Archived: The Brookland

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 Good. At this assessment the rating has changed to Inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to the provider not adhering to the principles of the Mental Capacity Act 2005. People’s health needs were not always assessed, reviewed or monitored.

This service scored 29 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them. Whilst we saw care plans were reviewed by the provider; they were not always updated with the most accurate information around people’s needs. There was a lack of guidance in the care plans around how to support people with their mental health needs. There was no evidence that people had been involved in the reviews of their care.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards. People did not always receive support that was in line with good practice standards to ensure compassionate and therapeutic care and support. Whilst there was a copy of Malnutrition Universal Screening Tool guidance in care plans, leaders and staff were using this information to determine whether people were nutritionally at risk. For example, 1 person had gained weight over the last 2 months. We saw the GP had stated the person was at risk of high cholesterol and their health and weight needed to be monitored. Their nutrition care plan still related to their weight before the weight gain. This lack of monitoring placed the person at risk.

The provider did not work well across teams and services to support people. They did not always share accurate information to health care professionals. For example, in relation to people’s seizures, nutritional information and people’s sleep patterns. We saw information fed back to health care professionals around these needs did not match the information held on records and information provided to us by the provider and staff. For example, the provider said of a person’s seizures, “X’s epilepsy is so stable, very minor ones, 1-2 minutes or less.” However, the records showed the seizures were, for the majority of time, longer than this.

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. People were not supported to increase their daily exercise to improve their health.

We saw people had attended other health appointments including visits with consultants, dentist, opticians and breast screening.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. The provider told us they reviewed a person’s seizures records and that the seizures were ‘silent’ (a brief loss and return of consciousness). However, we saw from care records and with discussions with staff, the person’s seizures were more significant than this. There was no monitoring of people’s wellbeing and mental health needs.

The service did not consistently act in accordance with the requirements of the Mental Capacity Act 2005 and associated code of practice, or their own MCA policy. For example, a person’s mental capacity assessments documented multiple different decisions. There was no evidence about how the person was involved in the assessment, how information was provided or what adjustments were made, and what the person’s views were. Often the same information was repeated around the person’s health diagnosis as the reasons for concluding they either had capacity or not. The capacity assessment failed to provide details about other named professionals and family members involved or what decisions were made in the person’s best interests or whether least restrictive options had been considered.

Where the provider told us a person’s family had Power of Attorney over a person’s health and welfare there was no evidence of this. This meant the family may make decisions around a person’s health where they did not have the legal authority to do so.

The provider had also not submitted an application to the local authority where a person had been deprived of their liberty (DoLS) including the locked front door. Submitting a DoLS to the local authority is a legal requirement.