Homebeech

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 requires improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. The provider was previously in breach of the legal regulation in relation to person centred care. Improvements were not found at this assessment, and the provider remained in breach of this regulation.

This service scored 62 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People told us about the assessments that were completed before they moved into Homebeech. One person said, “I think I was involved. My relative was involved. I was impressed when I came here. Two staff looked me over to see if I had any bruises. I suppose it was insurance on their part. It’s very good here.”

When a referral was made, an assessment was completed of the person’s care and support needs, to ensure these could be met. The manager explained, “We go to people’s homes or hospital. We will look at all the hospital records and meet with the person and their family. We put the care plans in place for an agreed date of admission. We look at everyone on an individual basis, working alongside anyone who is important to them, involving people in the initial care planning. We look at any adaptations or specific requirements. For example, we put in a new call bell system for 1 person so they could communicate better.”

The provider did not follow legislation and current evidence-based good practice and standards such as Right support, right care, right culture.

Out of 48 people living at Homebeech, 7 people’s primary care needs related to their learning disability or autism. Systems and processes were not fully in place to support this group of people, although improvements were planned. For example, an additional kitchen area was planned to enable people, with staff support, to promote their independence with the preparation of meals and snacks.

Although people were monitored on an individual basis, for example with regard to their nutrition and hydration needs, monitoring charts were generic. Some people were at risk of constipation, so their fluid intake was monitored. There was guidance for staff on people’s mental health needs, but this was primarily clinically based. For example, if a person had ‘increased confusion’, staff were advised to check bowel movement and the use of laxatives, complete a urine analysis, body temperature and fluid intake. Having completed all these checks, staff were then advised to identify any other possible cause, leaving it to care staff to identify something. A last resort was a referral to the community mental health team. There was no intervention or guidance for staff on how to support this person with their anxieties which put them at potential risk of a lack of consistent and appropriate support.

The provider worked well across teams and services to support people.

The home worked with a variety of health and social care professionals. For example, speech and language therapists provided advice and guidance when people had a swallowing difficulty (dysphagia) or an identified risk of choking. People at risk of pressure damage were referred to tissue viability nurses for advice on wound management, and occupational therapists advised on equipment and assistive technology.

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 had access to a range of healthcare professionals and services. One person said, “I had an appointment for a scan and the staff went with me.” Another person told us, “Oh yes, I saw a doctor recently and they’ve kept up with the treatment.”

We asked people about the food and whether they had a choice of menu. One person said, “They do their best. It can be iffy. Sometimes the food is lovely and hot, sometimes it’s stone cold.” Another person told us, “It would be nice if it was tasty, but it’s bland. A lot of it is cold. You have to call staff to have it reheated. The vegetables are cold because the plate’s cold.” We fed these comments back to the management team. A representative of the provider told us they would order some heated trolleys to ensure food was kept and served to people when it was hot. Where people had been assessed as requiring a modified diet, this was prepared in line with professional advice based on each person’s individual needs.

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 and consistent, or that they met the expectations of people themselves.

Although people’s care and support needs were reviewed, the monitoring of people’s health, including mental health needs, was not always effective. For example, we read how 1 person would like signs of depression recognised and managed, but there was no information of how this would be done or whether it had been explored. A mental health and wellbeing care plan was written for a person living with a learning disability. This included information on providing calm and relaxation, reassuring communication and gentle conversation to promote relaxation and reduce agitation. There was no positive behaviour support (PBS) plan. A PBS is a good practice approach used to support behaviour in a person with a learning disability. The focus is not on any challenging behaviour, but is based on the principle that if you can teach a more effective and acceptable behaviour, any anxious behaviours will reduce.

The provider told people about their rights around consent and respected these when delivering care and treatment.

People told us they could make every day choices such as when they got up or went to bed. One person said, “Staff come round about 6pm and ask when you want to go to bed. Sometimes, if I’m tired, I’ll say, ‘let’s go’. But if there’s something interesting on telly I’m reluctant to miss it. I’m left to my own devices.” People were routinely asked for their consent by staff before personal care was delivered. People communicated their wishes in a variety of ways. For example, 1 person moved their head up for ‘yes’ and down to indicate ‘no’.

Where required, capacity assessments relating to people’s ability to make specific decisions had been completed. If needed, decisions were made in people’s best interests where they had been assessed as lacking capacity to make specific decisions. The home worked within the principles of the Mental Capacity Act 2005 (MCA) and, if needed, appropriate legal authorisations had been applied for to deprive a person of their liberty under Deprivation of Liberty Safeguards (DoLS).