Burger Court

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

At our last inspection we rated this key question requires improvement. At this assessment the rating remains unchanged. People's needs were not always assessed, or reviewed, in a timely manner. The monitoring of people’s outcomes through care plans and review of assessments was not fully effective, as information was not always accurate. People’s consent to their care was not always considered or clearly recorded. Systems were in place to make sure people were supported effectively throughout their stay at the service and during any transition of care. People were supported to live healthier lives and spoke positively of the support they received from staff.

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.

We received mixed feedback from people about their involvement in their assessments and reviews of their care. Some people felt involved whilst others could not recall having any involvement. Comments from people included, “I’m not sure if I was involved in the assessment or given the opportunity to be involved” and “I have a care review every month where my needs are discussed to see if any changes need to be made.”

Staff and leaders told us there were processes in place for assessing and reviewing people’s needs. Staff told us people were involved in assessing their own needs. They said care plans were reviewed monthly and discussed with people to determine any changes needed. The manager was aware of the need to update people’s current assessments of needs and was working on this as part of their review of people’s care records. This was a significant piece of work and the provider assured us the manager would receive support to achieve this.

People's needs were not always assessed, or reviewed, in a timely manner. Although some people’s care plans and risk assessments included good detail, others were not always up to date or fully reflective of people’s needs. For example, 1 person’s care plans and risk assessments contained conflicting information about the level of support the person required to ensure their personal safety. This meant staff did not have enough information to be able to support the person safely.

People told us they had recently become involved in menu planning and had choice around the meals they ate. We received positive feedback from people about the food at the service. They told us, “We get a choice, and it is tasty. I had pies and baked beans today”. People also told us they received support from specialist health professionals, such as the mental health team.

Staff we spoke with were able to give examples of specific diets, such as halal, that some people followed, and particular likes and dislikes of people. They explained how this information fed into meal planning within the home.

People’s care plans did refer to their nutritional needs. However, information was limited and we found 1 person’s care plan showed there was no evidence of any action taken when their recognised weight assessment showed a significant weight loss. We found some evidence in people’s care records of information and guidance in relation to drug use and the effects on mental health, good practice in relation to managing diabetes, managing stress and information about some medications.

People and their relatives felt supported by staff to help them liaise with other people involved in their care. We saw 1 person have an appointment with a member of the mental health team. The person had chosen which member of staff they wanted to support them in the meeting. A relative also told us, “The home provides support with healthcare appointments to the GP.”

Staff worked with health and social care professionals to make sure people were well supported. For example, staff were working with social workers to make sure people were prepared to move on from the service. The manager also gave examples of how they maintained contact with professionals involved in people’s care and wider support teams. This included contact with the mental health team, social workers and GP’s.

We received positive feedback from the local authority on how they had been working with the service to achieve actions set out in a plan they were working on. Feedback included, "Burger Court facilitated the enhanced visit well, with no barriers to accessing information and documentation."

Systems were in place to make sure people were supported effectively throughout their stay at the service and during any transition of care.

People were supported to live healthier lives. For example, some people attended a ‘walk and talk’ group organised by a mental health charity and the service had obtained a piece of gym equipment to support a person to take part in their preferred activity. A wall display also detailed an external activities timetable for people to attend. However, activity preference forms and activities schedules were not always completed to reflect recent activities undertaken. People spoke positively of the support they received from staff. Comments from people included, “If I have had any problems with my mental and physical health, I can approach any of the senior management and this would be dealt with as soon as possible by providing immediate support from the staff” and “Staff would support me if I needed to take exercise, the staff would also contact a doctor for me if needed.”

The manager and staff gave examples of physical activities some people engaged in to support healthy living. A staff member told us, “There are 2 or 3 people that we provide 1:1 support for hospital appointments. For others, sometimes it depends on what the appointment is for. They might be fine going on their own or they might want someone to go with them, we’ll have that conversation with them and we’ll be guided by what they want.” The manager had sourced information for people living with conditions such as COPD and stress and easy read information had been shared with people about maintaining sexual safety and health. However, people’s care records did not always reflect the activities they participated in and we did not see evidence of conversations with people about anything they might like to do to improve their health.

Care records showed the involvement of some health care professionals such as mental health nurses and doctors, social workers and GPs. However, there was no information about other health care services people may need to access such as opticians and dentists. Where possible people had been provided with information to help them understand their care needs. For example, leaflets from mental health and other health and social care professional organisations had been given to people to support their understanding.

We received mixed feedback from people regarding their ability to give their views about their care and support. Although 1 person told us they were supported to set personal goals, care files contained little evidence of how this was done routinely. One person said, “I would say some staff support me with making goals. I have never been asked about my thoughts about the care received at this home."

Staff told us about how they supported people to improve and achieve good outcomes. For example, they told us how 1 person had been supported to develop their independent living skills, which had resulted in them preparing to move to more independent living. Another person was being supported through weekly key worker meetings to raise and resolve concerns directly with the home manager, which had been successful. The manager acknowledged care plans and reviews were not always up to date. This meant, measuring outcomes for people against their planned care may not accurately reflect their current circumstances.

Systems were in place for monitoring people’s outcomes through care plan and assessment review. However, the manager was aware this process had not always been followed which meant people’s care records did not always accurately reflect how people’s outcomes in relation to their health and well-being were being monitored. People’s views about the service were sought on a quarterly basis, although the results had not been made available to people. The manager said the current surveys were being collated and a ‘you said, we did’ document would be produced to let people know how their opinions were used to drive and improve outcomes. The manager also said they were looking into electronic polls for people to give their feedback, as they thought this would be the preferred method for most people.

People’s consent to their care and treatment was not always considered, as people were not consistently involved in the decision making around their care and support. Feedback we received from people was mixed. Comments included, “I have not seen my care plan or been involved in this”, “The staff always provide the care the way I would like it to be given” and “The staff ask for my permission before providing care.”

Staff told us they checked for consent before supporting people or entering their room, unless there was an emergency. They told us that where people had capacity, they discussed activities and actions with them and the possible outcomes of unwise decisions, but that people were supported to make their own decisions. Staff had received training in Mental Capacity and Deprivation of Liberty Safeguards (DoLS) and most were able to explain what these meant in practice.

People’s consent to care and treatment was not always clearly recorded. For example, 1 person’s risk assessment said they had not actively engaged in the process due to capacity, but a review stated the assessment had been discussed and agreed by the person. In addition, where mental capacity assessments were in place for a person who lacked capacity, there was no record of any related best interest decisions. DoLS were well managed, and staff made records as required by any conditions placed on the DoLS.