Bishop's Cleeve Care Home

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 requires improvement. At this assessment the rating has remained 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 54 (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.

Whilst people had care plans in place that assessed the majority of their day to day needs, these weren't always accurate or up to date. People and relatives did not always have person-led support when reviewing their care plans. The service had a ‘resident of the day’ however, relatives were not informed of when this day was and were not able to plan to be available. Staff members phoned relatives to ask for input; however, relatives were not given access to their relative’s care plans to enable them to review the information. People we spoke with told us they had never seen their care plans. The acting manager told us this is an area they were working to improve on. Where people had risks, such as being at risk of falls, these were not adequately assessed.

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

People requiring nutrition and fluid monitoring did not always have their input and output recorded. For example, one person on fluid monitoring did not meet their required target for one week. This had not been identified by the acting manager or by senior staff. People did not receive consistent support to enable them to have input into their care records and what matters most to them. Staff were not always aware of best practice, for example, in relation to people living with dementia. The provider was unable to demonstrate people experienced positive impact to their health as a result of living at the service.

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.

People were referred to clinical services appropriately. People were supported to access different external professionals as required for their clinical needs. One external professional told us, “Staff are knowledgeable about people when we come in and ask the right sort of questions. I’m not concerned about people living here.”

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.

Referrals to external professionals were made appropriately, however referrals were not always made in a timely manner. We found some people had experienced several falls, however there was no evidence of referrals to local agencies, such as the falls clinic. The GP had not been informed or requested to conduct a medication review in line with the providers policy. This meant people were not always able to access the support services in a time appropriate to assist them to live healthier lives.

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

Staff did not engage in activities designed to monitor people’s on-going experiences of their lives at the service. For example, there were no mealtime observations or dignity audits. One incident had occurred in which a person was admitted to hospital after staff did not follow up on observations which led to the person not receiving appropriate treatment in a timely manner. Another person was given food they did not enjoy whilst their family had told staff to serve it to them. Staff had not checked with the person if they wanted the food item.

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

During our observations, we saw staff were not consistent with their approach to asking for consent. For example, during one of our lunchtime observations, a person was asked if they wanted soup, however, before they could respond, a bowl of soup was placed in front of them. While we did see some staff knock on people’s doors, this was inconsistent. Staff would knock on closed doors, but not open doors and not when answering call bells.

People and relatives told us they did not get a choice of male or female staff. People told us, “I like a shower every day. I am helped but always by a male carer. It’s not ideal, I’d prefer a woman but that’s what it is” and “I’m not minding male and female carers now (for personal care). At first, it was a bit odd but I’m getting used to it.”

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We observed very little interaction from staff. On day 2 of the assessment, people were seated at the dining table at 12:30pm, by 12:50pm lunch was just being served. Tables were not set in preparation for lunch. Items were being placed on the table, with no explanation from staff what they were placing in front of individuals. No visual prompts of what menu options were available.