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

During our assessment of this key question, we found the systems in place did not ensure people’s capacity and ability to consent had been adequately assessed and planned for. This has resulted in a breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below. The systems and processes in place did not always ensure people’s care plans were up to date which increased the risks to people of receiving inconsistent support. Changes in people’s health and wellbeing were not always identified in a timely manner.

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.

The systems and processes in place did not always ensure people’s care plans and assessments were up to date. Whilst assessments considered a range of needs and contained some helpful information that was personalised and reflected people’s current needs, this was often lost in extraneous, out of date, and at times, inaccurate information that masked the key information staff needed to understand how to meet people’s needs. It was evident from our discussions with staff that they did know people well and did appear to understand people’s needs, but the information staff shared with us was not always in keeping with the information in people’s care plans. This approach increased the risks to people of receiving inconsistent support, support which is not reflective or in line with their preferences or wishes. People’s care plans were reviewed as part of the monthly key worker meetings, but where changes or actions were identified there was not always evidence the care plans were updated in practice. Following a complaint whereby a person said a staff member made them feel mistreated, uneasy and angry, the advice given by deputy manager was that ‘each staff member was to find their own way to create banter with resident’. Whilst it is important staff have the confidence to tailor support, this response supported our findings that staff were not being given sufficient personalised, proactive guidance on how to support people in a meaningful way.

People told us their needs had been assessed and understood and the support being provided met these needs, for example, 1 person said, “Once the staff have built a therapeutic relationship with me the staff do well… The service meets my needs the whole set up for works very well for me.”

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

The registered manager told us people were offered the support they wanted in relation to attending healthcare appointments and ensured it was the person’s preference and choice. The registered manager recognised the record keeping in relation to this could be improved upon. Staff spoke of the importance of promoting oral care and described how many of the activities had a health and wellbeing focus, for example, yoga and relaxation. The provider told us the chef had developed menus which were based on people’s preferences, likes and dislikes and which were nutritionally balanced. People were offered opportunities to develop their cooking skills to increase their independence and to promote healthy balanced diets.

Where people had specific health conditions their care plans did not always detail how these impacted them individually and what support they required to manage their conditions. The systems in place were not always effective at identifying and responding to changes in people’s health and wellbeing in a timely manner. For example, there were recorded accidents and incidents where people had experienced falls, but it was not evidenced, they had been supported to access appropriate healthcare services to explore potential underlying health conditions, or to access assessment and/or equipment to manage ongoing risks. People were supported to access healthcare services such as GP’s and dentists. However, outcomes were not always effectively recorded and the system for recording consultations with HCP was difficult to maintain oversight of, limiting the ability of staff and leaders to identify healthcare risks and support people to prevent deterioration. We received mixed feedback from partners as to whether the systems and processes in place ensure people received the care and support, they needed with health conditions. Concerns were raised by 1 HCP that there had not been an appropriate initial escalation of concerns to relevant healthcare professionals, but another told us staff had acted promptly on changes to a person’s mental health.

We only received limited feedback from people regarding this specific quality statement, although 1 person told us they were fully independent with their healthcare appointments. No concerns were raised by relatives with regards to how their family members healthcare needs were managed.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

At the last inspection a recommendation was made that the provider review mental capacity assessments to ensure people have appropriate applications, DoLS authorisations and assessments in place to support decision making and any restrictions to their liberty. Although we were assured DoLS had been applied for, the systems in place still did not ensure people’s capacity and ability to consent had been adequately assessed and planned for. For example, people’s care plans did not always contain evidence of consent. There remained a concern mental capacity assessments had not always taken place when it was indicated the person lacked capacity to make specific decisions. For example, 1 person’s finance care plan identified they lacked capacity to manage their finances, but there was no evidence of a mental capacity assessment or a best interest consultation having taken place. People’s capacity to make decisions through verbal or nonverbal means was not always well documented. For example, there was no mention in 1 person’s care plan that they used a tablet to communicate decisions due to a deterioration with their verbal communication. Feedback the provider had collected from people in November 2023 identified 2 people had raised concerns they had not been involved in their care plans’ reviews; we were not assured this had been effectively responded to. We received mixed feedback from healthcare professionals about how the systems and processes in the service supported decision making, the completion of mental capacity assessments and best interests consultations. For example, 1 healthcare professional raised concerns that mental capacity assessments were not reflective of decision specific assessments, lacked detail and relevant content with conflicting information, whilst another felt the registered manager and staff did consider people’s capacity and documented this as needed.

The people we spoke with confirmed that their wishes and choices were respected with 1 saying, “If I refused consent, this would be respected.” We have described elsewhere in this report how people told us their wishes were taken into account when decisions were made about the management of their medicines for example.

During our discussions with the registered manager, they were able to demonstrate an understanding of the Mental Capacity Act 2005 and legal frameworks regarding consent. However, as identified below, this knowledge was not always used in practice to ensure people fully understood what they were consenting to.