Welshwood Manor

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 assessment we rated this key question good. At this assessment the rating has changed to 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 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. We identified a poor culture where some people spent long periods socially isolated within their respective bedrooms. This was not always people's personal choice, and alternative options to spending time outside their rooms were not explored or facilitated. Staff told us they did not have time to provide meaningful interaction, especially to people who were cared for in bed. One staff member told us, “Not very much is done activity wise with our [people cared for in bed] which I feel is a shame, there is so much that they could be doing with them.” Another staff member commented, “Activities are non-existent for the [people cared for in bed], it’s the same residents that benefit from the poor choices they do have.”

Some people were living with dementia however, the care environment required improvement to ensure that good practice guidance in dementia care was being followed. There was a lack of directional signage to assist people to navigate, and walls and doors were plain white. This increased the potential risk for people of disorientation, confusion, and from an unstimulating environment.

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 provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.

Whilst the provider was monitoring people’s weight loss, where people had previously been at risk of or had experienced weight loss, records did not show they were offered alternative foods or extra snacks.

During the inspection, concerns were raised by many relatives about the quality and choice of food provided to people. One relative told us, “My relative does say to me the only thing not liked about the care home is the quality and quantity of the food. I had spoken to a manager and other members of staff and was told the same thing, the care homeowner gives the kitchen a very small budget for food, to make this budget stretch to cover all the food needed the very cheapest products are bought from [supermarket] value range.” Another relative said, “When [family member] first went to Welshwood Manor, I [contacted them] and said that I was concerned about the lack of healthy options such as fresh fruit and brown bread for tea. I was told that there was fruit available on the table, but I know [family member] wouldn’t help themselves to this. I haven’t seen anyone offer fresh fruit to residents at teatime when I have mostly been present at mealtimes.” A third relative stated, “Food always looks incredibly basic.”

During the inspection, records viewed demonstrated that mealtimes were not reasonably spaced out. Some people were having breakfast early at around 6am but then for some people records did not reflect any further food offered until lunch time some 8 hours later. On other occasions records showed people were offered lunch but nothing again until breakfast the next day some 17 hours later. This is not in line with Public Health England guidance good practice guidance for older people in residential care homes, which states nutrient intake across the day is conventionally divided across four eating occasions. Namely, breakfast, lunch, evening meal and food consumed between meals (snacks).

For those people who required a modified diet, food was not always presented in an appetising manner, and training was not always in place for The International Dysphagia Diet Standardisation Initiative [IDDSI] levels. IDDSI is a global framework which provides standardized terminology and definitions for texture-modified foods and thickened liquids used for individuals with swallowing difficulties. There was limited evidence people were offered food and drinks on an evening, as there was no supporting documentation in people’s care notes.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

People’s care plans had not been monitored to check they included accurate information and there was no process to monitor outcomes for people. We also found care records were not person-centred and did not provide an accurate view of people’s lived experience; as such, they could not be relied upon as a contemporaneous record of the care and treatment people received.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Where it was deemed some people did not have the capacity to consent, robust assessments were not in place to determine if people had capacity to consent or not and staff had not followed a best interests process. Failure to implement appropriate capacity assessments puts individuals at risk of decisions being made without appropriate legal or ethical safeguards.

We also found that care was delivered to meet the needs of the service and not according to what was in people’s best interests.

The staff office was open and accessible to anyone in the home, cabinets containing people’s personal details were unlocked. This meant people’s confidential care records could be accessed by visitors without their consent.