Westacre Nursing Home

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 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.

The service was in breach of legal regulations in relation to consent.

This service scored 62 (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 treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People's initial assessment was completed by senior staff, to ensure their care needs could be met. The registered manager told us within their provider information return (PiR), which is an annual form providers use to tell us about their service, that the physical layout of the building was a challenge and, how they assessed people’s needs carefully to ensure available rooms were suitable for people’s physical needs.

People's care plans showed their physical, health, wellbeing and communication needs had been assessed. Staff reviewed people’s care plans and risk assessments monthly and updated them as required. The provider audited this process to ensure care reviews were completed.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff used a range of clinical tools to assess and monitor people's risks and care needs. The registered manager followed national guidance to determine if any pressure ulcers met the criteria for referral to safeguarding. Staff had access to the providers policies and procedures for guidance.

People’s care plans addressed their nursing needs and risks. We identified a person's initial assessment of their wound lacked sufficient detail. The registered manager advised nurses were already booked to attend a tissue viability course. Staff were supported to access information and training to keep their knowledge up to date.

Whilst people said meals could be cold, they thought they tasted good and there was plenty to eat. We saw people were provided with a choice of appetising looking meals and an alternative was available if required. People who needed a modified meal had a choice and their meal was attractively presented.

The provider had robust processes to ensure people received adequate fluids. People had daily targets which were kept under review. There was a hydration assistant to promote people’s fluids intake during the day and a hydration champion to monitor how much they drank. We saw evidence that concerns about people’s fluid intake were escalated. There was also a fluid audit to evaluate practice and to drive improvements.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The provider had processes to ensure people were referred to other services as required. There was a weekly GP clinic where any concerns and GP referrals to other services, such as physiotherapy or occupational therapy, were requested. There was effective recording of the outcomes from the GP clinic, multidisciplinary team meetings and communications with other professionals. Staff were updated about any resulting changes to people's care. Health care professionals confirmed staff worked closely with them and acted upon guidance provided.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Nursing staff monitored people’s health to promptly identify and escalate any signs of ill-health using RESTORE2 a nationally recognised tool. The provider audited staff’s use of RESTORE2, to ensure staff used it consistently and effectively for people.

People's oral health care needs were assessed to identify any immediate concerns and people were referred to a dentist for review shortly after moving in, they then had regular dental check-ups. The home’s oral care champion ensured staff followed professionals’ guidance.

People were offered annual eye tests, audiology assessments where required and a podiatrist regularly visited. People confirmed they had been seen by these health care professionals. People were referred to the older persons mental health team for assessment and guidance if required. Staff supported people to attend hospital appointments where required.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The provider had processes in place to monitor people’s care and treatment. These included the use of clinically recognised tools, care plan reviews and audits of people’s care. This enabled them to monitor people’s outcomes.

However, for the people whose care we reviewed they had the same planned outcome within their general care plan, which described the planned outcome as, “[name of person] needs are met and that we provide person-centred holistic care.” Whilst this outcome was applicable to each person, there were no individualised planned outcomes within their general care plan. We did see where people had additional care plans related to their health conditions and end of life care, these contained individualised planned outcomes, which made it clear what the expected outcome from these aspects of people’s care was for them.

The provider did not ensure people’s rights around consent were upheld or legal requirements met when people lacked capacity to consent.

Staff completed training on the Mental Capacity Act (MCA) 2005 but were not secure in their knowledge or its application, which negatively impacted people’s legal and human rights. As a result, some people had mental capacity assessments completed which were not required, some required mental capacity assessments were not completed and where people had capacity to consent to their care plan, the provider could not evidence this had been obtained.

A person had 3 mental capacity assessments in relation to the use of locked doors, care plans and the use of bed rails, on each it was confirmed, they had capacity to make the decision. These assessments were not required by the MCA 2005 or the provider’s MCA policy as there was not a reason to doubt the person’s capacity to make these decisions. Staff should have presumed they had capacity, in accordance with principle 1 of the MCA 2005.

One person had a DoLS application in place to authorise the use of 2 restrictions, however on the date of the application there were no corresponding mental capacity assessment records, which were not dated until later. Mental capacity assessments should take place and be documented prior to the DoLS application as the DoLS application seeks authorisation for the restrictions assessed as being in the persons best interests. Both the provider’s MCA and DoLS policies required staff to record the outcomes of mental capacity assessments to demonstrate compliance with the MCA 2005.

People had mental capacity assessments for the use of locked doors to prevent them leaving the premises. However, where there were also locked stairgates internally which controlled some people’s access to the corridor where their bedroom was located. Mental capacity assessments had not taken place to reflect this greater level of restriction. These keypad locks had not been mentioned in people’s DoLS application.

When staff had determined during mental capacity assessments people had capacity to make the decision in question, they could not evidence consent for decisions such as the person’s agreement with their care plan had been obtained. Staff told us there were no consent to care forms for people to sign, which would have provided evidence of their consent.

The registered manager, afterwards, provided copies of signed consent forms for other decisions such as the sharing of information. However, 1 was signed by the person's power of attorney for finances rather than health and welfare which meant they did not have the legal authority to sign this form. Staff had not ensured representatives with the correct legal authority acted for people.