Belsfield House

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

At our last assessment we rated this key question outstanding. At this assessment the rating has changed to good. This meant people’s needs were met through good organisation and delivery.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs. People and their relatives told us they had been involved in the care planning process. One relative said, “I was involved in reviewing [persons] care plan, and we review it with (other healthcare professionals).” Another relative said, “I am always reviewing [person’s] care plan and they (staff) let me know if anything is wrong. When the phone rings the first words are, ‘There is nothing to worry about’ to reassure me and to update me on everything.” Relatives told us people had a choice including what they would like to eat and how a person liked to spend their time. They said, “If a resident [person] doesn’t want to go to bed at 8 o clock, it doesn’t matter.” Another relative spoke of how a person didn’t warm to a staff member, and the management team ensured this staff member did not work closely with the person.

Staff told us they were kept informed of people’s changing needs. They said, “I can understand what (people) want because everyday we look after them. There is an alert board with information, and it is updated.” Staff also spoke of how person-centred care was delivered. They said, “There are PBS (Positive Behaviour Support) plans, and we get an idea of previous history. There is a handover from the senior staff), and people have activity plans.”

Thought had gone into the design and model of this service to ensure it was person-centred but also felt like people’s homes. Every bedroom we went into was personalised specifically to that person including themed rooms for people who liked certain hobbies and flags and scarves of football teams people supported. One person who was born in another country had a calendar for that country and signs on the door, prompting staff on the translation of certain words into that person’s native language. All bedrooms had a board detailing how a person liked to spend their time and a list of activities tailored to that person’s wishes. People chose how they spent their time, and we observed staff supporting people both in communal areas and in their own bedrooms. Bedroom doors were personalised, and the service was designed with separate units and lounge areas as well as communal garden and cinema areas. This meant people could choose to sit within their own community or socialise with others in communal spaces. Boards were displayed around the service with pictures of people celebrating special events including birthdays or the birth of grandchildren. This gave the service a more personal feel.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. Relatives told us any healthcare referrals would be made promptly and that they would be kept up to date of any appointments. One relative said, “If [person] has a dentist appointment they (staff) are on the ball and keep me up to speed.” Relatives also commented on the consistent staff team. They said, “They seem to have consistent staff, not a high turnover, on the wall there is a list of staff and their roles. They rotate staff to different floors to give them all an equal level of caring roles.”

Staff told us there was continuity in the staff team and that most staff had worked at the service for some time. Staff had a good knowledge and understanding of people’s needs. The registered manager spoke of how they would ensure joined up working. They said, “We maintain collaborative, multi-agency approach to care. Families are encouraged to participate in care planning, reviews and decisions. We liaise with GP’s, community health professionals, therapists, social workers and mental health services to ensure input is timely and coordinated.”

We saw evidence in people’s electronic care records of referrals being made including referrals to the community mental health team and dieticians as required. Feedback from outside agencies was shared amongst the staff team through regular handovers and information sheets. The registered manager completed weekly analysis to monitor what referrals were being made and to chase up any outstanding actions such as test results.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Some concerns were raised in relation to staff communication by partners and relatives, however, a relative did say, “I usually speak to the senior (staff), they don’t speak good English, but they don’t need to to be caring, but the manager is the one to talk to.” Work around staff communication was ongoing and we saw this was discussed at team meetings and supervisions where managers were always looking for ways to support staff in this area. We did note during our site visit that staff did not always fully understand what we asked and there did appear to be a communication barrier. Confidential information was not always kept secure; this was rectified during the site visit.

Staff knew how to communicate with people who cannot express themselves verbally. They said, “We do activities with [person]. We know when they are happy because they smile and wave.” Staff also spoke of different forms of communication including picture cards and number blocks to promote choice and inclusivity. Key information including menus, activity schedules and the complaints procedure were available in alternative formats including large print, easy read and pictorial to support people who use this service who may have alternative communication needs.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result. Relatives told us they knew how to raise a concern, should they need to. They said, “I would speak to the (deputy) manager, and he would listen, but we have never complained as we are so pleased.” Another relative said, “I put in 1 (complaint) about a certain member of staff and it was dealt with immediately as the manager said these people are vulnerable, they need protection.” Relatives also praised the staff’s ability to listen to them, they said, “(Staff) are always there to listen and to help.”

Staff told us the process should a concern be raised. They said, “If a relative is not happy, I would take them to the nurse to speak to them.” Staff knew the process of escalating concerns to higher management and told us they ensured all whistleblowing concerns were taken seriously. A complaints procedure was in place including an easy read complaints procedure. We saw evidence of feedback gathered from people, relatives and other healthcare professionals which was mainly positive and shared amongst the staff team. One relative praised the service for enabling them to sleep better at night knowing their loved one was safe.

The registered manager told us when a relative finished their visit, staff always asked ‘was everything OK with the visit’ to ensure voices were heard and any concerns could be rectified there and then.

The service made sure people could access the care, support and treatment they needed when they needed it. Relatives and partners told us the service was accessible. One relative said, “Everything is on display and easy to see.” One person praised the space and wide corridors. They said, “The wheelchair can get through and staff open doors with a fob.”

Staff told us this service was accessible and told us how support was given to people who stayed in their bedrooms to avoid social isolation. One staff member said, “Some people are bedbound or like to stay in their bedrooms, so we do things like hand massages.” The registered manager told us how the service had been adapted to meet people’s reasonable adjustment needs including the use of specialist equipment, environmental adaptations including signage and quiet spaces, communication aids, visual prompts and tailored room layouts to support independence. Contingency plans were in place should an emergency situation occur, and care plans held evidence of reasonable adjustments people required as well as evidence on how best to support people.

Staff and leaders actively listened to information about people who were most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. People and their relatives told us they felt listened to by staff and that any concerns would be acted upon. Staff told us they had no concerns about people’s care provision and felt all staff were treated fairly. One staff member said, “There is no discrimination we are all treated the same, the (registered manager) treats all staff well. They’re a good manager.”

The registered manager told us they were proactive in identifying and addressing any barriers to inclusion. They said, “We work to ensure our service is inclusive, welcoming and respectful and that no [person] is disadvantaged by assumptions or system-based limitations.” We saw evidence of care plan reviews where people and relative voices were valued. Feedback forms sent to people and relatives had overall positive feedback.

People were 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. Relatives told us they had been involved in end of life care planning, as appropriate and advanced wishes were discussed where necessary. Staff had completed training in end of life care and this service followed the Gold Standard Framework while working closely with GP’s, community nurses and palliative care teams to ensure appropriate clinical support is given when necessary. The Gold Standard Framework aims to ensure every person can live well before they die and die well in the place and manner of their choosing. The registered manager said, “End of life preferences are explored sensitively involving the (person where possible), family and legal representatives. We use advanced care planning and DNACPR (Do not attempt Cardiopulmonary Resuscitation) documentation where appropriate. These discussions are handled by trained staff with empathy and respect, ensuring that emotional, spiritual and cultural needs are met.”