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We are carrying out a review of quality at Borrage House. We will publish a report when our review is complete. Find out more about our inspection reports.
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Inspection report

Date of Inspection: 16 May 2013
Date of Publication: 8 June 2013
Inspection Report published 08 June 2013 PDF

Before people are given any examination, care, treatment or support, they should be asked if they agree to it (outcome 2)

Meeting this standard

We checked that people who use this service

  • Where they are able, give valid consent to the examination, care, treatment and support they receive.
  • Understand and know how to change any decisions about examination, care, treatment and support that has been previously agreed.
  • Can be confident that their human rights are respected and taken into account.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 16 May 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members and talked with staff.

Our judgement

Before people received any care or treatment they were asked for their consent and staff acted in accordance with their wishes. People’s preferences and experiences were taken into account in relation to how care and support was delivered.

Reasons for our judgement

Some people were not able to tell us about their experiences because of their complex needs. We therefore used a number of different methods to help us understand these experiences, including talking to people, observing the care being delivered and looking at records. We noted that before people received any care or treatment they were asked for their consent and staff acted in accordance with their wishes.

At the time of our visit staff were in the process of rewriting care plans and introducing a new format for keeping records relating to care delivery. They were part way through the process so we looked at both new and 'old' care plans as both were being used. Overall, care plans were created with input from the people who used the service and/or their relative. People’s wishes were respected where possible. The care plans were individual and reflected background, culture and individuals preferences. Information in the care plans showed the home had assessed people in relation to their capacity to make their own choices and decisions about the levels of care they needed. People and their families were involved in discussions about their care and the risk factors associated with this. Individual choices and decisions were well documented in the people's care plans.

Staff had an awareness of the Mental Capacity Act and deprivation of liberty safeguards and understood their obligations with respect to people’s rights and choices when they appeared to lack the capacity to make informed and appropriate decisions. The care manager told us that staff had received training around the Mental Capacity Act and dementia awareness. We were told that new staff had yet to receive this training. However, the staff we spoke with had a clear understanding that where people had the mental capacity to make their own decisions, this would be respected. The care manager told us that when necessary, they would hold a best interest meeting to discuss a person’s care and treatment. (Best interest meetings take place when informed choice cannot be made by a person using the service, and considers the views of all those involved in the individual's care). We saw written evidence of these discussions in people’s care plans. The staff we spoke with told us they were confident that they would recognise a person’s lack of capacity so that best interest meetings could be arranged. One visitor we spoke with during the inspection told us, “I have been fully involved in my relative’s care and have always felt part of the decision making.” They also told us, "Staff here are really good at knowing when it is right to contact me and we talk about what needs changing." A visitor also told us that they were kept informed of services available to their relative and the best way to access them.

Two people using the service talked with us about how they had been helped to decide if 'a home' was the best way forward for them. They also told us how they had been given different options about how they could best use the service and every step was taken at their own pace and agreement. Both people wanted us to know how important that had been to them and had helped them to settle in and accept they needed additional support to keep well and healthy.

During our visit we saw examples of how staff respected people's privacy and dignity. We noticed staff knocking on doors, and waiting to check if anyone was in the room, before entering bedrooms, bathrooms and toilets. We also saw staff supporting people in a way which was respectful, professional and caring.