Burrow Down Shortbreaks

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• 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 requires improvement. This meant the effectiveness of people’s care, treatment, and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to the need for consent, safeguarding and good governance.

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 had systems and processes in place to ensure people’s needs were fully assessed before support was offered. However, staff were not always following the provider’s processes. For example, we looked at care records relating to the last two people who had been offered support by the service. One person’s assessment had been completed several months before they moved in, and another person’s assessment had been shredded and was therefore unavailable for review. This contributed to a breach of regulation relating to good governance.

Other assessments of people’s needs did take place and were used to develop individualised care and support plans.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Systems were in place to ensure care was delivered in line with best practice guidance. For example, nationally recognised risk assessments were used to assess risks, such as the Malnutrition Universal Screening Tool (MUST) and Water Low Risk Assessment. However, we found people’s care records were not being regularly reviewed or did not contain sufficient information to mitigate risks. For example, in relation to effective epilepsy, diabetes, or oral health care.

Staff had received training to ensure they were informed about and kept up to date with best practice guidance. Although, we found training did not always determine practice.

Staff knew people’s likes and dislikes and appeared to have a good awareness of people's dietary needs. However, care records did not always highlight where risks with eating and drinking had been identified. This contributed to a breach of regulations relating to safe care and treatment, and good governance.

Relatives spoke positively about the care and support people received. One relative said, “Both my relatives have been using this service for 8 years and are happy.” Another said, “They know my relative well, and she is happy to go there. I am happy with all that they do.”

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.

The provider had systems and processes in place to effectively share information about people with the local hospital, their GP practice and primary care health services.

Records showed how the service worked with healthcare professionals to share important information quickly. For example, most people had a hospital passport, which enabled the effective sharing of information.

Staff had access to people’s care and support plans to understand people’s needs and deliver their care. Daily handover meetings along with the computerised care system help to ensure all staff had access to the most up-to-date information for each person they supported.

One staff member said, “The team work well together, and the team meetings we have regularly are really beneficial. We go through each client and go through our concerns, and we also get feedback and constructive criticism.”

A relative said, “Communication with the service is very good, the registered manager and staff are all very approachable and keep us updated.”

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

People were supported to access a range of healthcare services such as GPs, dentists, opticians, and local mental health support. Records showed, and staff told us, they reported/escalated concerns with regards to people’s health to the management team and made referrals to healthcare professionals as needed. The registered manager said regular handovers enabled the sharing of information about people’s health needs.

Relatives had confidence in the staff and told us their loved ones were supported to manage their care, support and health needs by staff who knew them well. One relative said, “The manager is a good manager who is approachable, available, and cooperative. If they have any concerns, or my relative is unwell, they will ring me.” Another said, “If my relative is unwell, they call the GP. One time, they had to call 111, and they did let me know.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive andconsistent, or that they met both clinical expectations and the expectations of people themselves.

The provider had systems in place to ensure people’s care and support was continuously monitored and reviewed to promote good outcomes for people. The registered manager and staff described how they monitored people’s health and care needs regularly to ensure risks were mitigated and people received care according to their assessed needs. Some support plans were informative and provided staff with detailed information on people’s likes, dislikes, personal preferences, care needs, and medical history. However, some lacked detail of the support people needed to meet their assessed needs, develop life skills, and increase their independence, which meant staff did not always have the information they needed to meet people’s needs safely, as identified within the safe section of this report.

Support plans were not accessible to people, and there was limited information to show how people were involved in developing their care and support. More work was needed to ensure people were truly involved and seen as partners in their care.

Reviews of people’s care and support failed to identify the concerns we found at this assessment. This contributed to breaches of regulations relating to safe care and treatment and good governance.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. 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 take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

The provider had policies and procedures in place to support people in understanding their rights. Records showed, and staff confirmed, training had been provided in safeguarding adults, the Mental Capacity Act 2005 (MCA), and Deprivation of Liberty Safeguards (DoLS). The registered manager and staff spoke about the importance of obtaining consent and following the principles of the MCA. However, this knowledge was not consistently applied in practice. For example, the registered manager told us they had applied for DoLS for all people receiving support at the service, as they would not be allowed to leave the service without staff, due to safety concerns. However, staff had not carried out any best interests’ decisions and MCA assessments were not available for review at the time of the assessment.

Two people were receiving covert medicines (without them knowing), as part of their planned care arrangements. However, staff had not carried out mental capacity assessments, nor had they followed a best interests decision-making process, as required under the Mental Capacity Act 2005.

People were not always supported to make decisions about their care, and some staff did not fully understand their roles and responsibilities under the MCA, including DoLS. This meant people who lacked capacity or who had fluctuating capacity did not always have decisions made in line with current legislation. For example, where staff restricted access to 1 person’s personal belongings. Staff did not recognise this as a restrictive practice, and the person’s capacity to consent to these arrangements had not been assessed, nor had staff followed a best interests process.

The failure to assess and record people's capacity and best interest decisions risked compromising people's rights. This contributed to a breach of regulation relating to the need for consent, safeguarding and good governance.