Brandon 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

During our assessment of this key question, we found people’s care plans were not always person centred and changing needs were not assessed as required. Care plans and risk assessments often lacked details to ensure people’s need could be met. People we spoke to said they were not involved in their care planning, changes and/or reviews. Feedback from people was mixed about their experiences of accessing support from health care professionals. Some people told us their treatment had been effective with positive outcomes and others told us staff did not understand their needs. Consent to care and treatment had been assessed and recorded however, staff and people living in the home said their wishes were not always respected.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from people and their relatives about their care and treatment. Comments included, “[Name] has a tumour on their eye which [name] wipes and it bleeds, I wipe it but I don’t know if they (staff) know to do this when we are not around” and, “I am quite happy here, they do what I need and pop in to see I am alright” and, “They do help you but at certain times of the day, you have to wait. When they are changing shifts or mealtimes.”

We received mixed feedback from staff around the effectiveness in assessing and reviewing peoples care and treatment. Comments included, “Discharge notes are usually where we will find stuff, but I have not been fully trained on how to do care plans. We can look on our work phones for their care plan but have not been shown fully how to do that” and “Care plans on care visions, updated by seniors of any changes.”

People’s care plans were not always person centred and changing needs were not assessed as required. Care plans and risk assessments often lacked details to ensure people’s needs could be met. For example, one person required catheter care however, there was no guidance for staff on how to clean the site area to prevent infection nor any guidance on when to change the person’s catheter.

People we spoke to said they were not involved in their care planning, changes and/or reviews. People told us, “I don’t know about any care plans” and, “I don’t know about care plans.”

Management told us that they plan and deliver people’s care and treatment with them involving them in the process. However, we did not find any evidence on the system that people or their families had been involved in this process.

People's care plans and risk assessments were not always personalised, and support was not always in line with people's care plan. We found one person’s religious and cultural care plan lacked detail with no evidence of involving the person in the process. Records we looked at failed to demonstrate people’s needs were being regularly reviewed through assessment to ensure their support plans continued to reflect their needs.

Feedback from people was mixed about their experiences of accessing support from health care professionals. People told us, “If you are not feeling well, someone will come and see you. [Name of staff member] is absolutely tremendous, they know what to do. [Name of staff member] has good communication. If you have an appointment, they will make everything happen. [Name of staff member] is wonderful too” and “They will ring for the Doctor, but they don’t tell you want is going on, if they can’t come or you have to wait. It would be better if you knew what was happening.”

Management told us they worked effectively across teams and services to support people. However, we saw evidence of a breakdown of working effectively with the General Practitioner and pharmacy in relation to when medication was out of stock and saw no evidence of alternatives being requested.

No concerns or comments were raised by partners when we gathered feedback as part of our inspection.

We found the home did not always work effectively with other services to ensure good care. For example, one person had been admitted from hospital with discharge notes however, the home had not implemented a care plan or risk assessment for their nutritional needs in a timely manner.

We received mixed feedback from people on their experiences of being supported to live healthier lives. People commented, “I waited 7 hours for a jug of water” and, “I get a choice, my appetite is enormous, and I get enough. Sometimes we can have a cooked breakfast but not all the time. I can have a bacon sandwich or an egg sandwich, it’s nice. After breakfast they come and ask what you want for dinner, which I find a bit strange. My nephew brings in apples, pears and banana’s as they don’t always have that here” and, “If you are late coming for dinner the carers will come and check you are alright. It’s not inevitable what you get. It depends on what they get delivered. The food can vary, if they bring it and it’s not right and you say, they will take it back. A carer was going to give me a plate of food today and another said don’t give it to him, he doesn’t like a couple of things that were on the plate. They changed it so they do know me and what I like.”

Management told us they supported people to manage their health and wellbeing and support them to live healthier lives however, we found evidence people were not always supported to maintain and improve their health. For example, one person having to wait 7 hours for a jug of water.

People were not always supported to maintain and improve their health. For example, people were not always supported with their food and fluid intake and prescribed supplement drinks to enhance weight gain were not always available to be given. People’s weights had not been monitored and action taken as required. Food and fluid charts were not always completed as required to ensure people were supported to drink appropriate amounts and to maintain good health.

We received mixed feedback from people and relatives around how the home monitored people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent. Comments included, “The problem is the agency staff. [Name of service user] doesn’t know who they [staff] are or what they need to do and when [name] says ‘help me, help me, as they don’t know [name]. We raised this and there are two regular carers who look after them which is better. At weekends there are agency staff, and they don’t know what [name]’s needs” and, “It’s five star, [Name of staff member] has got rid of ulcers on my legs and has made it me much better.”

Management told us they routinely monitor people’s care and treatment to continuously improve it and ensure that outcomes are positive and consistent. However, we found no evidence audits took place to monitor this. For example, two people using the service had weight loss but this had not been monitored therefore, consequently no treatment had been put in place to improve outcomes for these people.

Risk assessments, care plans and records were not robust and often lacked detail. We found evidence that some people’s care requirements were not being monitored effectively to ensure good outcomes for people living in the home. For example, one person required support as they had nutritional and continence risk however this was not monitored, and risk assessments had not been completed.

People provided mixed feedback when asked if they were given choices. Comments included, “I wash myself every day and like to have a shower once a week. They are promised but not always done. I requested one but it doesn’t always happen, occasionally it can be two weeks before I get one. I am clean because I get myself washed” and “They know I like to be quiet and listen to my music and they respect this.”

Management told us they tell people about their rights around consent and respect these when we deliver person-centred care and treatment. However, processes were not always in place to ensure care and treatment was provided with the consent of the relevant person. Staff told us rights around consent and respecting these to deliver person-centred care were not always effective. Comments included, “Getting them all up when they don’t want to first thing on a morning, this isn’t person centred at all. It’s not what resident’s need, it’s what management want” and “I don’t appreciate having my hours threatened if I don’t do what they (management) want us to do within the time frame you want. For example, wanting all residents up by 10:30am. Not always possible and we can’t force people out of bed”.

Processes were not always in place to ensure care and treatment was provided with the consent of the relevant person. We saw Mental Capacity Assessments (MCA) and best interest decisions were in place where people lacked capacity to make a particular decision for some people however, not all relevant decisions had been considered and appropriate action taken. We saw evidence of one person’s food being restricted to a soft diet and upon checking was found to have an MCA in place, however this was incorrect, and the person had no reason for any restrictions to be imposed.