Blackthorns

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

We assessed all 7 quality statements from this key question and found areas needing improvement. The scores for these areas rated this key question as requires improvement, which meant the rating of good given in our last inspection [Published March 2023] had not been maintained. Although we received positive feedback from people and their relatives, we also identfied the quality of people’s experience varied. Shortfalls identified in people’s pre- admission assessments, care planning, and emotional and social support, impacted on the quality of people’s experiences. The provider told us they would be taking action to address this including making improvements to their pre-admission processes, and further training for staff in completing care records.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s relatives told us their family members had been living there for periods ranging from 1 week to 2 years. Generally, they felt well-informed about any changes in their family members' health and welfare and praised the standard of care. They felt staff had a good understanding of people's needs. One relative told us, "I am happy with [family member's] care. [Family member] seems happy and that is the main thing." However, most of the relatives said they had not been involved in care planning and reviews. One relative told us, “They keep saying I need to be involved in one, but I have not been so far.” Another relative said, “I have not at any time seen [family member’s] care plan or been involved in any review of it. I know that if I wanted to see it, I am sure they would let me.”

Discussions with people and their relatives revealed while there were planned activities, they felt there needed to be more meaningful occupation. For example, one relative hoped their family member with dementia would receive more stimulation, as they felt there was a lack of meaningful activities. Another relative acknowledged if staff, “Have the time they will make the effort to chat with [family member].” One person said they had not attended that morning's activity, picture bingo, as they felt it was, “A bit babyish.” Other feedback showed where some people expressed a desire for more staff interaction and meaningful engagement to alleviate feelings of loneliness.

Management acknowledged the need for improvement and expressed enthusiasm about tailoring activities to people’s interests and preferences. They mentioned plans to increase staffing hours to address the issue of staff primarily focusing on meeting personal care needs rather than engaging people in activities. The use of electronic care records was also discussed, with some staff talking about the benefits of accessing summarised information about people’s needs through handheld devices. One staff member told us, “You can go through the device, a summary of what they need and don't need.” Although the provider’s policy was to read the care plan, not all staff said they had time to read it. Therefore, there was a reliance on the summary page and information from staff handovers, instead of gaining a more in-depth knowledge of the person recorded in the care plan.

The registered manager told us they used the initial pre-assessment as the basis for people's care plans, which enabled them to review and update it as they got to know the person. However, where the pre-assessment had not been effective enough in obtaining enough information, it impacted the quality of the initial care plan. For example, Blackthorns provided specialist care for people living with dementia, however important information on a new admission's care plan about the person's preferences, routines, and how to support any anxiety was blank.

We found improvements were needed in the electronic care planning system where it was not being used effectively. This was because gaps in personalised information reflected a more task-led rather than a person-centred approach. For example, a care plan for a person who had recently come into service, was lacking information about how to support them to settle in, and awareness of emotional impact. Although management said staff did spend time chatting with people, and if people refused a meal, they went back later, and offered them a snack, this was not recorded.

Records of people's care showed they accessed a variety of community services to support their health needs, such as speech and language therapists, occupational therapists, GPs, hospital services, consultants, dementia specialists, and community nursing teams. Relatives told us they were kept informed about the outcomes of appointments. One relative stated, "I have received calls from them to update me about the doctor's visit to see [family member]," and noted that their family member, "Was much better after the treatment." Where there had been a break down on communication between staff and health professionals, this had negatively impacted on people’s experience. We saw that action was being taken to improve communication systems in cases where people's experiences of 'joined-up care' had not been as positive.

The registered manager told us they had always maintained good relationships with external professionals, which had grown stronger over the years. They also expressed optimism about the new Deputy Manager, who brought clinical experience and knowledge of working in the community.

Records from social care professionals showed instances where they had requested services from external health professionals to support people's changing care needs, which had not been identified through the providers' monitoring processes.

We identified conflicting information and gaps in personalised information within the care records, which reflected a more task-led rather than a person-centred approach. Detailed information is required, especially for new admissions, to ensure a holistic approach to care. Additionally, staff interactions and responses to residents' needs were not always recorded in peoples care plans.

The provider responded to feedback and was working to address any deficiencies in their monitoring/communication processes that were identified through safeguarding outcomes or reports from visiting professionals.

One person said they were aware staff could provide information in different formats but preferred to ask staff as needed. One relative expressed disappointment about the lack of information given to them regarding what to expect when their family member was admitted. Another relative told us, “One thing I found difficult when [family member] moved there was how to find out information about the routine of things there, like for example the hairdressing salon.”

The provider told us that staff received training in supporting people with communication needs related to disability, impairment or sensory loss. They also highlighted they used picture signage throughout the building, and pictorial menus and visual options were available at all mealtimes. They told us Blackthorns strived to improve communication continuously through e-mails, video calls and social media. Also, handsets, mobile phones and electronic tablets were available for people to use.

