Archived: Purbeck House Care Home

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

Responsive – this means we looked for evidence that the provider met people’s needs.

This is the first assessment for this service. This key question has been rated inadequate. This meant services were not planned or delivered in ways that met people’s needs.

At this assessment we reviewed all the quality statements for this key question. Our findings detailed in this quality statement support the breaches of the legal regulation in relation to person-centred care and dignity and respect.

This service scored 29 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People did not experience person-centred care. People’s care plans failed to reflect their physical, mental, emotional and social needs, including those related to protected characteristics under the Equality Act.

People were not supported to pursue any interests, and staff did not have the relevant information to understand people better to provide more meaningful engagement.

The provider said they were due to transfer to an electronic record system which would be easier to manage people’s care plan information, as all records were currently paper based. However, the information staff had access to lacked vital information about people’s specific needs, wishes, interests and goals.

The staff and management team demonstrated they lacked knowledge about the people they cared for, particularly those living with dementia and communication barriers.

We spoke with the management team about the lack of person-centred care and clear guidance for staff on how to support people in a person-centred way. The management team stated they were completing immediate reviews and would include people and their families where appropriate.

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity.

There was limited feedback from people regarding personal care provision, integration and continuity. However, our observations and review of people’s care found it was not joined up, flexible or supportive of their choices. The staff and management team did not understand all people’s needs on an individual basis and lacked knowledge and understanding of people’s specific needs and health conditions.

There was a lack of systems to ensure there was detailed and up to date information about people’s needs and how these were communicated to staff. This meant we could not be assured people would be provided with appropriate, flexible and joined-up care where required. For example, in relation to capacity and consent and ensuring detailed and up to date information could be provided to other organisations in a timely way were required to ensure person centred and continued care would be provided.

The provider failed to supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The staff and management team were not knowledgeable or proactive in promoting the Accessible Information Standard (AIS). AIS is a legal requirement for adult social care organisations in the UK, ensuring individuals with disabilities, impairments, or sensory loss receive information in a way they can easily access and understand.

The provider failed to ensure people’s information was made accessible to meet their individual needs, such as information in pictorial versions, large-print or audio formats to support with effective communication. This meant some people did not receive information in a way they could understand, and this had the potential to cause isolation and frustration to them when unable to express their needs or wishes.

Not all staff had received training in relation to meeting people’s communication needs and care plans did not guide staff on how best to support people who would require additional methods of communication.

The provider and manager failed to demonstrate consideration had been given to allow people to move freely and independently around the home. For example, clear signage was not always in place to support people to find their bedrooms or bathrooms.

Information about activities in the service was displayed on a wall in the lounge. However, this information was difficult to read and when discussed with a staff member we were told it was inaccurate.

We found people’s care records were not securely stored, to prevent unauthorised people from gaining access to their personal information. On all days of our assessment, we found people’s personal care records had been left unlocked and could be accessed by anyone. The provider failed to recognise the risk of potential inappropriate access to people’s personal and private information.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

We saw evidence of some resident meetings which gave updates and opportunities for feedback. However, these meetings were only attended by people who were able to engage fully. There was no evidence of how all people, including those living with dementia had been supported to participate in this process. Therefore, we could not be assured all people had been given the opportunity to provide feedback and make suggestions about the care they received.

We were told by the provider and manager there was a process to deal with complaints and that no recent complaints had been received. However, the provider could not be assured this information was correct. For example, during our assessment we received correspondence from a relative that they had sent a formal complaint to the service via email, yet the complainant had not received any response or acknowledgement of their complaint. The provider told us they were not aware of this complaint and would look into it.

People’s care records did not provide evidence which demonstrated they or those important to them had been involved in discussions and decisions about their care. However, during our inspection one person living at the home told us they felt fully engaged about making decisions in relation to their care, we could not be assured this was always the case for all.

Relatives were generally positive about the service and felt able to discuss the care of their loved one with the provider and nominated individual should they have any questions or suggestions. A relative told us, “[Provider] and [Nominated individual] are great and really helpful. They have really helped get [person] to a point where they are more settled.” However, there was no evidence provided which demonstrated the management team were proactive in involving people and their relatives in discussions in relation to people’s individual care needs, care reviews, reassessments or changing needs. Relatives confirmed they had not been invited to attend any formal meetings to discuss the care, support and needs of their loved one.

The provider did not make sure that people could access the care, support and treatment they needed when they needed it.

People’s needs, including their protected characteristics, such as age and disability, were not considered which could impact people’s access to services. Where people had a disability which impacted their ability to leave the home or contact health services and access health, care or wellbeing support outside of the home, they were not consistently supported to have equitable access.

Barriers to accessing health and care services were not considered, and those with higher needs were negatively impacted as a result. People living with dementia had less access to activities and stimulation in the home, as well as access to the community outside of the home. There was no evidence of how these people were supported to reduce the risk of social isolation.

Staff and leaders failed to listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

Staff rotas did not demonstrate a suitable mix of skills and experience to meet the assessed needs of all people using the service. This meant some individuals, particularly those with higher support needs, did not consistently receive appropriate or responsive care.

People with protected characteristics or complex health conditions, such as Parkinson’s disease or dementia, did not always have their needs promoted or appropriately documented. People’s care records did not reference important aspects of people’s cultural or spiritual beliefs, indicating a lack of attention to individual identity, values, and person-centred planning. This omission risked care being delivered in ways that did not respect individuals' values and rights.

Our observations and feedback from some people highlighted that those living with dementia experienced poorer quality care than others. This was reflected in how they were spoken about, treated, and documented by staff. For example, it was noted in one person’s care records the person was refusing to sit up and not listening. Such language suggests a lack of understanding, empathy, and training in supporting people with dementia.

There was no evidence of action taken to understand the underlying causes of such behaviours or to ensure these individuals were treated with dignity and compassion. This contributed to a clear disparity in care experiences between people with complex needs and others. Overall, the service did not deliver equitable care. People’s protected characteristics and individual differences were not consistently identified, respected, or met, leading to discriminatory practice and significant shortfalls in inclusive, respectful care.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People’s end of life care plans were basic, not person-centred and contained shortfalls in information. For example, whilst some contained information of the funeral directors and whether the person wished for a burial or cremation, there was no information or guidance to support staff between the beginning of the persons palliative journey to final breaths. This would be to ensure that people’s wishes during the final stages of their life was carried out and respected.

End of life care plans did not include or fully detail information in relation to people’s spiritual and cultural needs, involvement of family and friends, reassurance about pain management and rapid support to anticipatory medicines.

There were inconsistencies in a person’s record in relation to their ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) status. For example, within one area of a person’s care record it was noted they had a (DNACPR) in place however, later it was noted a (DNACPR) was not in place. When this was discussed with the management team, they were unsure of which was the correct information. This meant staff or healthcare professionals may not receive correct and reliable information to ensure appropriate care was given should the need arise.