Briarfield

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 changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. The service was in breach of legal regulation in relation to consent.

This service scored 54 (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 always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication
needs with them.
The provider did not always make sure people’s care and treatment were effective because they did not always make sure people’s current support needs were clearly recorded in their care plans. When people’s needs changed in relation to areas such as needing more support with their behaviour, their care plans and risk assessments were not updated to reflect this.
When people started using the service they had a thorough assessment process to help make sure they could be supported in line with their preferences. This included overnight stays at the service and discussions with other people living at the service to make sure people would be happy living with each other.
 

The provider did not always plan and deliver people's care and treatment in line with best practice guidance or ensure care was based on a complete assessment of their needs. Opportunities to assess, monitor and review some risks were missed, which reduced the provider's ability to deliver consistently effective care and treatment.
The provider had been unable to weigh people for several months following damage to weighing equipment caused by a flood. As a result, important assessments used to monitor risks relating to nutrition and skin integrity, had not been completed. Although the registered manager told us any visible changes in a person's weight would result in referral to a healthcare professional, the lack of routine monitoring reduced opportunities to identify and respond to potential concerns at an early stage.
We did not see evidence that people were consistently supported to discuss how they wanted to be supported, develop new skills, try new experiences or build relationships. This was not always in line with the principles of Right Support, Right Care, Right Culture and best practice guidance for people with a learning disability.
However, people had enough to eat and drink, and systems were in place to monitor food and fluid intake where required. Food and drinks were readily available, and people were supported to make choices about what they ate. One person told us, "The food is good. I love jacket taties and salad and coleslaw. I get to choose what I eat. We all eat different things."
People were supported to access healthcare services and national screening programmes. The provider demonstrated how staff adapted their communication to help people understand and engage with appointments, including cervical screening. Staff and the registered manager were passionate about supporting people well. People's bedrooms reflected their individual preferences, and we observed people being involved in decisions about their living environment. The provider also demonstrated how one person's bedroom had been thoughtfully designed to support a successful transition into the service.
 

The provider worked well across teams and services to support people. They worked effectively with a range of external professionals, including the learning disability team, district nurses, advocacy services and GP practices. This helped ensure people received coordinated care and support that met their needs. Information was shared appropriately with relevant professionals to support continuity of care when people moved between services.
Professionals spoke positively about the service's approach to joint working. One professional told us, "They link in with the Community LD Nurse, LD Hospital Liaison Nurse, the General Practitioner, Advanced Clinical Practitioners and Hospital Consultants where required to advocate for residents."
A relative told us, “Some staff go above and beyond, the last two weeks they’ve taken [person] to hospital, staff are there to meet him at the hospital and stay.”
Feedback from staff about teamwork was mixed. Some staff spoke positively about communication and working relationships within the service. One member of staff told us, "This is one of the best teams we've had. We all communicate really well." However, others felt communication could be improved, particularly between day and night staff. One staff member said, "Yes and no. We do work well together, but handovers don't always happen and there is a bit of them versus us with day and night staff." Despite this, we saw evidence of effective partnership working with external professionals to support people's care and treatment.
 

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff worked proactively with people and healthcare professionals to promote good health outcomes and support people to access the care and treatment they needed.
Feedback from professionals was very positive. One professional told us, “I have been impressed at their willingness to push against the system and achieve the best clinical treatment for their patients’ medical concerns, even when there is a reluctance to engage from Medical Specialties.”
Professionals also described how staff adapted support to help people access healthcare services. One professional told us, “[Registered manager] and myself discussed Briarfield supporting my patient with attending retinal screening appointments, as advised for patients with [health condition]. My patient had previously not tolerated the screening. [Registered manager] mentioned proactively considering additional visits and adjustments in order to help my patient feel comfortable to hopefully attend their screening in the future.”
People had access to a range of healthcare services, including dental care, and appropriate oral health care plans were in place. Health Action Plans were available to support continuity of care and help healthcare professionals understand people's needs. However, these documents would benefit from more regular review and auditing to ensure information remained accurate and up to date.

The provider did not always routinely monitor people's care and treatment to continuously improve outcomes. Systems were not always effective in ensuring outcomes remained positive, consistent and in line with people's goals and aspirations.
Although outcomes had been recorded for some people, these were not always reviewed or updated in a timely way. Some records had not been reviewed, monitored or updated for several months. There was limited evidence that people were regularly consulted about their goals or actively supported to achieve them.
Staff told us staffing challenges had affected people's opportunities to take part in activities and access the community. Only a small number of staff were able to drive the service's minibus, which staff reported had contributed to a reduction in outings and activities over the previous 12 months. Some staff told us the focus had shifted towards maintaining people's care needs rather than supporting them to achieve meaningful outcomes and experiences.
However, staff knew people well and understood how to support them on a day-to-day basis. We observed staff supporting people to make choices, maintain their wellbeing and respond to their emotional needs. Staff understood people's preferences and how to support them to feel comfortable and settled in their home environment.
 

The provider did not tell people about their rights around consent or ensure their rights were respected when care and treatment was delivered. Systems were not always effective in ensuring consent was obtained, recorded and reviewed in line with the Mental Capacity Act 2005 (MCA).
Consent had not been consistently obtained or recorded for key areas of people's care and support. Where people may have lacked capacity to make specific decisions, appropriate Mental Capacity Assessments (MCA’s) and best interest decisions were not always in place. We also found limited evidence of involvement from family members, advocates or relevant professionals when best interest decisions had been made.
Following the assessment, the provider took immediate action to complete MCA’s and best interest decisions for people using the service. However, these were applied using a blanket approach across multiple areas of care and support. Under the Mental Capacity Act 2005, capacity must be assessed on a decision-specific basis. The approach taken risked assuming people lacked capacity to make a range of decisions without demonstrating that all practicable steps had been taken to support them to make their own decisions. Assessing multiple complex decisions together may also limit opportunities for people to demonstrate capacity and does not reflect a person-centred approach to decision making.
We also identified concerns regarding the quality and accuracy of some records, including incomplete evidence of consultation and involvement from those who knew the person well and inaccuracies within documentation. This meant the provider could not always demonstrate decisions had been made in accordance with the principles of the MCA.
However, we identified some good examples of recent MCA and best interest decision-making where people lacked capacity to make specific decisions. For example, assessments relating to cervical screening clearly documented the steps taken to support people to understand the decision and the rationale for acting in their best interests.