Bright Meadows

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 changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (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.

The provider used both the local authority’s referral documentation, and their own pre-admission assessments to gather information about people to determine if the home was suitable and could meet their needs. Information gathered though this process had also been used to assist with the care planning and risk assessment process.

Relatives we spoke with confirmed they had been involved in the process and were also included in ongoing reviews. One relative told us, “I was involved in her care plan initially and they do a care review every month which we can attend if we want to, but if anything changed, they would let me know.” Another relative stated, “I had a call last week to make sure I was happy with everything. Communication is brilliant.”

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.

Monthly clinical risk meetings had taken place to review people’s care, identify issues, and ensure action was taken to address these. Each meeting had covered topics such as infections, falls, nutritional issues, management of modified diets, skin integrity, use of bed rails and covert medication. Actions and/or learning from these meetings was shared at daily flash meetings with department leads, who in turn would feed this back to care and ancillary staff.

The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global framework that standardises terminology for texture-modified foods and thickened liquids. Providers are expected to ensure documentation references IDDSI, and staff understand what this means. Staff spoken with knew what IDDSI was and how to meet people’s needs when they required modifications to their diet. The provider had a robust system for ensuring the kitchen prepared meals which were of the correct consistency.

Some examples noted of the environment being designed to meet people’s needs, with pictorial signage used to indicate toilets and bathrooms and help direct people around the home. Flooring, lighting and choice of décor had also been considered. However, we discussed with the provider how further study of current best practice for dementia environments would be useful to ensure they remained up to date.

The provider worked well across teams and services to support people. They ensured people’s care was holistic.

The provider worked closely with other professionals, to ensure people’s care needs were met. Referrals had been made in a timely way to services such as the falls team, dietician service and speech and language therapy. Care records explained what the referral had been made and logged feedback received following any consultations or visits.

The provider utilised the ‘resident of the day’ model. This involved a different person on each unit being subject to a full review of their care. This involved staff from various departments, such as housekeeping, kitchen, maintenance and activities spending time with the person so they could provide feedback on their care and express their preferences. The model aims to make people feel valued and give staff a deeper understanding of individual needs and preferences.

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 healthcare professionals as and when required. People told us they could request to see their GP, who also visited the home regularly, along with other medical professionals such as podiatry. Comments included, “If I am unwell, they will call the Doctor if needed and call my husband or daughter and they come in. If I have any creams to put on, they will do all that for me. I am being well looked after here” and “They would call the GP if needed. I also get support from a weekly visiting podiatrist.”

A weekly exercise activity was completed, facilitated by an external organisation. This helped encourage movement and support wellbeing. The provider had also reformed links with a well-known age-related charity, with the aim of getting them back involved with the home to provide additional opportunities relating to exercise and wellbeing.

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

A range of monitoring was completed on a daily and weekly basis, this covered areas such as continence, repositioning, personal hygiene, oral care, food and fluid intake. Whilst some monitoring had been completed consistently, we identified gaps and inconsistencies in others. For example, based on records, we were not assured people received regular oral care in line with their care plan. People reported no concerns and told us they received support with personal care tasks; however, staff were not constantly documenting this.

Staff documented what people ate and drank. Although records were completed consistently, fluid charts did not specify how much people should be drinking so staff knew what to aim for. Food logs did not indicate what people had actually eaten, instead they referenced people having eaten lunch, tea or supper. How much people had eaten, which is important to monitor where people are losing weight was also not documented clearly. Staff used terms such as ‘had a standard portion, ate most of it’. Nothing was documented to explain what a standard portion was. The provider took action to address the issues with monitoring during the assessment. We saw some improvements had been made at our 3rd site visit.

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

People’s care records contained consent forms, which covered a range of areas including consent to care and treatment.

Where people lack capacity to consent, unless they have previously appointed a lasting power of attorney (LPA) to make health and welfare decisions on their behalf, any decisions need to made by following the best interest process. This involves a group of people, often the provider, family members and relevant professionals, meeting to discuss decisions which need to be made, and agreeing what is in the persons best interest. Where people lacked capacity, the best interest process had been used to make relevant decisions. These included for staff to provide care, use of bed rails, use of a lap belt where people required a wheelchair and the administration of specific medications, usually those with a sedating or calming effect.

Information was available regarding access to local advocacy services. An advocate supports people to express their views, understand their rights, and participate in decisions that affect them. At least 2 people living at Bright Meadows received support from an independent advocate, due to not having anyone else to support them with decision making.