Information about people's communication needs was recorded on their pre-assessment and incorporated into their care plan. The service provided a connection to the internet and free WiFi for people to use.

People's relatives felt staff listened to them and or their family members and generally acted on what they said. One relative said, "I do think staff listen to [family member] and respond to what," they had said. Another relative felt staff did, but "Not always straight away. Sometimes, I have to repeat the same things before they get done." Another relative commented, "You can tell some of the carers' love doing the job and others can barely acknowledge you. They have some really good staff there, but I just feel that some are more engaging than others." Some people had mentioned when English was a second language, communication issues with staff could lead to misunderstandings. Additionally, when staff were busy, they may not have the time to listen.

A staff member told us, "There's very little communication between myself and residents. There's no time; I'm always working." Another staff member was asked how they involved relatives in reviewing care plans. They replied, "We have residents of the day. When we start care plans, we contact the resident's family, then we review it with them on residents of the day.”

Care plans were under regular review; however, it needed to be more evident how people and their relatives were involved in reviewing care and setting goals. The provider had a complaints policy, although not all relatives said they were aware of it. However, relatives felt comfortable speaking directly to management. When issues were raised, except for the ongoing problems with clothing and personal items going missing, they were addressed. Systems were in place to record, investigate, and respond to complaints. Lessons learned from the complaints were shared with staff as part of their approach to learning from incidences. The registered manager stated that they were continuing to identify ways to prevent people's clothing items from going missing.

People were supported to access local health services, however where staff had not independently identified a change in a person’s needs, this had caused delays in accessing equipment/support in a timely manner.

Staff provided examples of contacting out-of-hours GP services, using 111 services for advice, or calling 999 in an emergency to ensure people had access to appropriate support.

A visiting professional felt staff advocated well for people to ensure they accessed services. However, feedback from other professionals, showed people’s equity in experiences and outcomes varied, depending on how well staff knew the person and their holistic needs when they moved in.

The service offered short-stay care for individuals transitioning from the hospital to their home, providing respite for family caregivers, or in cases where the person was unsafe at home and required support with their care and well-being. Improvements were necessary in the pre-assessment process to ensure that sufficient information about the individuals staying in short-term care was gathered to ensure their holistic needs could be met.

Differences in people's experiences were influenced by staffing levels. One individual expressed that it was unfair that those who could walk independently could enjoy the outdoors while others were left behind closed doors. Another person who needed assistance to access the gardens mentioned having to wait at times due to staff being busy. Some people preferred eating in their bedrooms as they found the dining room too noisy, especially if they wore hearing aids, or loud noises triggered their anxieties. At lunchtime, we observed the noise level to be loud: a combination of plates banging, noise from the kitchen, and music playing. This did not support a relaxing environment. The Deputy Manager picked up on the noise level, turned down the music, and alerted kitchen staff to the noise.

The provider's information return (PIR) stated that an all-inclusive culture was promoted in the home, treating all people as individuals and supporting their preferences, goals, and choices. However, where there was missing information about these areas, this led to care plans not being tailored to people’s needs. The provider told us people were supported to participate in elections, and they were supported by staff and relatives to update their names on the electoral register.

Improvements were necessary in monitoring the contents of care plans to ensure that the language used was respectful and dignified, reflecting the providers' values. There were instances of generic statements, such as, ‘Is usually good tempered.'

In 1 person’s care plan, information appeared to be cut and pasted as it gave the wrong name and pronoun.

A person’s care plan informed staff they had a do not attempt cardiopulmonary resuscitation (DNACPR) order in place. This meant they had made the decision, if they stopped breathing, not to be resuscitated. However, after informing staff there was a DNACPR in place, the next line stated, ‘If I am found to be unconscious and not breathing CTL (care team leader) to contact 999 and perform CPR (cardiopulmonary resuscitation).’ This could cause potential confusion and the risk of the person’s choice not being adhered to. We alerted the management so they could take action to clarify the situation.

Where people were reaching the end of their life, anticipatory medicines, also known as ‘just in case’ medicines, were prescribed and held in the service, to be administered by visiting health professionals to relieve symptoms such as pain, nausea, anxiety when needed.

Staff spoke sensitively about ensuring people were supported to have a comfortable death. The registered manager was aware of the local palliative care services if they needed to access for advice/extra training

The provider’s pre-admission assessment included asking people if they had any of the following in place: a living will (advance decisions), DNACPR, and Recommended summary plan for emergency care and treatment (ReSPECT). To ensure staff were made aware of the person’s wishes, the information was transferred onto the person’s care plan. However, improvements were needed to ensure the information was transferred correctly.