency protocols were limited, with only the manager available on an on-call basis, and minimal documented guidance for staff or residents in out-of-hours emergencies. Care records generally demonstrated that residents had access to the support they required, including use of generic emergency services (111/999) when needed, but there was limited evidence of proactive planning for other out-of-hours contingencies. For example, the service did not clearly define who was responsible for running the service when the registered manager and deputy were absent. During the assessment period, both were away at the same time, and staff did not have clear guidance on who held accountability for service oversight or emergency decision-making. This created a risk of poor coordination and delayed responses in emergency situations.

Some staff told us they felt discriminated against by colleagues because of their background, and ethnicity. Leaders took limited action to address these concerns, which suggests a lack of robust systems to identify and respond to inequality or discrimination within the staff team, which indicated a potential closed culture within the service.

The provider had some measures in place to support equality and human rights, but these were not always applied consistently across the service.

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

The provider had policies on equality and discrimination, and care plans demonstrated some consideration of people’s protected characteristics and included reasonable adjustments to support equity in experience and outcomes, such as providing mobility aids for residents with physical disabilities. People did not always feel empowered by the provider or staff to give their views or fully understand their rights, including their rights to equality and human rights. During the assessment, we observed evidence that people’s complaints were not always handled appropriately. For example, one complaint form recorded a service user stating, “I wish I never said anything,” reflecting their dissatisfaction with how the investigation was conducted. Undermining people’s allegations in this way could make them feel vulnerable and may discourage them from speaking up in the future. Additionally, not all staff had received training to understand equality, recognise discrimination, or respond appropriately, which may affect the consistency of care and support provided.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. Care plans and reviews partially demonstrated planning for the future, including end-of-life care, with involvement from people and their relatives in some cases, but not consistently. Advance wishes and DNACPR forms were in place for those who had expressed preferences. Staff supported some people to make choices about their care and plan for the future while they had capacity; however, these conversations were not consistently documented for all individuals.

Although the provider supported people who received palliative care, not all staff had received training in end-of-life or palliative care, which could limit their ability to provide effective, and appropriate support. People approaching the end of life were generally identified, and this information was shared with staff, and other services to help ensure coordinated care.

Notifications of death were submitted appropriately, reflected concerns where relevant, and demonstrated partial oversight of end-of-life care. However, overall, there were inconsistencies in ensuring care at the end of life was consistently informed, dignified, and responsive to people’s wishes.