Brisen Company Limited

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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last inspection we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

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 provider made sure people’s care and support was personalised by assessing and reviewing their health, care, wellbeing and communication needs with them. People told us they had been consulted about their care needs and took part in the ongoing review of their care plan. Comments included, “I have a copy of the care plan and it covers [family member’s] needs” and “Yes we have regular reviews. Two months ago, they did a review.”

The provider assessed people’s nutrition and hydration needs however we were not assured the plans put in place were robust. Most people were able to take control of their own nutrition and hydration and could communicate their daily needs to staff. However, one person’s hydration assessments said they were at risk of dehydration and staff should record the person’s fluid intake. There was no information about how much fluid the person should have per day or what to do if the person failed to reach their fluid target. Despite our concerns with the processes, people/relatives told us staff managed their nutrition and hydration in line with their needs. Comments included, “[Family member] is totally dependent on staff for all this and they do a good job” and “[family member] can’t have anything but pureed on food and they make sure that this is done.” There were guidelines in place to ensure staff provided food that was safe for people to eat and staff demonstrated a good understanding of these.

The staff team worked well together and with external professionals to ensure people received joined-up care. The registered manager told us they liaised with a range of health and social care professionals including GPs, district nurses, occupational therapists and social workers when required. Where people were receiving input from other health and social care professionals this was recorded in their care plan.

At the last inspection we found the provider did not ensure there was adequate information in place about people’s health and medical conditions. Despite some improvements we were not assured there was sufficient information in place for staff. Most people had numerous long-term medical conditions which were recorded in their care plan. Despite these being listed there was insufficient and/or conflicting information to ensure staff understood how these affected them. Staff we spoke with had a good understanding or people’s conditions, however without clear recorded information there was a risk that less familiar staff would not understand how the conditions impacted people’s daily lives. People and their relatives told us they managed their own health appointments and could communicate with health professionals without support from staff. People were also confident staff would seek immediate assistance if they had a medical emergency.

Monitoring processes were not always robust. The fluid charts that were being filled in were not being monitored to identify when people were at risk of dehydration. The registered manager was carrying out regular reviews of people’s care however, the care plans were not always updated to reflect the changes in people’s health and wellbeing. For example during the last review meeting a relative had raised that their family member required 2 staff for all personal care tasks due to a decline in their mobility. The care plan and corresponding risk assessments did not contain this guidance of requiring 2 members of staff. Other monitoring processes had improved. The registered manager regularly contacted people to gather their feedback about the care they received. We saw that in general the feedback given was positive which corresponded to the feedback we received.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. Staff carried out mental capacity assessments when they had cause to suspect people could not consent to their care and support themselves. They also consulted with people’s representatives to make best interest decisions about their care. Despite generally good practices, we found capacity assessments were not completely in line with Mental Capacity Act 2005 guidance as they did not explain how staff had concluded the person lacked capacity to make decisions about their care. We discussed this with the provider and we will check this when we next carry out an assessment. Staff told us they respected people’s wishes and choices at all times. One member of staff said, “People have the right to refuse care if they want. I try to understand why they might be refusing but sometimes people are not in the mood for personal care and I respect that.”