Bosun Care Limited

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 of the provider’s previous registered location, 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.

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. People’s support and care requirements were assessed before people transitioned into the service to ensure the service could meet their needs. We were told people were involved in the assessment and review of their needs however this was not evident in their care records. We were told people’s needs were routinely reviewed or reviewed after incidents but impact and recording of the reviews were not always clear.

People’s communication needs had been assessed and were being met by staff. However, people were at risk of being unable to express their views because their preferred and unique forms of communication had not been documented to guide staff who may not be familiar with their preferred ways of communicating.

Documents had been created to share with professionals and health services in the event of an emergency. However, not all the documents contained key information which may assist professionals in communicating and supporting people in an emergency. The registered manager agreed to review these documents.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People’s care and support was not always delivered in line with legislation and current evidence-based good practice and standards. There was not always evidence care and treatment had been delivered in line with people’s assessed needs. The provider had not implemented appropriate tools and monitoring systems in line with good practice and standards when supporting people with a learning disability and autistic people such as the REACH standards and CQC’s Right Support, Right Care and Right Culture guidance. Effective systems to monitor and manage people’s routines and specialised health needs and other areas of risk such as people’s nutrition and hydration needs were not in place.

The provider generally worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. The registered manager and senior leadership team mainly worked well with key professionals and escalated concerns when needed. However, one professional linked to the service felt the service was not always responsive to their requests.

As a result of specific incidents, the provider had actively reviewed their processes and was in the progress of implementing an internal Multidisciplinary Team (MDT) with the aim to provide expertise and oversight around certain areas of peoples care and promote an integrated and person-centred framework.

Systems were in place to scrutinise and manage the staffing levels and experience of people and to ensure they had the right level of staff support. Staff reported they worked well together and there was a clear management structure to report any concerns.

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.

There was limited evidence showing how people were empowered and supported in managing their own health and wellbeing needs or involved in regular reviews of their health and medicines.

People’s care records lacked details regarding routine health and medication reviews, maintaining a healthier lifestyle, and the necessary support for early health risk identification and preventative actions tailored to people’s individual health and risks.

We found people’s care records prompted staff to encourage people to make healthier choices such as healthy diets. However, on reviewing people’s daily records, it was evident on occasions people had not been supported to eat healthy meals in line with professional recommendations.

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 andconsistent, or that they met both clinical expectations and the expectations of people themselves.

The registered manager and deputy manager regularly visited people’s homes to oversee the care being provided and to monitor people’s well-being. However, there was inconsistent practices by staff or managers to record their observations and monitoring of people’s risks, including body positioning charts and weight as well as changes in people’s emotions. This meant the registered manager could not be assured people’s care was being delivered in line with their care needs.

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

Whilst staff understood the importance of obtaining consent before delivering care and had received up to date training around the Mental Capacity Act (MCA); their evidence of providing people with choice about how they wished to live their lives was not always clear. Staff daily records did not always evidence why decisions had been made in people’s best interest. This meant people may not be living a life of their choice or as required in their best interest.

However, we found some evidence of mental capacity assessments and best interest meetings around specific decisions and assessments being completed for people who may lack or have fluctuating capacity and inconsistent decision making.

People’s relatives spoke positively about how staff supported their family member and provided them with choice. They said, “Yes most definitely, they treat him with such kindness and compassion that I don’t even have the words for it" and “They support him to be as independent as possible."

Where required, people had been supported to access external advocates who acted in their interests to help resolve concerns or make specific decisions.