Whetstone Grange

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 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 did not make sure people’s care and treatment was effective because they did not always check and discuss people’s health, care, wellbeing, and communication needs with them.

The needs of a person newly admitted to the service not been comprehensively assessed. For example, their weightbearing status was ‘TBC’ (to be confirmed), as was information about their cognition/orientation, hearing/vision aids, and sleep routine. This meant staff did not have all the information they needed when they began supporting this person. Managers said they would gather the missing information as a matter of priority.

The pre-admission assessment was not signed or dated so it was unclear who had completed it and when. Documents must be signed and datedto establish accountability, ensure data integrity, and create an accurate, contemporaneous record of care.

The provider did not make sure people’s care and treatment was effective because they did not always check and discuss people’s health, care, wellbeing, and communication needs with them.

The needs of a person newly admitted to the service not been comprehensively assessed. For example, their weightbearing status was ‘TBC’ (to be confirmed), as was information about their cognition/orientation, hearing/vision aids, and sleep routine. This meant staff did not have all the information they needed when they began supporting this person. Managers said they would gather the missing information as a matter of priority.

The pre-admission assessment was not signed or dated so it was unclear who had completed it and when. Documents must be signed and datedto establish accountability, ensure data integrity, and create an accurate, contemporaneous record of care.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People’s nutritional needs were not always identified and met. A person was admitted to the service and offered food without their nutritional needs being recorded. Staff kept a list in the kitchen of people’s dietary needs/allergies/special diets, etc. The person had not been added to the list. A member of the kitchen staff said they had met with the person who told them their food preferences, but there was no written record of this for staff to refer to. The kitchen staff member said they usually had a sheet with people’s dietary needs on it, but they had not yet had one for this person.

Another person said they didn’t like the food served as they preferred more fruit and salads and often bought their own food items to supplement their diet. With the person’s permission, we told managers, who immediately met with this person and made plans to provide a menu that was to the person’s liking and met their dietary needs.

Most people had care plans for their nutrition/hydration needs. Staff used the nationally recognised Malnutrition Universal Screening Tool (MUST) to identify people at risk of malnutrition. This helped them assess and manage people’s nutritional needs to ensure they were met in line with current standards and evidence-based guidance. If people had swallowing difficulties staff said they would refer them via their GP to speech and language therapists.

People participated in menu selection. The cook said, “I let residents choose menus. I go around and ask people individually what they like and from that develop the menus. They like stews, rice pudding, ham egg and chips, vegetables, fish Friday, and they love scampi and full roast on Sunday.” A person commented, “We have good food, and you get plenty.”

During lunchtime there were enough staff available to assist people with their meals if they needed support. Staff sat and talked with people, ensuring the lunchtime experience was positive and interactive.

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

Staff lacked training in some of the health conditions people using the service lived with. No staff had Parkinson’s disease training, and only 8% were trained in diabetes. A person with a health condition said they would like more support with this from staff. Managers said they would address this to ensure the person was assisted to understand and be involved in managing their health condition.

Other people and relatives were satisfied with how staff supported people to get medical support when necessary and live healthier lives. A relatives told us, “They will call the GP if there’s ever a problem and [family member] is not well.” Records showed people had regular input from a range of healthcare professionals.

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.

Staff documented people’s medical needs in their care plans. Records showed staff monitored these and acted taken to bring about improvement where possible. Medical conditions were explained in care plans and information provided to inform staff what to look out for if a person’s health deteriorated. Care plans included desired outcomes for people and what staff could do to help them achieve optimum health.

A relative gave us an example staff taking prompt action when a person showed signs of an infection. The relative alerted staff to find out they had already contacted a GP. This resulted in the person being given medicines to resolve the issue.

The provider told people about their rights around consent and respected these when delivering person-centred care and support.

People had mental capacity assessments to determine if they were able to consent to care. If people lacked capacity, best interest decisions were made. Deprivation of Liberty Safeguards (DoLS) were in place for people who could not consent to their care arrangements. DoLS provides a legal framework for restricting people’s liberty when it's necessary for their safety, ensuring it's done in their best interests and with the authorisation of the local authority.

Most staff were trained in the Mental Capacity Act 2005 (MCA). They told us they always asked for people’s consent before providing care and support. A staff member said, “A few people have not got capacity, we help them make decisions and be safe, they cannot leave the home [unaccompanied] as they would be at risk."