Wymeswold Manor

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.

This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (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 had systems in place to review people's care records; however, these processes had not been effective in identifying and addressing inaccuracies and gaps in documentation. We found information relating to people's health and care needs was not always accurately assessed and reflected within their care records. For example, 1 person had a wound which required monitoring and care; however, there was no record of this within their care plans and no guidance for staff on how the wound should be managed. This meant staff may not have had access to the information needed to provide consistent and effective care.

In addition, staff were not consistently recording the care and support provided to people overnight. The absence of contemporaneous records meant there was insufficient information available to evaluate whether people's needs had been met, identify changes in their wellbeing, or review the effectiveness of the care provided. The provider had not ensured accurate, complete and up-to-date records were maintained for each person. As a result, people's needs could not always be effectively assessed, monitored and reviewed to ensure care remained appropriate and responsive to their changing circumstances.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People did not always receive care and treatment that reflected recognised guidance and best practice. We reviewed the records of 1 person who had a specific health condition that required regular monitoring by staff. The person's care plan contained guidance on the action staff should take when monitoring results which fell outside of the specified parameters. However, records showed there were occasions when the person's readings were outside the agreed range and staff had not followed the guidance or documented any appropriate action being taken.

The provider had not ensured staff consistently followed care planning guidance designed to support the safe management of the person's health condition. This meant care and treatment were not always delivered in line with an evidence-based approach, increasing the risk that changes in the person's health may not be recognised or responded to appropriately.

During the inspection, we also found not all staff had received training or competency checks to monitor and respond to people’s specific health needs. This placed people at risk of harm, as staff may not have had the necessary knowledge and skills to provide safe and appropriate care. Following the inspection, the provider took action to start addressing this by implementing additional training and reviewing staff competency in relation to people’s individual health needs.

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.

The provider worked with other services to support outcomes for people. The GP, or a representative from the practice, carried out ‘ward rounds’ weekly, which helped ensure people’s health needs were reviewed regularly and any concerns were addressed promptly.

We received mixed feedback from visiting professionals. One visiting professional told us staff would take handover after their visits to ensure any changes to their support needs were followed. However, another professional commented, “Clinical risk information could be a little better. There does seem to be a lack of understanding of how care is triangulated with many facets and information does need to be shared on occasions. A training issue I feel.”

The provider did not always support people to manage their health and wellbeing. Staff did not always support people to live healthier lives.

People were supported appropriately with their nutritional needs. Care records showed individuals' dietary requirements and preferences were assessed and we observed staff encouraged people to eat throughout the day and provided support where required. Feedback from relatives was positive regarding the support provided. One relative told us, “Everyone [staff] is so kind. They give [relative] drinks and encourage [relative] to eat.”

However, records relating to people's food intake were not always sufficiently detailed. Daily care records consisted of tick-box entries to indicate meals had been eaten but did not record what people had eaten or the quantity consumed. This meant the provider could not be fully assured people were eating enough to meet their nutritional needs or identify any changes in food intake that may require further monitoring or intervention.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The provider did not have effective systems in place to routinely monitor people's care and treatment to ensure continuous improvement in outcomes. Records reviewed showed staff did not consistently monitor and document aspects of care that were important to people's health and wellbeing. As a result, the provider could not be assured outcomes were positive, consistent, and met both clinical expectations and the needs and preferences of people using the service. For example, 1 person's health condition placed them at an increased risk of dehydration and required regular monitoring of their fluid intake. However, staff did not consistently or accurately record the person's fluid consumption. This meant the provider could not demonstrate the person was receiving adequate hydration or that appropriate action would be taken if concerns about their fluid intake arose.

The provider did not always respect people’s rights when delivering care and treatment.

Individualised mental capacity assessments were in place and Deprivation of Liberty Safeguards (DoLS) had been applied for appropriately. However, some improvement was required for staff guidance in peoples care plans on what people could or could not decide for themselves. For example, peoples care plans were more of a blanket approach with people described as deemed to lack capacity to consent to care and treatment. It was not clear if some individuals could make some decisions about their care themselves; for example, choosing what they would like to wear or choosing where in the home they would like to spend their time.

Staff demonstrated a good understanding of mental capacity and what that meant for people. A staff member told us, “I ensure the person is involved as much as possible using appropriate communication methods, I also consider their past and present wishes and preferences, when required, family members will be involved and lastly the mental capacity act of making decisions in the persons best interests will be followed.”

We observed and people and relatives told us that staff sought consent to care at the point of delivery.