Boldmere Court Care Home Also known as 1-341197990

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 the same.

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 providing person centred care.

This service scored 42 (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 individual needs and preferences were not always clearly documented in their care plans. The majority of people living at the home at the time of our assessment could not easily communicate their needs and wishes.

Guidance in care plans for people whose distress could sometimes lead them to pose a risk to themselves or others sometimes lacked detail. For example, guidance sometimes lacked detail about what could help to calm them or was too generalised in nature. This meant people were at risk of receiving ineffective and varied responses to supporting them to manage distress.

We saw that people’s needs were routinely reviewed. However, most of the relatives we spoke with told us they had not participated in the reviews of people’s care. Some said they had initially helped to develop a care plan but had not been asked to participate in further reviews. One relative told us they had never been asked about the needs and wishes of their loved one. Speaking to relatives is particularly important in ensuring people’s needs and wishes are understood, when they cannot easily speak about these themselves. We shared this feedback with the registered manager, who told us plans were underway to include relatives in future care reviews.

A recent audit of care documentation had identified the need to gather more information about people’s needs and wishes in relation to their gender identity and sexuality. Work was underway to gather and record this information.

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

Some of the people we spoke with told us they were unhappy with the meals they received. Some told us they were not receiving meals which were appropriate to their cultural preferences and beliefs. For example, one person told us the range of meals for vegetarians was limited and they tended to be offered the same meals a lot. Those who were unhappy about the choices of meals and the quality of the food offered to them said they had asked for specific meals. However, they said their requests had not been met.

Some staff told us they were aware that people were not receiving the meals they wanted to eat. They told us they felt it was unfair and that providing the meals people wanted could improve the quality of their lives.

Some staff and a relative told us people who needed modified diets to help them manage choking risks were not receiving a choice of meals. They also said they tended to be offered the same meals a lot. Our observations also supported what the relative told us about choice for modified diets. People who did not need modified diets were offered choices. One relative told us they were so unhappy that their relative was being offered the same meal practically every day, they had started to bring in meals themselves.

We also saw people living with dementia were not always supported to make choices about their meals. We saw for example one person was struggling to respond to a verbal choice of meals offered to them. The staff member appeared to make the decision for them. We did not see people being offered plated options or pictures of meals to help them to decide.

Records for one person who was being monitored for the risk of weight loss, showed they were sometimes being offered the same meal twice per day. The meals they were eating were not being recorded in enough detail to help staff understand what they were enjoying and what they liked less.

Staff and people we spoke with told us they were generally not offered any fresh fruit. We saw people were not offered any choice of drink during lunch and were simply given a cup of squash to drink.

We shared these concerns with the management team. The provider told us they would gather details of everyone’s food preferences and needs so that they could be incorporated into the regular menu.

The provider did not always work well across teams and services to support people.

Guidance for staff on responding to head injuries and unwitnessed falls lacked sufficient detail. Policies and procedures did not prompt staff to consider the specific risks associated with unwitnessed falls, including the possibility of a head injury where a person was unable to explain what happened. This created a risk that people may not receive appropriate care for potential head injuries.

Staff guidance also did not identify facial injuries or blows to the face as possible indicators of a head injury. As a result, people did not always receive appropriate head injury monitoring, and concerns were not consistently escalated to emergency services when required.

When we raised this with the provider, who updated the policies and procedures very quickly.

We saw other examples of effective communication between teams and external services. For example, specific signs of possible infection were shared during handover between teams, and the GP was asked to review people’s symptoms.

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.

The failure to ensure people were offered meal and drink options which they wanted meant some people were at risk of not eating and drinking as much as they might if their options were more appealing to them.

Records of what people were eating and drinking were not always detailed enough to inform plans to provide nutritious meals people were more likely to choose. We saw a lack of evidence for some that fluid consumption was being monitored effectively.

We shared these concerns with the provider; they put plans in place to better record and monitor people’s food and fluid consumption and offer more of the foods they wanted.

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.

A relative said they were concerned their loved one often seemed thirsty and would consume a whole drink at once when they offered it. They observed that drinks were offered to people infrequently during their visits. We reviewed 1 person’s records and saw gaps in fluid consumption records of several hours on some occasions. We saw although total fluids consumed were calculated in care records through the day, there was little evidence fluid totals were regularly checked to ensure they were sufficient. The gaps of several hours in between drinks records were during hot weather. This left the person at risk of feeling thirsty for many hours. We raised this with the provider. A system was introduced to the nursing team to monitor fluid consumption over a 24-hour period for people deemed at risk of dehydration.

Some people were cared for mainly in bed or had limited mobility, increasing the risk of developing pressure injuries. Care plans and risk assessment included guidance to reduce this risk, such as supporting people to change position at intervals tailored to their needs.

However, records did not consistently demonstrate that people were receiving this support. Whilst we saw evidence pressure wounds had been managed effectively and healed well, staff were not always able to evidence regular repositioning through their records. Monitoring processes had not identified this issue. We shared our concerns with the provider, who took steps to remind staff of the importance of accurately recording these interventions.

The provider told people about their rights around consent. They ensured people’s capacity to consent to care and treatment was assessed and reviewed regularly. Capacity assessments detailed how staff and others important to people had contributed to consideration of what decisions people could make and what they may need help with. Best interests decisions were recorded to detail how decisions about the use of, for example, bed rails and CCTV in the home were necessary and beneficial to people’s wellbeing. However, we saw some records which did not demonstrate people’s refusal to consent to care was balanced against the risks of not providing the care. We also saw an incident where a person was physically prevented from doing what they wanted to do. In this instance the person’s resistance to engaging in what was planned for them was not recognised as a form of refusal. The provider developed an action plan in response to these observations to improve staff understanding of supporting choice and using restriction as a last resort.