Boulters Lock Residential Home

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 remained good.

This meant people’s needs were met through good organisation and delivery.

This service scored 82 (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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People’s care plans were comprehensive and included detailed information about every aspect of their lives. They were developed from the initial assessment and were regularly reviewed and updated as needed. Relatives told us, “It feels like we have had a few care plan reviews for [family member]. It was all done well and to our satisfaction” and “We were all involved with the care plan and we were all happy with it.” Care notes were kept electronically. These were completed appropriately and respectfully, and included details of any event, activities and interactions, and any healthcare concerns.

People told us they received person-centred care in line with their needs and preferences. One relative told us, “My [family member] is happy with their care and that is all that matters. If they weren’t they would definitely say something.”

There was a wide range of activities on offer which were varied, to suit everyone’s needs. 2 activity coordinators provided a programme of activities over 7 days. The registered manager told us, “We have been focusing on improving people’s quality of life. One way we have done this is by focusing on dream lists. The activities team have worked with people and relatives to find out what is on their dream list. No idea is too big or too small.”

One person used to work for a prestigious [Car company] and was interested in engineering. They were encouraged to be involved in projects with the maintenance team. The activities staff reached out to the car company to see if they could bring the person and their spouse over to have a look at some of the cars. This was organised, and as an additional surprise, the team had arranged a private tour and afternoon tea. They were also given a goody bag full of memorabilia. The registered manager told us, “Seeing the change in the person, from being quiet and not someone of many words, to not being able to hide [their] excitement was truly a magical moment.”

A person had recently been admitted to the service. it was identified there had been a decline in areas of their care such as continence, mobility, food intake and cognitive ability. The staff had observed the person seemed to have pain when mobilising. The GP was involved and prescribed pain relief. This meant the person was able to mobilise without discomfort using a walking aid and the support of one staff member. The person was also referred to a dietician and physiotherapist.

The home’s nutrition champion spent time with the person showing them pictures of different snacks and meals and the person was able to point out some of their favourite foods. This information was passed over to the kitchen team, who ensured these meals and snacks were provided. As a result, the person’s food intake started to increase, and they appeared to enjoy eating again. The registered manager told us, “The resident continued to go from strength to strength, and is now mobilising with a walking stick independently, gaining weight and is no longer having any concerns with [their] continence. It is lovely to see the resident smiling, joining in more with activities and overall appearing happy.”

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

People told us they received good care and their healthcare needs were met and relatives echoed this. People’s care plans described their healthcare needs and how to meet these. Some of the people had complex needs. We saw their care plans were detailed and personalised. There were clear instructions for staff to follow, so they understood each person’s condition and how it impacted on their daily lives.

The provider was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People’s communication needs were assessed during the pre-admission assessment so information could be made available to them in a format that suited them. People's care plans detailed their preferences and any aids they needed to support effective communication.

People and relatives told us that communication was very effective, and they were provided with all the information they needed.

The staff supported a person with a hearing impairment by using a whiteboard to write things down for them so they could remain involved with activities, understand what was happening around them and make choices for themselves. This had helped the person feel less isolated and anxious.

A person with advanced dementia and impaired vision found eating and drinking independently challenging. After spending time with the person, the staff team had identified the person was able to see the colour red. Involving the person, relatives and the kitchen team they were able to source red crockery. This had enabled the person to continue to enjoy their dining experience. The registered manager told us, “We have observed an improvement in the person’s food and fluid intake.”

Another person living with dementia had difficulty with verbal communication. The activities co-ordinator had created visual cards to help the person express their needs, wishes and preferences on a daily basis. The registered manager explained, “This has provided a positive outcome, and we continue to add to these cards for example using pictures of [their] personal belongings so [they] choose what [they] would like to wear, which toiletries [they] would like to use. Relatives have also started to use these cards when visiting and have adapted to a new way of communicating that works for their loved one.”

Another person who was partially sighted was supported to access talking books and newspapers, to fulfil their love of reading and current affairs. They had also been provided with a TV remote control with 3D buttons in blue and red, so they could use this independently. The registered manager told us, “This has been life changing for the person and [their] quality of life has improved significantly.”

People with visual impairments were supported to identify their bathrooms as the doors had been painted a bright colour. They were also supported to take part in activities by being given their activity planners in larger print and using a large tablet to complete crosswords.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

People and relatives were involved in the planning of their care and support. Care plans were reviewed regularly, and people and relatives were asked for their feedback about the care they received and anything they would like to change.

The provider ensured that people and relatives had the necessary information regarding processes for sharing feedback or raising concerns. Records showed complaints received were addressed in accordance with the provider’s policies and procedures. Any learning from complaints and concerns was shared with staff to inform their future practice.

