Braywood Gardens

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 we assessed all quality statements in the effective key questions. We found concerns with the application of the Mental Capacity Act (2005). This meant the provider was not lawfully gathering people’s consent. This is a breach of regulation. People’s holistic needs were not effectively assessed to provide evidence-based care. People did not feel involved with reviewing their care plan. Staff did not always work effectively with external professionals, or within their own team. Some people found it difficult to make decisions, but their decision-making ability had not been assessed in line with the requirements of the Mental Capacity Act (2005)

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People said they were not always involved with writing their care planning documents. Three relatives/people told us that they were asked questions when they first moved to the care home but had then not been involved with any care plan reviews since this date. This meant that people were not involved with ongoing assessments of their needs. This can impact the effectiveness of care provided.

Staff told us how they would read care plans to understand people’s needs. If a person had an incident (such as a fall), they knew which documentation would need filling in. This would allow people’s changing needs to be understood and updated. While staff had good knowledge, we found they did not always use documentation effectively. For example, staff did not clearly document what occurred before, during and after a person became distressed. This would impact learning from this documentation.

People’s needs were not clearly assessed. We saw that while national tools were used, this did not result in clear guidance for staff. For example, staff used a national tool to assess the person’s risk of a pressure sore. While this tool recognised that the person was at very high risk, staff did not have clear care plan guidance on how to reduce this risk. Care plans were not always kept up to date. For example, we saw one person’s swallowing needs had improved so they could now eat a less soft diet. Their care plan had not been updated to reflect that they could now eat a wider range of foods. We raised this with the registered manager. We saw their care plan was then updated to correctly reflect the person’s new dietary needs. However, the care plan now incorrectly noted that the person’s swallowing needs had worsened instead of improved. Not correctly documenting the history of a person’s physical health (such as swallowing needs), risks staff not understanding how the person needs have changed.

People explained that staff did not always understand their needs well. A person explained that they were prescribed some medical equipment; however, staff did not know how to use this. They felt this had impacted their health. We saw that there was a lack of guidance in the person’s care plan to aid staff on how to use this equipment.

The registered manager explained that they attend internal manager meetings and conferences to ensure they are up to date on evidence-based care. We found documentation was not always up to date, therefore this approach had not resulted in good outcomes for people.

People were not always supported to have good hydration. Records showed one person was at risk of drinking too much. The person had a mental health condition which could impact their decision making. One day, staff wrote that they offered 7 litres to drink, and the person had drank nearly 3.5litres of this. Drinking this much, could have implications for the person’s health. Another person’s records showed they were not always offered fluids, or they were they drinking enough. For example, one person was only offered 560ml of drink one day, of which they drank 430ml. This puts the person at risk of being dehydrated.

People explained that staff were able to call support from external health and social care professionals. However, they felt that staff within the care home did not always have effective communication with professionals to understand their needs.

A staff member described that they are sometimes moved to support a different area of a home in the middle of a shift. They explained that they do not get a handover for this mid-shift move, meaning they are not up to date on people’s care needs to support them effectively. This could also impact the handover of information to external health professionals who visit the person and would like to know the person’s recent health and wellbeing updates.

Before the assessment, different external professionals had expressed concern to the management team with regards to medicines, staffing levels, incident management, skin integrity and cleanliness of the care home. During the assessment, we found this feedback had not been sufficiently acted upon to improve care.

Staff did not work effectively with other external professionals, or with professionals within the care home. For example, a speech and language therapist had explained to staff that a person was at risk of choking and so they needed a different texture diet. This guidance was not clearly documented in the person’s care plan. This means that other care staff could be unaware that this professional guidance was in place – consequently feeding the person a texture diet that was not prescribed. The kitchen staff also had the wrong type of diet written down in the kitchen. Therefore, this professional guidance had not been passed to the team who were making this person’s food.

People felt they were not always supported to live healthier lives. This is because they were not supported to go to the toilet in a timely way and felt bathing tasks were rushed.

Staff explained that they work hard to meet people’s needs. However, staffing levels in the care home meant they often felt rushed. One staff member explained staff sometimes stayed late to stay with someone who was unwell, as they felt other staff would not have enough time to support the person.

Some people at the service used external health and social care professionals. We saw that when these professionals had given guidance to care staff, this guidance was not clearly reflected in care planning. For example, a visiting health professional told us that they were concerned a person was not being supported effectively and had explained this to the care staff. When we reviewed the person’s notes, this professional guidance was not written down. Instead, the staff had written that the external professional had no concerns. We were not assured that guidance was in place to ensure people lived healthier lives. One person had been able to transfer using a rotunda. This is a swivel plate which allows the person to stand and be manually pivoted by staff into a new position. As the person’s physical strength had reduced, they were no longer able to safely stand and needed to use a full hoist to move position. While the person’s moving and handling needs had been reviewed, the care plan had not been clearly updated to ensure staff knew the person’s needs had changed. This means the staff risk moving the person in an ineffective and unsafe way.

People explained that due to staff being rushed, they did not always feel staff monitored their needs well. One relative was concerned that staff were not suitably monitoring a person’s hydration. When we reviewed the person’s care records, we found there was poor record keeping for how much the person was drinking.

Staff explained that the leadership team monitored their work carefully and asked them to improve if needed. We did not observe this to be accurate, as we saw people did not always receive timely care and the management team were not present to recognise this.

Staff documented what care people received. However, there was poor quality oversight to ensure improvements were made. For example, people drank too much or too little, or were not repositioned by staff safely to help their skin health. While records were regularly audited, these audits had not recognised this or made improvements. This meant people would continue to have poor outcomes.

People told us that staff usually asked permission before supporting with tasks like bathing and toileting. However, we saw that some staff interactions did not include consent. This included staff repeatedly putting meal aprons on people to protect their clothes from spilt food. These aprons were put on people from behind, without any permission being sought and without any interaction between the person and staff member.

Staff explained they had received training on the Mental Capacity Act. They understood how to apply this legislation when working with the people at Braywood Gardens. However, as we did not see staff ask for consent, we were not assured their training was always applied effectively.

We saw people’s mental capacity had not been assessed in line with the principles of the Mental Capacity Act (2005). For example, one person’s care plan described that they could decline staff support with their personal care. There had been no assessment of their ability to make this decision, and whether declining personal care should be respected as an unwise choice or whether this person did not understand the consequences of declining support. Therefore staff needed to have guidance on how best to support them in the least restrictive way. The training document, provided by the registered manager showed that staff had received training on mental capacity. Due to concerns seen, we were not assured that this was enough to ensure people received care in line the Mental Capacity Act.