Bonhomie Sarisbury Green

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

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack capacity to. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to make a particular decision, any made on their behalf must be in their best interests and as least restrictive as possible. We found the service did not always support people in line with the MCA, and consent to care and treatment was not always sought in line with law and guidance. The service was in breach of the regulation in relation to consent to care and treatment.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although care plans were person-centred and contained information about people’s life histories, likes and dislikes, we found information was not always up to date or accurate. Staff we spoke with clearly knew people well and spoke in detail about how they supported people and their needs. However, different staff sometimes described supporting the same person in different ways, which at times also conflicted with the information in their care plan. This meant we could not be assured people were receiving consistent support in line with their needs and preferences.

The provider mostly planned and delivered people’s care and treatment with them, including what was important and mattered to them. We saw people’s care plans were discussed at monthly key worker meetings, and people told us they felt involved in their care.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

We received positive feedback from health and social care professionals about how the service worked with them. They told us, “I have worked in collaboration with both the manager and care staff”. Another commented positively about a staff member’s skill in supporting a person to engage with them. This meant they were able to gather the person’s views and wishes effectively.

The provider mostly supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff mostly supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff used a nationally recognised evidence-based tool to identify and respond to early signs of deteriorating health. We saw evidence staff used this effectively to support escalation and communication with health professionals.

People had keyworkers who were responsible for reviewing areas of people’s care with them monthly. This included areas such as care plans, risk assessments, goals and achievements, health support and actions to be completed and monitored. However, we found this was not always effective. For example, although a person’s behaviour charts showed multiple incidents with clear potential triggers, we did not see these were explored or discussed. However, this was an area the provider was actively working on improving and we received positive feedback from health and social care professionals. One said, “[people] I have placed there are very happy, and their wellbeing has improved since their placements”

The provider did not always act in accordance with the Mental Capacity Act (2005) and associated code of practice. Processes for obtaining consent did not always follow current legislation and guidance.

When decisions were made on people’s behalf, decision specific mental capacity assessments and best interest meetings were not always completed in line with the Mental Capacity Act (2005). When mental capacity assessment records were completed, they did not demonstrate how people were assessed as lacking capacity, or that best interest decision making processes were followed to ensure the least restrictive option. One person’s mental capacity assessments all stated they lacked capacity ‘due to [person’s] severe learning disabilities’. This was not in line with the code of practice, which states a person’s capacity must never be based simply on assumptions about their condition, to ensure people’s rights are upheld.

A provider audit identified mental capacity assessments were not always completed and noted this was ‘due to being a residential home’ and management were not trained to do so. This demonstrated a lack in the provider and management’s understanding of their responsibilities under the MCA.

However, we observed staff seeking consent before supporting people, and staff we spoke with told us how they sought consent. A staff member told us what they would do if a person refused their medicines and explained how they respected a person’s right to refuse while supporting them to maintain their health.