People and relatives told us they felt able to raise any concerns or issues and had the opportunity to attend meetings. Their comments included, “Oh yes, I would say something if I wasn’t happy with things here” and “If there was something to complain about, I would pass that to my sister to deal with. You could go to any of the seniors here. They’re all good.”

Staff were encouraged to monitor people’s care to help identify issues before they could develop into complaints or concerns. There were regular meetings with people so they could raise concerns and make suggestions. The registered manager told us, “We also have daily chats with people, planned reviews and one to ones to discuss concerns. We have an open-door policy. We do ‘resident of the day’ to fully review their care and check the environment and any concerns they may have.”

The provider made sure that people could access the care, support and treatment they needed when they needed it.

People told us they had access to the care and support they required and were happy with this. They felt their needs were met, and the staff cared for and supported them effectively. Records showed they were supported to attend appointments, and a range of healthcare professionals visited the home regularly. A healthcare professional told us, “I believe that the feedback and recommendations I provide to the staff and the manager in particular are followed up on and that the relevant action is taken.” Records of visits were included in people’s care plans and the staff ensured they followed instructions.

People were supported to access the community, and the support they required to do so was planned and organised effectively.

Care plans were regularly reviewed to identify any changes in a person’s care needs so the appropriate support could be found if needed. This included making appropriate referrals to external professionals as needed.

Staff and leaders actively listened to information about people most likely to experience inequality in experience or outcomes, and tailored their care, support, and treatment in response. People's care and treatment promoted equality and protected people's rights. People told us they were consulted regarding their cultural and spiritual needs.

A person who had been recommended by the SALT team whilst in hospital to have a modified diet. However, the person had expressed their wish to eat a doughnut. A care meeting was organised with the person and the family to discuss this further. The person continued to express their desire to eat a normal consistency of food. The GP was contacted and a new referral was made to the SALT team to reassess.

The registered manager told us the person seemed to have lost their love of food and was starting to withdraw from activities. The person was made aware of the risks that could occur by eating their choice of food. With the support of professionals, and family members, a risk assessment was put in place. The registered manager told us, “The person is offered the choice of the modified diet and the normal consistency allowing [them] to make that choice each time. The resident is now 99 years old and has improved. [They are] now engaging in activities, talking more with others and shares a love for food again and even gaining weight.”

The provider had an equality and diversity policy in place and was committed to creating a welcoming and inclusive atmosphere for all people and staff, regardless of sexual orientation, gender identity, or gender expression. People were consulted in relation to their sexuality needs if they were comfortable discussing these.

People’s care plans indicated they had been consulted in decision making, including whether they preferred to receive care from a male or female care worker. Their care plans reflected people’s physical, mental, emotional and social needs.

People were given exceptional support to plan for important life changes, so they could makeinformed decisions about their future, including at the end of their life. However, this was not always a subject that people or their relatives were willing to discuss, and this was approached sensitively by the management team and the care team.

The staff received training in end-of-life care and understood how to support people when they reached the end of their lives. Details of people’s wishes were recorded in their care plans, so the staff would know how to meet their needs when the time came. People’s care plans outlined how they wanted to be cared for at the end of their lives. Some people had Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms in place. These documents record a person's preferences and clinical recommendations for their care during an emergency when they cannot make or express decisions for themselves. These were signed by an authorised clinician.

The provider was passionate about promoting a high quality of life for people, enabling them to live well and have a dignified, pain-free end of life. The home had met the necessary standards to obtain accreditation to the Gold Standard Framework (GSF). GSF is an approach to planning and preparing for end-of-life care. The registered manager told us, “This has really helped us embed high-quality person-centred care, not only in a resident’s final days but their final years.”

The provider ensured relatives were offered the support they needed to make a difficult time more comforting and reassuring. They had created a private area of the home for families and friends to be able to go to, when they needed time or a space. As part of the GSF, the provider held regular clinical governance meetings and had introduced a care practitioner role. This had been key to identifying early signs of health deterioration in people. This had resulted in a significant reduction in hospital admissions. A healthcare professional told us, “We have had some end-of-life patients, and they have been given a quiet, caring environment with room for their families to be with them.”

A person living at the service was able to be reunited with their spouse who was poorly and entering end of life stage. They were both supported to spend time together until the end, and specific end of life wishes were carried out, such as playing their wedding song in the background. The registered manager told us, “Everyone involved, relatives, people and staff all wore red socks in memory of the person (red was their favourite colour). The [spouse] continues to wear red socks every day in memory of [their] late [spouse].”