Welcome House - The Chestnuts

On this page

• 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

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires Improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to person-centred care.

This service scored 46 (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 and staff did not always make sure people were at the centre of their care and treatment choices.

Although people’s care plans were very lengthy, they were detailed and gave a good level of information on how people ended up living at the service and the care they required. A staff member said, “I think they (care plans) are helpful. If people’s needs change or new habits become regular, we’d change the care plan to reflect this.”

Care plans were essentially up to date with people’s needs, care requirements and likes and dislikes. There was a good overview of a person’s personal history to help staff get to know people or understand why people may suffer from anxiety or agitation.

Yet, although there was supporting information for staff, we did not see this put into practice. For example, to support one person’s mental health, staff were encouraged to keep them engaged in meaningful daily activities, take them to the park for fresh air and involve them in cooking and meal preparation through one-to-one support. But there was no evidence this was happening and the person told us they had not been encouraged to cook, but would like to do so.

Although people had keyworkers who met with them to review their care plans, the notes from these discussions were largely task-focused, covering areas such as general well-being, personal care, oral hygiene, room cleaning and finances. There was little evidence of exploring social, emotional, or developmental needs or individual goals, preferences or aspirations. This meant, that although people were receiving the day to day care they required, opportunities for people to achieve outcomes beyond basic care needs were missed.

There were some shortfalls in how the registered manager and staff understood the diverse health and care needs of people. There was little improvement in people’s lives since our last inspection as once again, there was little going on for people.

Although staff provided a caring service to people, there was little evidence that people were being supported to integrate back into the community. We discussed the support one person received with cooking and were told by a staff member, “It is the basics like chopping veg because she loses interest, so they have not done anything more complex.” There was no clear plan, gauge or review of this person’s current cooking skills to determine what support they needed and as such staff had not considered if this was why the person may be losing interest.

A second person wished to move back to their flat and had told staff of this. However, there was no plan for staff to help the person work towards this. A staff member told us they spent time with this person on a 1 to 1 to achieve their goals, but there was no evidence of what these goals were, and from the daily records there was no evidence this person was doing anything other than watching television.

There was no evidence of a coordinated approach across care services to support people. Although professionals were involved, we did not read any multi-disciplinary meetings having taken place so staff could work together to enable people to ingrate back into society.

Some people were, however, supported with continuity by staff. This included 1 person who was supported to participate in their religious activities during the week and some other people who were encouraged and supported to see friends or family members.

The registered did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

We asked the registered manager how they ensured information was presented in a way that could be understood for people. They were not really able to answer us as they said, “We let people know through one to one’s any changes that are going to be made, like the weather conditions – if it is going to be very hot.” However, after giving examples and clarifying what we meant by presenting information in a pictorial format, they confirmed that in-house meetings were documented in this way.

Staff encouraged people to participate in the running of the service through conversation and feedback.

The registered manager told us they held in-house meetings with people so they had the opportunity to raise any concerns or ideas for outings and activities. They told us staff would then make arrangements to meet their needs and choices. They said, “We have service user meetings and they air their views and if they do not wish to speak in front of others they can come to the office and speak to me privately.” They told us they had added another option to the menu through one person’s feedback. We did not see any evidence, other than in meeting minutes, of people raising concerns or complaints and those being recorded and investigated by the registered manager. This was despite people telling us they would like to go out in the evening and would like the opportunity to be more involved in daily life skills such as cooking and baking. This showed that although the registered manager held in-house meetings, people’s views were not always fully taken into account and used as a basis in which to establish routines or practices that develop people as an individual.

They also told us that each year there was an external outing which people from all of the provider’s 5 services could participate in. They said, “They have a choice of 3 places to go and we organise the trip to the place most people choose. This year it is Margate.” This demonstrated an institutionalised practice within the service as although people were involved in choosing 1 of 3 options, there was not opportunity for them to make their own suggestion of where the annual trip was.

The registered manager did not make sure that people could access the care and support they wished. One person told us, “I like going shopping, but I can’t always go out because of staff, especially if they are short staffed. It doesn’t happen a lot, but it does happen. I went out yesterday so I won’t go out today. I can only go out on certain days. I don’t have the opportunity go out in the evening. I would like to go to the restaurant down the road. I used to go there a lot.”

No specific goals were identified for people despite some people having expressed a wish to live independently again. The care plan for one person noted they required support with daily living skills, including learning to cook. However, there was no evidence this support had been put in place.

Staff did not also think creatively about how to support people with daily living tasks. For example, one person told us they were not allowed in the kitchen to make their own drinks. Staff explained this was because the person used a walker and could not carry a hot drink safely. However, they had not explored alternatives such as a kettle tipper, a perching stool, or adaptive two-handled mugs. They had also not considered starting with simple, achievable tasks and gradually introducing more complex steps as the person’s confidence and ability grew.

People were not encouraged or motivated to access external services or the community and nor did staff actively facilitate this. A staff member told us, “We encourage people to get out into the fresh air when it is nice.” However, they confirmed they meant the garden, rather than out in the community.

Staff and leaders did not actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Staff used weekly ‘activity planners’ and staff told us they followed these to ensure people went out, or spent their time doing something meaningful to them. However, they also told us external outings usually consisted of walks and several people went out at the same time, so there appeared little opportunity for people to spend time on individualised activities of their choice. Despite these planners being in place, upon review of the daily notes for 6 people over a period of 3 weeks, we found only 3 people had been out on one occasion each. The other 3 people had spent their time indoors watching television or doing colouring.

One person’s planner showed they should go out 6 days a week for a walk, go to McDonalds and to the cinema, then on a Sunday they would bake. But their daily notes viewed from 23 July to the first day of inspection contained no evidence this was happening.

Throughout our first visit, people spent most of the day sat doing nothing. They were in the lounge watching television or in the dining area either eating or doing an activity such as a game or colouring.

In addition, although people were offered the opportunity to go out once a year with people from the provider’s other services, these outings were largely staff-led. Rather than seeking people’s ideas and discussing options together, staff pre-selected the outings and then presented 3 choices to people.

People were 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.

There was some information in people’s care plans about the end of their life and their wishes. For example, one person had stated which prayer they wanted, the music they wished played, and where they would like their funeral service.