Merle Boddy 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 service met people’s needs. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. This meant services were not planned or delivered in ways that met people’s needs.

This service scored 36 (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 were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs. We identified restrictive practices within the service, impacting on the level and quality of person-centred care provided. Some areas of people’s care and support plans required further collaborative development to ensure people’s own wishes and preferences were reflected, as well as specialist advise from professionals. We identified a risk that staff had known people a long time, therefore made decisions for some people, and based these on past wishes and preferences, rather than continuing to offer choice. Limitations within the care environment impacted on the level of reasonable adjustments that staff were able to make to meet people’s changing, longer term physical and sensory needs.

There were some shortfalls in how the service understood 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. People were not always receiving care reflective of their individual risk histories, to ensure they felt safe, comfortable and confident visiting the community and mixing with others, including within the service. We identified concerns in relation to the quality of risk management plans in place where people travelled with other people from the service to day services, without staff oversight. Overall, the core staff team for the service remained consistent to offer continuity of care.

The service did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. We observed variable skills and levels of understanding demonstrated by staff in relation to their abilities to share information with people. Some people had limited verbal communication, and used individually tailored and adapted sign language, which not all staff understood. This could result in frustration for some people, and we identified examples of incidents where communication between the individual and staff member had resulted in poor care outcomes. Pictorial information was in place, so people knew which staff were working on each shift.

The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They did not always involve people in decisions about their care or tell them what had changed as a result. Leaders recognised the need for greater involvement of people and their relatives, in sourcing feedback about the care and support provided as part of the ongoing development of people’s care and support plans. We observed staff to try to source meaningful feedback from people following their meals, or while completing activities, but the level of feedback received varied, and some people did not have the skills to raise complaints. People’s relatives told us they felt able to complain or seek assurances from staff and leaders when required.

The service did not make sure that people could access the care, support and treatment they needed when they needed it. The standards of care people received were not always tailored to their individual wishes and preferences and did not ensure equality in access. This was due to blanket restrictive practices in place for individual risks, impacting on the care provided to all people living at the service. Improvements to signage and information to aid people’s movement around the service required consideration, particularly where people were experiencing changes in their sight, and abilities linked to living with dementia, to maximise their levels of freedom and independence.

Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this. There was a lack of proactive approaches used to address barriers in access to care and support. This was particularly noticeable where people had low or no funding in place to support them with activities and community outings. There was a greater need for staff and leaders to explore alternative activities and engagement within the service, or ways to support those people without fundings to still become an integrated member of the community. From reviewing incidents, we identified examples of people recorded as feeling ‘jealous’ due to a lack of 1 to 1 time with staff, and access to opportunities, which was not resulting in them having the same care outcomes as others living at the service. Whilst some areas of people’s protected characteristics were reflected in their care records, greater emphasis was required to ensure areas of individual importance were fully recognised and understood by staff.

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. The service did not work to a recognised model that potentially would support people to explore options around moving on from living in a residential care setting. Most people living at the service had been there for a long time, and recognised Merle Boddy House as their home. Some people had end of life care plans in place, where family and people felt comfortable to discuss their wishes for this stage of their life. Some people and their relatives found the subject of end-of-life care planning distressing to discuss, and this was handled sensitively by staff and leaders.