Merle Boddy House

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

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service 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. People’s care records lacked required details around the management of risks associated with specific long-term conditions, or where they were prescribed certain medicines. There was a lack of guidance in place around how staff should respond in the event a person sustained a suspected head injury to ensure emergency services were called for further medical input and advice. Most people at the service would need support to safely leave the building in an emergency such as in the event of a fire. There was a lack of clear guidance for staff to ensure they knew how to evacuate people safely. The plans in place had not accurately considered the number of staff required to support people to evacuate.

The service 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. We identified limited use of recognised assessment tools as part of the care and support model in place within the service. We identified use of a monitoring tool for malnutrition, which was not valid for use with certain individuals to ensure accurate oversight was in place. We could see some indication of involvement of people in the development of their care and support plans, however, leaders identified further work around involving people and their relatives was needed.

The service did not work well across teams and services to support people. They did not share their assessment of people’s needs when moving between different services. We identified examples of where risk information was not being shared between the service and external day services people attended. This did not ensure suitable management of risk and demonstrated a lack of communication arrangements in place. Staff relied on accurate information being recorded on the service’s electronic care records system, to ensure they were aware of any incidents or accidents that happened prior to their shift. The quality and level of detailed information, particularly in relation to accidents and incidents was found to vary in quality and the level of detail recorded. This did not ensure safe and effective communication across shifts.

The service did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. The service did not support people to live healthier lives, or where possible, reduce their future needs for care and support. From reviewing people’s daily records, we identified some people’s nutritional intake lacked variety, to ensure they received a balanced diet. We identified concerns in relation to the monitoring of people’s weight and associated nutritional risks. These findings were of particular concern for people diagnosed with health conditions increasing their risk of weight changes, and where their care plans stipulated the need to try to maintain a balanced diet.

The service 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. We found a lack of monitoring arrangements in place to identify themes and trends for example in relation to people who experienced regular falls. Poor oversight of incidents within the service did not ensure people were kept safe, or experienced improved care outcomes. People’s overall quality of life varied, and in part was linked to funding arrangements in place for 1 to 1 support and time spent in the community.

The service did not tell people about their rights around consent or respect these when delivering care and treatment. The quality of mental capacity assessments varied, and we found some were recorded retrospectively which was not best practice. We identified some staff lacked training around how they interacted and sourced verbal consent from those people experiencing changes in their capacity, including people living with dementia. We observed some staff to rush people for answers rather than afford people more time to respond and answer questions at their own pace. Some written records did not demonstrate staff awareness into the level of understanding and insight people had following incidents, with records indicating people were being reprimanded.