Bushell House

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 outstanding. This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 89 (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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

A thorough pre-admission assessment was undertaken to capture people’s needs and managers worked with people to agree goals regarding what people wished to achieve. Care plans were reviewed alongside monthly. A person told us, “My care was put in place from the day I arrived and I am asked regularly whether I am happy with my progress.” Another person said, “My care plan is very much me. I have helped the staff put together what is me.” A relative told us, “My [relative] is very independent, so his care plan is more about his likes and dislikes and what he enjoys. He does sometimes join in but occupies himself a lot of the time. That’s his choice.”

The provider had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The registered manager advocated for 2 people at Bushell House which resulted in a private physiotherapist providing treatment within the home environment, rather than externally to the home. This was more suitable and led to positive mobility outcomes for the people involved.

Staff worked alongside GPs to make sure information was accurate and up to date. Staff supported people to ask questions during health appointments so that relevant information was captured. On behalf of 1 person with consent, the registered manager worked with the dressings clinic to make sure the correct dressings were ordered and used; this helped the person’s overall healing of their wound. Leaders understood the importance of continuity of care without any gaps in support. On behalf of another person that required blood thinning medicine, the registered manager contacted the district nurses for the area the person was moving to, which made sure the medicines were ordered and supplied in a timely manner.

We received positive feedback from relatives, for example, “The care and support have been continuous and resulted in a lot of health improvements, my [relative] is so well cared for. If necessary, appointments are made quickly. My [relative] had to go to hospital and I wasn't available. A member of staff stayed with her the entire time.” Another relative said, “My [relative] had a couple of issues when I was away. Staff dealt with it straight away which meant some health issues were resolved. This for me was amazing and reassuring.”

The provider was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Clear information was provided to family members using different methods. We were told, “We received good information and felt that we knew the manager before our [relative] moved in. The contact with us and my [relative] was just great.”

The provider adapted information in different ways. For a person with eyesight difficulties, staff read aloud their written correspondence, and the registered manager arranged for the advanced nurse practitioner to help understand the medical terminology used in healthcare letters. This meant the person had a clear understanding of their condition and treatment pathway.

The provider had good links with organisations such as Galloways (a charity which supports people with sight loss) which meant support and technology could be provided to enhance communication for people with sight loss. The provider purchased items and equipment such as iPads and headphones for people with hearing loss. This was important for a person who enjoyed watching the television to keep abreast of current events, and the technology meant they could continue to do so when their hearing ability reduced.

Staff made sure information about events and activities within the home and in the local community was accessible with visual aids and pictures to show what would be involved. This was adapted for 1 person who preferred something plainer, and staff continued to provide individualised information and correspondence according to their preference.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

The provider sought feedback about the care and support in different ways such as residents’ meetings and surveys. There was a complaints policy and although no high-level complaints had been received, low level concerns were dealt with effectively and in a timely manner.

A person said, “I would have to look very hard indeed to find something to complain about, but I would know who to talk to and would say if I had a problem.” Another person said, “I have no complaints but know how to raise any issues if necessary.” Family members confirmed staff kept them up to date and 1 relative said, “I am kept fully updated on my [relative’s] care. I never have to worry.”

The provider made sure that people could access the care, support and treatment they needed when they needed it.

The premises and equipment were accessible for people who lived at Bushell House. There was ramp access externally, each bedroom had a level access en-suite, and all floors were accessible via a lift. People had mobility equipment if required and people were supported to maintain physical independence. Visitors were welcome at any time and were often invited to join people at mealtimes.

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes.

The leaders at Bushell House often noted discrimination faced by the older people they supported and took positive action to challenge this. A person experienced a dispute about access to important medicines to reduce symptoms during a rapid deterioration in health, including pain, discomfort and agitation; both the person and their family were in distress as a result. The registered manager challenged the decision in different ways, which was stressful and difficult to resolve. Ultimately the medicines were prescribed, and the person’s extensive symptoms were eased, including being able to sleep and breathe easier. This also meant the family members could focus on caring for their relative at a difficult time.

We were told of other examples, including advocating for someone to receive important medicines following a stroke, which otherwise would not have been prescribed. Additionally, leaders found it a challenge for falls referrals to be accepted and advocated strongly for people to be able to access the service as many people at Bushell House were able to maintain independence.

People were given exceptional support to plan for important life changes, so they could make informed decisions about their future, including at the end of their life.

Leaders and staff completed end of life training and put together a thorough policy. The provider had links with the local hospice and the registered manager worked alongside the nurse to design further bespoke training for the service to better meet their specific requirements.

The registered manager was completing further learning to train as a non-medical professional providing holistic emotional, practical, and spiritual support to individuals and their families before, during, and after death. This learning was shared to benefit the whole staff team. The registered manager had begun the application process to become accredited with the gold standard framework. This is an evidence-based framework designed to improve palliative and end-of-life care.

Staff made sure people’s wishes were upheld at their end of their life. People’s wishes and needs had been documented in their care plans which also included appropriate guidance about what to do in the event of a cardiac arrest.

We received positive feedback from a relative of someone that staff cared for at the end of their life; “The care received was exemplary. From beginning to end it was completely person centred. My [relative] was a minister, so his spiritual needs were very important to him. The hospice nurse helped staff put a plan together. We could ask any questions we wanted so felt very involved. My [relative] moved to a beautiful peaceful death thanks to Bushell House. I felt I could celebrate him and his great life.”