Woodlands Ridge 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 good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (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 had their needs assessed before moving to the service. Some relatives told us this had taken place in hospital or at home. Staff told us they were provided with information about people who were moving to the service before they arrived. One staff member said, “We’re always given a write up on new residents before it goes onto the care planning system, so that

we know all about them.” Staff told us they got to know people’s support needs by reading the information and speaking with people and their families.

Although most people’s relatives told us they had been involved during the pre-assessment process, not all told us they had been invited to take part in care plan reviews.

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.

Nationally recognised clinical tools were used to assess the risk of skin damage, falls and malnutrition. People’s weight was monitored and reviewed monthly to ensure oversight at management level; the chef told us they attended a monthly meeting with the registered manager to review people’s weights. They said, “I attend the daily meetings where the manager will bring weight loss to my attention. Once a month she will sit down and give me an update, and we will look at what needs focusing on. I really focus on fortified meals as we have some people at high risk of weight loss.”

Records showed concerns about weight loss were escalated to the GP. Nutritional care plans were in place and detailed any dietary requirements alongside people’s preferences for what they liked to eat and drink. One person’s relative said, “[Relative] needs encouragement with eating now and is given supplements to increase calories. I know the staff weigh [relative] on a regular basis, and I know staff have discussed it with the GP.”

When people needed staff support with eating and drinking or when adapted cutlery or utensils were required, this was documented. Records showed people were provided with enough to eat and drink. Kitchen staff were aware of people’s dietary needs and preferences. The chef told us, “We have the whiteboard in the kitchen; this is updated on a daily basis. I ask the carers when I come in whether there were any updates in handover. The management team also inform me if diets change or someone new is moving in. It’s changed immediately on the whiteboard.”

We observed lunch during the inspection. We saw that people eating their lunch were treated with respect by staff who were talking with them and checking they had what they needed and enjoying their food. Staff were polite when serving meals; however, we observed on both days that people were not always offered a visual choice of meal or told what the food was as it was placed in front of them. Additionally, although care plans guided staff to tell people who had vision difficulties what the food was and where it was on the plate, we did not consistently see staff do this. We fed this back to the registered manager who told us they would remind staff to do this.

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.

Staff had access to people’s care and support plans to understand people’s needs and deliver their care. There were weekly visits from the local GP and the service was also supported by members of the multi-disciplinary team. Health professionals we spoke with told us the staff were proactive in making contact for advice and followed any recommendations. One health professional said, “The staff are good at asking us to come and review people. I had actually discharged one person from our service, and it was the manager who contacted me with some concerns and asked me to come back again. I would say they are very helpful and know people well.”

People’s relatives told us the staff team always kept them informed about any healthcare appointments. For example, one person’s relative said, “Since [name] has been there, they’ve had an assessment by the hospice staff, been taken to hospital for a scan and been seen by the GP. The staff always let me know if the doctor has visited.”

Staff told us they worked well together, that shift change handovers took place and that information was passed on to the team on duty.

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.

Staff monitored people’s health and escalated concerns appropriately. Staff used a national early warning score tool to help them recognised and determine when to escalate clinical concerns. Staff were knowledgeable about people’s health needs. For example, staff understood how to recognise the signs of low blood glucose levels in people who had diabetes and the steps they needed to take if this happened.

The chef told us they had implemented more fresh fruit into people’s diets including offering fresh fruit as a snack and we saw this in practise.

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.

There was oversight of people’s needs and a daily meeting, attended by department heads, was held and documented. This included of review of any incidents that had occurred overnight, and anything for staff to be aware of. The deputy manager told us, “Every day I print a wound report, a bowel report and a fluid report. I tell staff to focus on these areas.”

We saw records which showed that wounds, weight loss and falls were monitored and analysed. We saw that referrals had been made for people who required additional clinical support, such as the local hospice, the older people’s mental health team and speech and language therapy (SALT). The GP carried out weekly reviews.

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

In the main, mental capacity assessments had been carried out in line with legislation. For example, people had their mental capacity assessed in relation to consenting to live at the service, to have bed rails in use and for staff to support them with their care. However, some people who were at risk of falls had sensor mats in place to alert staff if they tried to stand up unaided. Although some people had mental capacity assessments and records relating to best interest decisions for the use of sensor mats, not everyone did where this was required. We discussed this with the registered manager who told us they would address this with immediate effect.

The mental capacity assessments we looked at had been carried out in line with legislation. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care services, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. All legal applications had been made in accordance with DoLS. This meant people’s rights were fully respected. The registered manager kept a record and tracker of DoLS applications and authorisations.

We observed staff throughout both days of our inspection offering people choices and asking for their consent. For example, we saw a member of staff come into the lounge and say to one person, “Would you like another biscuit?" The staff member then walked around the lounge offering the plate of biscuits to people.

Not all the people we spoke with were able to tell us if staff asked for their consent before providing support. However, we saw staff knocking on bedroom doors before entering for example and asking people if they wanted to take part in activities.

People’s relatives told us they saw staff ask people for their consent and offer choices to their loved ones. One person’s relative said, “My relative is able to make [their] own decisions. The staff don’t force [name] to do anything.”