Boroughbridge Manor and Lodge Care Home

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.

This service scored 58 (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’s needs were thoroughly assessed and included all aspects of the care and support needs, including their physical, mental, sensory, social and communication needs. People were involved in these assessments wherever possible, and their relatives where required, were also involved. Assessments were reviewed regularly with both people and relatives, and when changes were made the reasons for these were noted.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. However, it was not always clear that people’s nutritional and hydration needs were met.

Support plans contained a good level of detail about people’s dietary needs, for example, where they needed textured diets or were at risk of malnutrition. Tools to support this were used effectively and appropriate professional involvement was sought through regular monitoring of people’s weight. However, we observed staff were not proactive in ensuring people had enough to eat or drink. For example, we observed people who had not eaten any food and had not been encouraged by staff to do so. People who live with dementia are often needed to be reminded about eating and drinking and we observed this did not always take place. One person was at risk of constipation and their care plan said this person should have a high fibre, fruit and vegetable diet. However, because this person was not classified as high risk, food monitoring was not undertaken. For example, one person’s care record said staff should monitor them for signs of dehydration and had a fluid goal. However, it was not clear what that daily fluid goal should be. We discussed this with the deputy manager who confirmed they would review this person’s care plan with the person and their family.

One person who had a catheter had their urine output monitored. However, on the instances where their output was low, there was no record of any action taken by staff. This meant this person was placed at an increased risk to their health. Where people were at risk of developing pressure sores, records showed staff did not always reposition them in the required timeframe to reduce the risk. We discussed this with the registered manager who said this was due to the time staff recorded the reposition rather than the time the repositioning took place. The registered manager told us this would be discussed with staff, and they were considering increased checks on repositioning records.

The provider 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.

Robust systems were in place so that staff had a good understanding of people’s needs and shared these appropriately with other professionals. Information sharing was appropriate and easily accessible to partner organisations, where required. Staff made detailed notes about other professional involvement and systems were in place to adequately chase support, when needed.

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. However, not all people had effective support in place.

People generally had their health and wellbeing needs met. People were supported to access GPs when needed and the service was proactive in working with GPs to review and manage medicines. Comments from people included, “I see the doctor if I need to” and “I see the GP and the chiropodist”.

Staff made appropriate referrals to specialists such as falls prevention and speech and language. However, we identified not all people were adequately supported with their health needs. For example, adequate fluid intake and output monitoring had not taken place for one person, which had the potential to adversely impact their health.

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 both clinical expectations and the expectations of people themselves.

Care and support plans reflected people’s expectations and goals. Detailed information about how staff should support people to meet these was recorded. However, we observed staff did not always engage in any meaningful conversation with people to support their emotional needs and interactions were not adequately recorded in daily notes. We identified this had been discussed with staff at recent team meetings and staff were encouraged to do so. This had not had time to become embedded.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment but did not always provide the appropriate support for people who were deemed to have capacity.

People’s rights and decisions around consent were understood and respected by staff. Staff understood the importance of seeking consent when delivering all aspects of care, and respected people’s choices. Assessments and decisions around consent were appropriately recorded. However, the service had not always identified the additional support people may need when they have capacity, for example, in accessing independent advocacy services or understanding decisions. These were not always appropriately recorded.