Winchley Home

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.
At our last assessment we rated this key question Good. At this assessment the rating has changed to Inadequate.

This meant services were not planned or delivered in ways that met people’s needs.
 

This service scored 25 (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 were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.
There were no effective systems in place to make sure people, and their relatives, where appropriate, were involved in reviewing and updating their care plans. Care plans did not provide the level of detail to ensure a person-centred approach to people’s care and support. People’s changing needs had not always been reassessed in a timely manner which led to insufficient support for people.
 

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity. The provider had not ensured systems and processes had been implemented to enable people to receive appropriate and skilled joined up care in relation to health care and social care needs. Although staff did liaise with some health professionals such as district nurses, care plans and daily records did not record the reason or any guidance that may have been given to improve care and support.

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.
Care plans did not always record people’s communication needs clearly and did not always consider the impact that vision and hearing loss could have on people’s ability to communicate. Staff had not received training on effective communication. The acting manager was unable to tell us how they meet the Accessible Information Standards (AIS) or what AIS was. Since 2016, all organisations that provide publicly funded adult social care are legally required to follow the AIS. The AIS tells organisations what they have to do to help ensure people with a disability or sensory loss, and in some circumstances, their carers, get information in a way they can understand it. It also says that people should get the support they need in relation to communication.
 

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result. There were no systems in place to seek feedback on the service from staff, people who used the service, relatives or external professionals. Meetings were not held with people who used the service or their relatives, when raised with the acting manager, we were told that these had not taken place as, “Residents have dementia.”
Complaints were not always recorded clearly. Relatives were aware of how to raise complaints and concerns and said that staff were approachable.
 

The provider did not make sure that people could access the care, support and treatment they needed when they needed it.
Most of the people living at Winchley Home had a diagnosis of dementia and deemed by the service to lack the mental capacity to raise concerns surrounding their health and well-being. However, due to a lack of information or conflicting information in care plans, staff did not have the guidance to advocate on their behalf to enable the right care and treatment when they needed. As a result, decisions were made for people without always understanding individual needs and wishes. The need for referrals to health care professionals such as dieticians were not always identified or made in a timely manner.
 

Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this. Care plans did not record people’s goals and desired outcomes, instead included generic statements that were not meaningful for people. Care plans lacked information on people’s life events, likes and dislikes. Relatives spoken with told us how their family member used to participate in activities, however, now showed no interest. A relative said, “[Family member] used to but now [they] do not want to.” Another relative said, “The staff visit [family member] in [their] room, they were going to play dominoes with [them], but they do not have enough staff. I have never known anyone go out for the day or on trips.” There was a lack of systems to ensure people receiving meaningful social interactions to enhance their quality of life.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.
People’s wishes at the end of their life were not always considered or recorded. People had a ‘death and dying’ care plan, however, these were not consistently detailed or completed and some contained basic and general information. Consideration had not been given to people’s individual beliefs and wishes such as if they had specific religious and spiritual needs that may impact on how their end of life was planned. Staff may not be aware of these details to ensure people were treated appropriately to end their life according to their wishes and beliefs. A person’s ‘death and dying’ section in their care plan recorded that they both did and did not have a Do Not Attempt Resuscitation (DNAR) decision in place. This could lead to the person’s wishes not being followed. Staff had not received end of life care training.