Burrow Down Community Support

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• 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 safe care and treatment, safeguarding, person-centred care, dignity and respect, need for consent and good governance.

This service scored 33 (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’s care and treatment were effective because they did not check and discuss people’s health, care, wellbeing, and communication needs with them.

The provider had systems and processes in place to help ensure people’s needs were fully assessed prior to offering support. However, the registered manager informed us assessments were not always completed before people began using the service. For example, people who had previously accessed the provider’s short break service did not have their needs reassessed before transitioning to supported living services. Additionally, following the acquisitionof another service operated by the provider’s parent company, the provider agreed to deliver care and support without carrying out assessments of people’s individual needs.

The provider’s failure to ensure staff completed pre-placement assessments and developed care and support plans that accurately reflected people’s needs and preferences contributed to a breach of regulations relating to person-centred care and safe care and treatment. For further details, refer to the Safe Systems, Pathways, and Transitions and Involving People to Manage Risks quality statements.

Other assessments of people’s needs did take place and were used to develop individualised care and support plans.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

We found a lack of understanding across all levels of the service regarding how to appropriately support people in the community. This contributed to a poor culture in which people’s dignity was compromised, and they were not treated as equal partners in their care and support. For example, people’s homes were not respected as their own, with staff entering and exiting freely without consideration. People were not always given a choice over who supported them, how they shopped, or what they ate.

Although support plans and risk assessments were in place to help ensure care was delivered in line with best practice guidance, they were not consistently followed. This led to failures in escalating concerns and contributed to the development of a closed culture which contained elements of institutionalised practices. For example, staff were trained but did not apply person-centred approaches. The language used in some daily records and incident reports was often disrespectful, and some people were subjected to punitive practices. These issues were compounded by a lack of oversight from both the management team and the provider.

This contributed to a breach of regulations relating to person-centred care, dignity and respect, safe care and treatment, safeguarding, staffing and good governance.

However, staff knew people’s likes and dislikes and appeared to have a good awareness of people's dietary needs. Care records highlighted where risks with eating and drinking had been identified. Where people needed a specific diet, this was provided in line with their assessed needs.

The provider had systems and processes in place to effectively share information about people with the local hospital, their GP practice and primary care health services.

Records showed how the service worked with healthcare professionals to develop people’s care and support. However, several relatives raised concerns about how the service involved them and kept them informed when changes occurred. One relative commented, “There is no contact. When [Person’s name] first went there, we had a weekly update. Now we are kept in the dark. No communication.” Another said, “Communication is poor. I only met the manager yesterday. Before that, I didn’t know who they were, and [Person’s name] has been there for 3 years.” This contributed to a breach of regulation relating to person-centred care.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or, where possible, reduce their future needs for care and support.

While people were supported to access healthcare services such as GPs and district nurses, attend appointments, and participate in activities, there was a lack of understanding around how to support people in a person-centred way that empowered and encouraged healthier lifestyle choices. This included areas such as diet, exercise, and daily routines. For example, rather than supporting people to shop at their local stores, most were encouraged to shop online. When asked, the registered manager said this approach was more convenient for staff. We found staff often pre-planned people’s menus, limiting their ability to change their minds or choose what they wanted to eat. In one instance, staff told one person they could not have a meal they requested, even though it was available, because it was not on the planned menu. Following the inspection, the provider informed us that our findings were not representative of everyone’s experience, as some people were fully involved and supported by staff in meal planning and budgeting.

Additionally, staff placed restrictions on access to areas of people’s homes, such as kitchen cupboards, to monitor food intake, without having the legal authority to do so. Although most people had access to their own mobility vehicles, the lack of recruited drivers meant they were often unable to go out as they wished.Following the inspection, the provider told us ‘A lack of drivers is a sector-wide issue and not unique to Burrowdown support services. People were supported to being supported on walks and using public transport.”

This significantly impacted their dignity and independence, as staff did not afford them the same rights as anyone else. This contributed to breaches of regulations relating to person-centred care, dignity and respect, safeguarding, and good governance.

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

The provider had systems in place to ensure people’s care and support was continuously monitored and reviewed to promote good outcomes for people. Support plans were informative and provided staff with detailed information on people’s likes, dislikes, personal preferences, care needs and medical history. This enabled staff to support people in the way they wished. However, we found staff did not always support people in line with their assessed needs, and reviews did not consistently take into account all available information. For example, information recorded following incidents was not used to update support plans or inform staff practice. This represented a missed opportunity to identify and address poor practice. This contributed to breaches of regulations relating to person-centred care, safe care and treatment and good governance.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

The provider had policies and procedures in place to support people in understanding their rights. Records showed, and staff confirmed, training had been provided in safeguarding adults, the MCA, and Deprivation of Liberty Safeguards (DoLS). The registered manager and staff spoke about the importance of obtaining consent and following the principles of the MCA. However, this knowledge was not consistently applied in practice. While some documentation relating to capacity assessments and best interest decisions was informative and of good quality, other people had not had their capacity assessed, nor had staff followed a best interests process. For example, staff were holding people’s money and door keys without having assessed their capacity to consent to these arrangements. Nor had staff followed a best interests process, as required under the Mental Capacity Act 2005.

People were not always supported to make decisions about their care, and some staff did not fully understand their roles and responsibilities under the Mental Capacity Act 2005 (MCA), including Deprivation of Liberty Safeguards. This meant people who lacked capacity or who had fluctuating capacity did not always have decisions made in line with current legislation. For example, where staff restricted access to personal belongings or areas of their homes. Staff did not recognise this as a restrictive practice, and the person’s capacity to consent to these arrangements had not been assessed, nor had staff followed a best interests process.

We also noted, following the closure of another service operated by the provider’s parent company people were not given the opportunity to choose who would deliver their care and support in line with their basic human rights.

The failure to properly assess and record people's capacity and best interest decisions risked compromising people's rights. This contributed to a breach of regulation relating to the need for consent, person-centred care, dignity and respect, and good governance.