The Chiswick Nursing Centre

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.

We identified a breach of regulation 9 relating to person centred care meeting their needs and preferences.

This service scored 50 (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 always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. However, the provider assessment processes did initially evaluate people’s needs, if they could be met, how and sponsoring placing authorities also provided referral information. The inspectors checked information and reviews for 20 people on different floors, of the care home, most were minimal regarding people’s social care needs and did not always correspond to the information in their care plans. This varied depending on which floor people lived on, their level of mental capacity, dependency and healthcare needs. Thirteen people’s care plans and daily notes had no confirmation their hobbies and interests were considered, actioned and took place. For example a care plan for 1 person recorded in the hobbies and life history section, “Still enjoyed hobbies.” The hobbies recorded included sewing, singing, and gardening. They also enjoyed chatting. The care plan for another person recorded they enjoyed watching TV, particularly sports. A further person’s care plan recorded hobbies of classical music on the radio, and formula 1 racing on TV. We found no evidence people had been supported to continue these interests and hobbies. The impact of this was people’s social needs, hobbies and interests were not always met.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. This was confirmed by the lack of detailed information contained in many people’s care plans regarding their hobbies and interests and whether they had been pursued.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services. The staff were observed working well together as teams and providing verbal information about people and their care to each other. This was despite struggling to achieve the tasks allotted to them. A relative told us, “Staff are organised into teams specific to individual people and this means that some people are left as another is seen as the priority. One team might be struggling whilst another is quieter, but they don’t see it is their job to go and help.”

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 support people to live healthier lives, or where possible, reduce their future needs for care and support. Whilst staff encouraged people to eat healthily, their nutrition status was recorded, and meal choices provided. Some practices did not support people to live healthier lives. This was because staff were rushed and had many tasks to carry out. One person asked an inspector to give them a drink, as they could not reach the water themselves because the cup was out of reach, and they were bedridden. Another person told us, “If she needed a nurse or carer, she said she had a call bell, but it was hit and miss when and if they came.” We observed that another person was thirsty with nothing in their cup and that they could not reach the water jug as it was over the other side of the room.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. Whilst the provider had systems and processes to monitor people’s care and treatment, they were not always completed or carried out within the identified timescale. We found the impact of this was accurate, up to date oversight and information regarding people and equipment was not always in place. This meant people may not receive the care and support they required and outcomes for them may not be improved. For example medicine audits were not completed in line with the provider’s policy each month, the last being completed in October 2024.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment. People and their relatives confirmed that consent to treatment, care, and support was sought prior to a service being provided.