Boldmere Court Care Home Also known as 1-341197990

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant people’s needs were not always met.

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 were at the centre of their care and treatment choices.

Some people living with dementia required greater adaptation of care and communication to support them to express their preferences and make informed choices. We observed limited use of communication aids such as symbols, pictures, large-print menus, or visual meal options.

Meal choices were selected the day before food was served. For people living with dementia, difficulties with memory and recall may affect their ability to confirm or revisit these choices at mealtimes. During our observations, some people did not eat well, and we did not see alternatives being routinely offered in these instances.

We saw posters displaying the day's meal options; however, the images shown did not always reflect the food choices available. This created a risk of confusion and could affect people's ability to make informed choices about what they wished to eat.

We did not see menus with pictures or large print available to support people to understand the options on offer. In some cases, people were not told what meal they had been served. This was particularly evident for people receiving modified diets, such as minced or pureed meals, which were often difficult to identify visually. As a result, some people did not have accessible information about the food they were receiving, limiting their opportunity to make informed choices and express preferences about their meals.

Some people’s rooms were very personalised, reflecting their interests and history. Some people’s rooms lacked any personalisation. We spoke with one person whose room had bare walls. They told us they were pleased to be able to choose the colour of the paint when their room was due to be re-decorated. They said they would like to have their own photographs around the room, but this option had not been discussed with them.

Some people’s doors were labelled with their name to help them find their room. Others were painted in various colours like front doors but simply had numbers on them. This would make it potentially difficult for a person living with dementia to identify their own room. We raised this with the provider who advised that this issue would be addressed as part of the redecoration of the home.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Staff recorded ‘ABC’ records (Antecedent, Behaviours and Consequences) when people became distressed, and this resulted in actions that could pose risk to themselves or others. These records were designed to enable staff to better understand what could trigger distress in a person. For example, a person may find loud noises very distressing, so if others were shouting, this could cause them to feel agitated and result in aggression.

We saw the ABC and incident records were sometimes lacking in detail. This meant analysis of triggers, themes and trends was difficult to conduct. This also meant the information which could be shared with other services was limited and could impact upon the resulting quality of support. For example, a relative told us it was difficult to ensure their loved one retained the funding they needed for staff to support them to manage their risks. There were limited records of when the person had been distressed and needed extra support. It was therefore hard to evidence the degree of extra support the person had really required.

We shared this concern with the provider who gave assurances that they were focusing on supporting staff to record more detail for incidents and ABC records.

We saw other examples of the staff team working well to coordinate care with other providers. One person told us about the care they were receiving as a result of the staff and an external team working together well.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

There was signage and information around the home to assist and orient people living with dementia. However more work was needed to improve information provided to people.

For example, we did not see clear guidance and information around the home in large print or easy read formats to inform people about their rights.

Menus and food choices in large print and pictures were not present in the dining areas to help people make choices. People’s rooms were not always labelled in a way which could assist them to find their room easily.

We did see the date and time displayed around the home to help people to orient to time and place. We also saw the use of some signage to help people find their way to different areas of their home.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

Some people we spoke with told us they had expressed wishes and preferences which had not been listened to. These were mainly around their food choices. Some relatives also gave examples of care they had requested for their loved ones which had not been provided.

Most of the relatives we spoke with told us they had not participated in reviews of their loved one’s care. This meant opportunities to tailor care using the knowledge loved ones had about people’s wishes and preferences had been missed.

The provider told us about a meeting held with relatives after our assessment commenced. They told us they planned to consult with people and their loved ones to ensure their wishes and views were understood.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

We found instances where people who had sustained blows to the head or had unwitnessed falls did not receive care to monitor for head injury risk. This meant in some cases people who could not easily communicate were at risk of receiving less effective care. For example, if a person had an unwitnessed fall and could not say whether they hit their head, the possibility was not always considered. People who could report that they had hit their head did receive the care they needed.

The care home was purpose built and designed to enable people to move around the home with the use of equipment and adjustments as needed.

People had ‘hospital passports’ which were shared with emergency services and detailed people’s key needs and communication requirements. Staff told us about instances whereby they had attended emergency services with people to help them get the care they needed.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

More work was needed to ensure all staff understood the needs and wishes of people unable to communicate verbally. Records did not always evidence that people were being offered regular opportunities to drink and remain comfortably hydrated. Records did not always demonstrate people were receiving support to reposition at the intervals required to protect them from pressure wounds. These records related mainly to people who could not ask for this support.

Some of the people who could speak with us were not happy with the foods they were offered. However, they told us they were generally happy with other aspects of their care and how their health needs were met.

Systems were in place to monitor the quality of care for all people living at the home. These systems had not always ensured equality in the standards of care provided to people.

The provider gave us assurances that actions were being taken to better monitor and understand people’s needs. This would then help staff to remove barriers and delays to people receiving the care they needed.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Records detailed people’s wishes about how they wanted to receive care in the future. At the time of our assessment some people were receiving end of life care. Systems were in place to enable staff to quickly check about people’s wishes in the event of a medical emergency.

People had access to anticipatory medicines. This enabled staff and other teams to help people to remain comfortable and as pain free as possible.