Welcome House - The Chestnuts

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

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.

The service was in breach of legal regulation in relation to people’s safe care and treatment and person centred care.

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 registered manager did not always make sure people’s care and treatment were effective because they did not always ensure that Welcome House – The Chestnuts was the most suitable place for people to live. People told us one person moving in had caused them to feel uncomfortable and we read from the records that the person who moved in suffered regularly from anxiety and agitation towards others. This had resulted in some people being harmed.

In addition, this person required 1 to 1 staffing throughout the day and 2 to 1 when going out which meant that other people’s opportunity to go out had been impacted. This demonstrated this person’s needs had not been fully assessed prior to them moving into the service.

We found the funding authority’s assessments included in people’s care plans, together with the registered manager’s initial assessment. Information from both of these formed the basis of the person’s care plan.

The registered manager did not always plan or deliver people’s care and treatment with them, taking into account any national guidance.

There was little evidence of staff supporting people to develop life skills to enable them to work towards living on their own, or achieving goals and aspirations, and there was nothing to show that staff were offering bespoke or therapeutical support to people, whether internally or from external professionals.

We spoke with the registered manager about national guidance to support people who had a mental health condition. They told us they were not aware of any and did not access any support groups or peer groups for advice and support, other than professionals such as the GP, psychiatrist or mental health nurse. Although later they said they referred to NICE guidance, they were unaware of charities such as MIND or Talking Therapies who may be able to support them to support people living at the service.

People were encouraged however to attend dental appointments, chiropodist appointments and visit the GP when required.

The registered manager and staff worked well across teams and services to support people.

When people first moved into the service there was a lot of input from external health professionals and services such as the mental health team, psychiatry, social workers and the GP.

Where people had lost weight staff made referrals to the dietician and in the case of one person who had a choking incident, the speech and language therapy team were involved. A visiting professional told us, “They (staff) contact us in time and when needed.”

Other people were supported to attend appointments with the GP, diabetic eye screening service, dental community team and chiropodist.

The registered manager and staff did not always ensure people would be supported in relation to their health as care plans were not always clear.

One person’s stated they needed to have 2 glasses of full fat milk in the morning and at dinner if they agreed and yet, in another part of their care plan, it stated they did not like milk. This was part of their fluid and nutrition goal, but it was difficult to determine what this goal was.

Other documentation, which would be important if a person was admitted to hospital, had not been updated for some time. For example, one person’s hospital passport (a document that provides healthcare professionals with essential information about a person’s individual needs and preferences) had not been reviewed since 2021. This included information that this person was on insulin for their diabetes which was no longer the case. Another person’s was written in 2022.

However, staff recognised when people required professional healthcare input to maintain their health. For example one person was put on milkshakes by the GP following weight loss and this had helped to stabilise their weight. Another person was under the dietician when they needed support with their nutrition.

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.

The registered manager and staff improved the outcomes for some people as some people had experienced harm or abuse prior to moving into Welcome House – the Chestnuts. Others were also at risk of self-neglect. Through staff’s input and care, people had started to accept support in their personal care and were living in an environment which was comfortable and much safer for them. People had clothing provided for them and for some people it was their first opportunity in a long time to sleep in a proper bed.

Staff training ensured positive outcomes for people. One person suffered a choking incident and it was through a staff member’s quick thinking, competency and training that they were able to carry out CPR whilst they waited for the ambulance. This resulted in the person recovering unharmed.

However, not everyone consistently experienced positive outcomes which met agreed expectations as set out in legislation, standard and evidence based clinical guidance as there were not structured approaches in place to improve people’s lives to enable them to attain their goals or aspirations.

The registered manager did not always assess people’s capacity to make decisions around living at the service and their care. They did not always follow the principles of the Mental Capacity Act 2005 to determine if someone had capacity to make these decisions alone.

We found some capacity assessments in people’s care plans, but these did not cover all aspects of a person’s care. For example, one person was determined to have capacity and rightly staff did not carry out any other capacity assessments with this person. However, a second person was determined as lacking capacity to take medication or receive assistance with personal care, but there were no further capacity assessments completed, for example, around living at a service with 24-hour care or for the locked cupboards in the dining room. And although staff told us everyone had the capacity to make their own decisions this was not immediately clear from people’s care documents.

Staff understood the need to ask for a person’s consent prior to providing care. This meant in some instances people refused support and staff respected this. Staff understood people had the right to go out alone if they wished and told us, “We encourage people to make choices. They choose if they wash and what to wear.”