Brownlands Nursing 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 good. At this assessment the rating has remained good.

Good: This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s care and treatment were generally effective. However, some improvements were needed to ensure care plans were always accurate and reflected people’s current needs. Relatives told us that staff knew people well. The provider assessed and reviewed people’s health, care, and wellbeing needs, and acted on changes. Most care plans were detailed and included clinical needs such as catheter care and wound management. For example, one person’s care plan included clear guidance on catheter care and monitoring, and another gave instructions on repositioning and skin care.

However, we found some gaps in how care plans reflected people’s current needs. For one person, there was conflicting information in the care plan. The person had grade 3 pressure sores, and the care plan stated that support from two staff using a sliding sheet was required, with repositioning every 3–4 hours. However, repositioning charts showed large gaps. When this was raised, the Registered Manager explained that the person is now more independent and does not require this level of support. They confirmed the care plan would be reviewed and updated.

For another person, the care plan stated they were at risk of choking, but this was not clearly addressed. There was no clear guidance for staff on how to reduce the risk, support the person safely, or what action to take if choking occurs.These findings showed that care plans were not always accurate or fully reflective of people’s current needs. The Registered Manager acknowledged this and confirmed that improvements would be made.

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.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them.Care and treatment were based on best practice and clinical guidance. To help deliver good care staff used tools such as Waterlow and MUST (Malnutrition Universal Screening Tool) scores and followed IDDSI (International Dysphagia Diet Standardisation Initiative) guidelines for modified diets. Wound care plans included TVN (Tissue Viability Nurse) recommendations, and medication protocols were person-centred.

We observed people who could not verbally communicate, being supported and prompted to eat and drink by staff who anticipated people’s needs. Staff planned people’s care with them to ensure people understood and agreed to the care they were going to receive, and people’s needs were met. The registered manager carried out audits to check people were receiving their care as planned.

The provider worked well with other teams and services to support people. Information about people’s needs was shared when they moved between services, so they did not have to repeat their story.

Staffing was organised to meet people’s needs. Each shift was supported by a nurse and a team leader. Communication within the team was clear and consistent. Daily handovers were used to share updates, new instructions and any changes, helping to keep care coordinated and responsive.

Staff had a good understanding of people’s care plans and were confident in using them to provide safe and effective support. They worked well together and with external professionals such as GPs, dietitians and speech and language therapists (SALT). Care records reflected regular communication with these professionals.

Staff described a positive team culture. One staff member said, “We work very well as a team. We have good relationships with external professionals. This helps us to provide good care to our residents.”

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 were supported to live healthier lives. Those at risk of weight loss were referred to dietitians and received fortified diets. Staff encouraged people to eat and drink regularly and monitored their intake where needed. For example, one person’s care plan included fortified meals and nutritional supplements, with staff recording their food and fluid intake.Care plans included repositioning to help prevent pressure injuries and maintain skin health. Staff also monitored people’s general wellbeing, such as changes in mood, mobility or appetite, and took action when concerns were identified.People had access to a range of meaningful activities to support their physical and mental wellbeing, helping to reduce isolation and promote engagement.

People were supported to attend healthcare appointments, and staff worked with professionals such as GPs and community teams to maintain people’s health and respond to any changes promptly.

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

Systems were in place to monitor people’s health, including bowel charts and fluid balance charts for people at risk. However, these were not always used effectively.Some people who were on bowel charts, who were doubly incontinent and at risk of constipation, had no recorded bowel movement for 4 days (some up to nearly 6). Escalation plans were not followed, and no action taken. Although staff said bowel charts were discussed during daily handovers, these concerns were not always identified or acted upon.

People with a catheter had charts in place to record fluid intake and urine output, with daily fluid targets set. However, records showed that fluid targets were often not met, with large gaps between times fluids were offered. Urine output was not always recorded, and no action was taken when targets were not achieved.

These findings showed that monitoring systems were not always effective in identifying and responding to changes in people’s health needs.

The provider did not always ensure people’s rights around consent were fully understood or consistently respected.

Processes were in place to apply the Mental Capacity Act 2005 (MCA), but these were not always used consistently. Some decision-specific MCAs were completed; however, others were not clearly linked to key care decisions, such as the use of restrictive equipment or supervision.

Some MCA and Best Interest records were basic and lacked detail. They did not always show what information was explained to the person, how they responded, or how they were supported to make decisions. Best Interest decisions mainly recorded the outcome, with limited detail about who was involved, what options were considered, the risks, or how the final decision was reached.

For one person, their care plan stated they had cognitive impairment and were unable to make complex decisions, but no MCA had been completed.

These concerns were discussed with the registered manager, who acknowledged the issues and confirmed that documentation and practice would be reviewed to improve quality and consistency. They also confirmed that a capacity assessment for this person would be completed as required.

Staff had received training in the MCA and were able to describe how they gained consent. During the inspection, we observed staff asking for consent and respecting people’s choices.