Bonhomie House

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. They did not always work in partnership with people to decide how to respond to any relevant changes in people’s needs.

Care plans were sometimes out of date or lacked detail about people’s physical, emotional, social, or cultural needs. This meant staff did not always have the right information to provide care that matched individual preferences.

People and relatives gave mixed feedback. Some enjoyed activities, but others said there were few opportunities for meaningful engagement, especially outside the service. Our checks supported this. For example, daily notes often lacked detail about activities and whether they were meaningful for the person and we saw missed opportunities for people to experience meaningful interactions.

Some people told us they wanted more chances to go out into the community. Limited access to adapted vehicles and staff availability sometimes caused delays or reduced opportunities. While we saw some positive 1:1 sessions, there were missed chances to involve people throughout the day.

The provider told us they were trialling person-specific activity plans to make activities more meaningful. However, these improvements were not yet fully in place at the time of our assessment, so we could not confirm their effectiveness.

The service did not always fully understand 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.

Care plans for people’s health conditions were sometimes unclear or lacked detail. This meant staff did not always have the guidance needed to provide responsive care or ensure health needs were well understood and planned for.

Feedback from people and relatives was mixed about how involved they felt in care planning and reviews. Some told us they were included and informed, while others said they wanted more involvement in decisions about their health and support needs. Feedback also reflected concerns that people’s health conditions were not always fully understood and that some staff lacked the skills and training needed to support joined-up care.

However, staff and leaders told us, and records demonstrated, how they worked with other professionals involved in people’s care. The provider was working closely with external professionals to improve care planning and coordination. This included updating care plans to better reflect health and support needs, helping ensure people experienced greater continuity and flexibility in their care.

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

People told us they were supported to make everyday choices. However, we observed this was not always consistent in practice. While some staff actively encouraged people to make decisions and respected their preferences, others did not offer the same level of support. This inconsistency meant people were not always fully supported to exercise choice and independence.

Although individual communication needs were recorded in care plans and staff could describe people’s preferences, these were not always applied consistently. For example, staff told us that visual communication tools, such as timetables used to support daily routines and choices, were not always used in the same way. Approaches sometimes differed between staff, which meant the tool was not always led by the person’s preferences and could reduce its effectiveness in supporting choice and independence.

We observed some positive practice where people were supported with their preferred communication methods to make choices. However, feedback from staff indicated this was not consistent across the staff team.

People and their relatives could share feedback and raise concerns, but the systems did not always work well. Staff did not always involve people in decisions about their care or explain what had changed as a result. When issues were resolved, this was not always communicated, which sometimes led to uncertainty and repeated concerns.

Most people felt comfortable speaking to staff and the manager, who was described as approachable and responsive. We observed the manager following through on commitments and maintaining a visible presence in the service. However, some people felt action taken was not always effective.

Communication within the service was sometimes poor. People and staff were not always told when issues had been resolved. For example, a premises problem had been fixed, but some staff and people were unaware, leading to decisions based on outdated information.

While some people and relatives said they did not always feel listened to or that action was taken quickly, they noted this was improving. One relative told us, “New manager, she’s sorted problems.” Another said, “They’ve changed management there and in a short time it’s got a lot better. A clear vision of what they’d like to do.”

Improvements were not yet fully embedded, and we identified instances where communication remained poor. The provider had recognised this and were taking steps to strengthen communication systems and processes within the service.

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

Leaders demonstrated a clear understanding of how to support people to access specialist health and social care services. This included making referrals to external professionals such as mental health services and speech and language therapists when required. People and relatives confirmed they had been supported with referrals to relevant services and professionals. For example, 1 relative told us of a referral in progress in relation to equipment to support moving and handling.

Arrangements were in place to ensure staff had access to support during emergencies, even when a member of the leadership team was not on site. Staff confirmed these protocols were in place and understood.

The provider told us they had identified that equipment recommended by professionals to support discharge home had not always been arranged promptly. Relatives confirmed that equipment had not always been available when needed. The provider had improved these arrangements to ensure timely access to essential equipment, reducing delays in care and support.

These actions reflected a proactive approach to maintaining access, particularly during periods of operational pressure.

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.

Due to shortfalls identified in care records, daily documentation, risk management, and the delivery of care in line with assessed needs, we could not be assured that the provider consistently tailored care and support to individuals. These gaps increased the risk that the service could not consistently or effectively identify or respond to the needs of people most likely to experience inequality in outcomes.

Feedback from people and relatives was mixed. Some felt their needs were understood and respected, while others told us they wanted more involvement in planning and reviews to make sure care reflected their preferences and health needs. Some relatives also expressed concerns that staff did not always have the skills or training to support people with more complex needs.

Although leaders and staff demonstrated a commitment to supporting people’s rights and wellbeing, the lack of consistent, person-centred planning and delivery limited the provider’s ability to remove barriers, promote equity, and protect people’s rights in practice.

People were not always 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.

Care records lacked detail about whether people were consistently supported to identify and work towards personal goals, or whether discussions about end-of-life care had always taken place. While some systems were in place to support these conversations, records did not always show how they were used in practice.

People told us about things they were working on, or looking to achieve, and spoke positively about specific staff who were supporting them with this. However, this was not always reflected in care documentation. We also received mixed feedback from staff about their awareness of people’s goals and the consistency of support provided. This limited assurance planning for future care was embedded and monitored.

These gaps reduced the provider’s ability to make sure people’s wishes were understood and respected and to help them plan ahead for important changes in their lives.