Bramble House

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. When we last assessed this key question, it was rated good. At this assessment the rating has remained good. This meant people’s outcomes were good, and feedback confirmed this.

This service scored 75 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs were assessed prior to admission to ensure these could be met by the staff. Staff told us they were provided with information about the needs of newly admitted people. They also had access to information about existing people’s needs, including changing needs and people’s communication needs, through care records and staff handover meetings.

The provider’s electronic care records system provided senior staff with assessment tools which they used to assess people’s physical and mental health needs. Audits were completed on the information held about people’s health needs, such as weights so patterns in losses or gains could be identified and reviewed with healthcare professionals. The deputy manager was responsible for ensuring people’s care records were regularly reviewed. This ensured all records; assessments and associated care plans, were completed and kept up to date to reflect people’s needs. Relatives confirmed they were kept informed of changes in their family member’s health.

People’s needs were assessed by visiting healthcare professionals to ensure people’s care and treatment supported their needs and to support referrals to necessary specialists. The assessment and management of some health needs were the responsibility of the community nurses, such as pressure ulcers and wounds.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Care and treatment were delivered in line with current good practice and recognised standards, although arrangements were not fully in place to support this in relation to the management of people’s escalated distressed behaviour. Managers however took steps to address this during this assessment by introducing appropriate policies and procedures which would support and underpin best practice in this area.

Staff used nationally recognised assessment tools to assess people’s health needs. These included for example, the Malnutrition Universal Screening Tool (MUST) to assess people’s nutritional needs. Where people required textured altered foods or drink to support them to eat and drink safely, this was prepared following the International Dysphagia Diet Standardisation Initiative (IDDSI). Staff received training which supported them to understand what best practice looked like and how to implement this.

Care records demonstrated referrals were made to various healthcare professionals such as speech and language therapists and behaviour support specialists who could support evidenced based best practice.

Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance when reviewing the care of a person with a learning disability, but whose primary needs related to another health condition. This person’s needs were being appropriately supported.

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.

Staff worked with various health and social care professionals throughout people’s care journey. Staff told us how they referred to GPs, mental health teams and community nurses to support continuity of care. Care records showed that healthcare professionals, were involved in providing support to people.

One group of healthcare professionals told us information sharing and communication with them needed to be strengthened to support their timely involvement in supporting people’s health needs. The registered manager told us they liaised with and met with these professionals to discuss any issues and to support joint working.

The provider had received positive feedback as part of a survey from other healthcare professionals stating communication between them and senior staff was good, staff made timely referrals, and they had appreciated staffs’ collaborative approach.

Information about people’s health and communication needs was in place and ready to be shared with paramedics and hospital staff in cases where people could not provide this information independently.

The provider supported people to manage their health and well-being 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.

The provider supported people to maintain healthier lives by having arrangements in place which promoted and supported their independence and well-being. Staff helped people to attend healthcare appointments, and a chiropody service visited regularly.

Activities were designed to promote physical and mental stimulation and included art sessions, exercise to music and community outings. Relatives described how staff encouraged participation and tailored activities to individual interests, helping people to remain engaged. One person enjoyed completing domestic tasks which supported their mental health by providing a sense of self-worth and purpose and another person was supported to garden, an activity which supported both their physical and mental well-being.

People had access to the garden to exercise, and they used this to walk in and help regulate their emotions, supporting their mental health and improving their sense of well-being.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service monitored care and treatment to improve outcomes for people. People’s weights were tracked over a period to ensure nutritional support was resulting in improvement to people’s weight and general health.

Accidents such as falls were monitored to identify patterns and trends which may indicate further action was required to reduce recurrences. The service was involved in an ongoing local initiative to collect county wide data on skin tears and falls within care homes. This was used to help inform future supportive initiatives for care homes.

Managers attended forums and meetings, including falls training provided by healthcare partners and from this involvement came improvements to the provider’s internal monitoring processes and practices. In relation to falls prevention and management this resulted in a significant reduction in the numbers of falls and skin tears experienced by people at Bramble House. The provider also audited call bell response times which helped to inform them where safety improvements maybe needed to support better outcomes for people. These processes helped the provider identify trends and take corrective action, supporting continuous improvement in care delivery.

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

Staff understood the requirement to gain consent from people before providing care and treatment and the importance of supporting people to make independent decisions about their care and treatment. Staff recognised when people may not have the ability to provide consent and they ensured relevant legislation, such as the Mental Capacity Act was followed

Mental capacity assessments had been completed where there had been reason to suspect people did not have the mental capacity to make independent decisions about their care and treatment. Where decisions about care and treatment had needed to be made, records showed that appropriate persons had been involved in making best interest decisions on behalf of people. We saw this for specific decisions made about people’s medicines.

Recommended Summary Plan for Emergency care and Treatment (ReSPECT) forms outlined the agreed clinical support to be provided to a person in an emergency. This information was made available to paramedics when they attended.