Wall Hill Care Home Limited

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. During the last inspection this service was in breach of a regulation relating to people consenting to their care and treatment. During this inspection we found similar themes, as well as safeguarding concerns. Therefore, this contributed to a breach of a legal regulation in relation to safeguarding people from abuse.

This service scored 42 (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 check and discuss people’s health, care and wellbeing needs with them.
One person was being supported when their health deteriorated. However, the person’s health had since improved but the way the person was being supported was not reviewed following this improvement. Therefore, the person was no longer being cared for in a way that suited their needs. We asked the management team why the person had not been reassessed. No action had been taken to reassess the person and there was no best interest decision in place to continue to care for the person in a particular way. We raised a safeguarding concern with the local authority on behalf of this person. A visiting professional told us they had visited the home at the start of March 2025 and had identified the same concerns as we did. The visiting professional spoke to a member of the management team and requested they reassess the person to ensure they were being appropriately supported. This professional advice was not followed. On day 2 of our site visit, the person’s care had changed to suit the person’s needs, but we had needed to prompt this.
Care plans and risk assessments were not kept updated with people’s changing needs. Where people experienced distressed behaviours risk assessments were not always in place. Where plans were in place they did not clearly describe the actions for staff to take in response to these behaviours. Where 1 person had experienced a symptom from their ill health, their care plan did not detail the actions for staff to take if this was to reoccur. This left the person at risk of not receiving appropriate care should they experience a recurrence.
Staff told us about people’s needs and signs and symptoms of people’s specific health conditions.
 

The provider did not plan and deliver people’s care and treatment with them. They did not use current evidence-based good practice and standards.
We received mixed messages regarding the quality of the food depending upon which kitchen staff member had prepared the meal. The provider told us 1 of the more experienced kitchen staff members was supporting and training the other.
Where people required their fluid monitoring, staff recorded the amount of fluid consumed. However, where some people consistently did not achieve their targets no action or escalation was recorded. In response to our feedback, the provider contacted a health professional to reassess fluid targets.
Staff told us how concerns or changes in people’s care were shared in handovers or using the electronic system. One relative told us the provider contacted them following any change in their family member’s health. However, the provider failed to accurately record changes in people’s care and keep care plans and risk assessments up to date. This placed people at risk of harm.
Where 1 person’s care plan stated they should be sitting on a pressure relieving cushion, we observed the person sitting in a chair without the cushion in place. We alerted staff who went to retrieve the cushion and place in under the person. This had left the person at risk of their skin breaking down as the necessary equipment was not always being used.
Where 1 person’s care plan stated they did not need their nutrition and hydration monitoring, we noted staff were consistently recording this in their daily notes. We spoke to staff who told us their needs had changed. However, the person’s care plan had not been updated, which left the person at risk of not always receiving the support they needed as staff did not have the guidance in place to prompt this. The registered manager told us they were in the process of updating all care plans.
Where 1 person had the consistency of their food changed by the provider, there were no clear assessments recorded in the care plan to explain when or why their food consistency had been altered and who had made this decision. On day 2 of our site visit, we observed the person eating foods not consistent with their care plan without difficulty. When we questioned the management team about this no one was clear when the assessments had taken place or why the person’s food was altered. The registered manager later sent us an update with information about the assessments and the date a new Speech And Language Therapist (SALT) referral had been submitted.
 

The provider did not always work well across teams and services to support people.
Care records confirmed people accessed health professionals such as doctors and district nurses when needed. However, we received feedback from visiting professionals which was less positive. One visiting professional told us the provider had not followed their advice in relation to supporting a person whose needs had changed. A further visiting professional raised concerns over staff not responding to people when they experienced an altercation with other people.
People told us they had access to visiting professionals such as doctors. One person said, “I can see the doctor if I need to, I have seen the dentist.”
 

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control.
People did not always have access to opportunities to exercise and engage in the community. The provider had 1 set day per week for people to engage in an exercise class. There were limited opportunities for meaningful engagement. We raised concerns in response to a person who appeared in a low mood and made self-injurious comments, a member of the management team told us, “They always make comments like that.” The provider had not sought advice from health professionals to support this person’s mental well-being. We raised a safeguarding referral for this person and the provider responded to our feedback by referring the person to a health professional. Where people spent prolonged time in their bedroom, no activities or social stimulation was recorded.
Staff told us they did not always have the time to be able to spend time talking and engaging with people in meaningful activities. The provider told us they had recently recruited a part time activities co-ordinator who was due to start working in their new position.
 

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.
Relatives told us they felt people were monitored safely. Staff told us about how they monitored people such as recording people’s weights. However, whilst some improvements had been made since the last inspection around monitoring people’s care and treatment, such as monitoring people’s bowel care, there had been insufficient improvement overall when monitoring people’s care, wellbeing and risks to people’s health. Incidents involving people’s wellbeing were not always recorded, analysed or followed up. People’s health needs were not always reflected in people’s care plans and there was sometimes conflicting information.This conflicting information increased the risk of staff error, and this placed service users at risk of harm.
When people’s fluid consumption was insufficient, this was not followed up. Where 1 person required repositioning and this was monitored, they were left in the same position for prolonged periods. Where 1 person’s nutritional needs had changed, daily records contained conflicting information about the type of food consistency the person consumed when compared to their assessed need. Where care plans detailed health tasks which did not require monitoring, staff completed these tasks explaining the person’s needs had changed. Where care plans indicated people required support with their oral care, this was not consistently monitored.
 

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.
One person we spoke to told us staff made them get out of bed in the morning. We raised a safeguarding concern with the local authority safeguarding team on behalf of this person and we asked the provider to investigate. The provider responded to our feedback by carrying out an investigation, although we raised concerns over the depth of the investigation and the fact the investigation did not detail a discussion with the person concerned or any rationale for not speaking to the person. Under the key guidance and law, people should be as involved as much as possible when investigating safeguarding concerns.
Other people told us they had choice and control. One person said, “I can get up when I choose to.” Another person told us, “I can have breakfast in bed, if I choose.”
Where restrictions existed, such as bed rails or food consistency, best interest decisions had not always been made. Some care plans contained conflicting information regarding people’s capacity, 1 care plan recorded the person had capacity and then stated the person lacked capacity. The manager responded to our feedback by updating the care plan.