Walfinch Chiswick, Hammersmith & Kensington

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

People and their relatives said that highly effective care was provided, They were not subject to discrimination and their equality and diversity needs were well met. The staff were well-trained and supervised. People and their relatives also told us staff provided excellent care in a dedicated, patient manner that was person centred, and focused on and met people’s needs. Staff encouraged people to discuss their health needs, and any changes to them or concerns were passed on to appropriate health care professional partners. This included transitioning of services when people became more dependent as their needs changed. Staff proactively protected people from the risks associated with nutrition and hydration, and people were encouraged to choose healthy and balanced diets that also met their likes, dislikes, and preferences.

This service scored 83 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us they were fully involved in the needs assessment process, and able to explain what their care, and support needs were. This made them confident that they would receive the support they needed and wanted. The assessments included all aspects of their health, wellbeing, communication needs, and were regularly reviewed, and updated as needs changed. A relative said, “Yes, every step.” Another relative told us, “I am involved, not my mum she cannot. It has been reviewed a couple of weeks ago and whenever there is a need for changes.” The impact of the assessment process for people was that they received care and support that was fully focused on their needs, and flexible when those needs quickly changed.

The management team said that people and their relatives were supported to be involved in their needs assessments. They explained that the assessments covered all aspects of health and social care required by people. This included health, care, wellbeing, and methods of communication. Staff told us that if they had any concerns regarding changes to people’s needs or indeed any aspect of their care, that they reported them to the registered manager, and management team, who would trigger re-assessments, and where needed inform relevant healthcare professionals. Healthcare professionals also confirmed this. The impact for people was that they received a fully integrated and joined up service, both internally, and externally that was flexible, and met their needs to a very high level.

The assessment processes evaluated people’s needs if they could be met and how. A sponsoring placing authority also provided a referral. The provider carried out their own assessments with people, and their relatives which were comprehensive, to ensure they met people’s current needs. The assessments fed care plans that were up-to-date, regularly reviewed, and updated so staff understood people’s current needs. Any required adjustments were made accordingly.

People and their relatives said the service provided up to date information regarding their health, care, and support. They told us staff supported and advised them regarding keeping physically, mentally, and emotionally well. The support was delivered by well, co-ordinated staff who enabled people to live as they wished. A relative said, “She is on a soft diet. They [staff] are aware of the diet, and the guidelines. She is encouraged to feed herself, slowly no distractions. It is in her notes, but I go through it with them.” Following staff member’s medication error, a medicine information sheet was created for, and distributed to all staff. The staff member who made the error was immediately re-evaluated, and then retrained by the registered manager. This process has been incorporated into the training and induction program. The impact of this was staff became more diligent, and people benefitted from a safer service.

The management team and staff said they provided people with evidence based care and support which was demonstrated by the care and support records we sampled. This included health, nutrition, and hydration needs. They told us the organisation encouraged them to learn about and investigate new and innovative approaches that evidence showed could improve the way their care was delivered.

The systems in place ensured that staff were kept up to date with national legislation, evidence-based good practice, new innovations, and required standards.

People told us staff supported, and advised them regarding keeping physically, mentally, and emotionally well. They said what they really liked was having familiar faces. The support staff provided was very well co-ordinated and enabled people to live the way they wished they wished. A relative said, “They [staff] do change, but [person using the service] has 3 main core carers and if one is unable to make it for any reason, they always have somebody to step in but always somebody she knows. They inform us the day before at the latest.” The provider gave us further evidence of how people had benefitted from being enabled to have a larger provider choice, by supporting them to take control of their direct payments, keeping frequently updated comprehensive assessments and detailed records, providing support for increased funding as support needs increased, and including families in holistic support. They also highlighted how people who experienced loneliness, and social isolation had been supported to alleviate loneliness by engaging with people in their community and taking part in social activities. The impact of the examples was specialised, client-focused carefor individuals with complex needs. This was provided by a consistent and trained care team, who also advocated for family needs. This significantly reduced the strain on them, as well as improving the quality of life for the person.

The provider promoted good working relationships with external healthcare services so the registered manager, management team and staff could support people to live as independently as possible, and keep healthy. Staff reported any health care concerns to the management team who alerted appropriate health care professionals. They also supported people to access community-based health care professionals, such as district nurses, GPs, and to refer themselves to health care services. This was supported by health care professional’s feedback. A staff member told us, “The service meets people’s needs well. Each person gets care that is planned just for them, in a holistic way.” Another staff member said, “Every manager is at our side in a minute when we need them to provide the best care for clients, and for us. They support us, listen to our needs, and focus on them, especially regarding our safety.”

The processes enabled the service and its staff to engage with relevant healthcare professionals, and other organisations within the community that may be able to meet people’s needs that fall outside the agreed care package. This provided joined up, linked care and support for people. A healthcare professional told us, “They provide excellent communication regarding people’s needs.” This meant that staff could provide a service meeting people’s needs to a very high standard as they had access to the most up to date information about people, both internally, and externally.

People and their relatives said staff supported them to keep healthy by suggesting healthier options and supporting people to make them. This included diet, and lifestyle. Whilst suggesting healthier options, people were still able to make their own choices, and eat the meals they enjoyed. One relative told us, “They [staff] provide 3 meals a day, every day. [staff] does a shop every week, they provide a list for specific foods she likes and meals, they run meals past her, and she is happy to have them.” This meant people were supported to follow healthier lifestyles by having access to healthier options, whilst maintaining their opportunities to make their own choices, and retain their independence.

The management team told us that people’s health was frequently monitored within the care plan process. Staff said they built up bonds and relationships with people that enabled them to better understand their needs, wishes, and how, and when they could be best met. This included suggesting healthier options and lifestyle choices regarding diet including meal choices. Although suggestions were made and advice given, people were supported to make their own choices, and take acceptable risks. This information was shared with other staff, and the office team so everyone was up to date, and aware.

The processes in place enabled the service to keep track of people’s health, update care plans, and inform healthcare professionals, and any care package purchasers of required changes.

The registered manager, and staff told us treating people as individuals, and focusing on their individual needs was paramount in how care and support was provided. This was achieved by staff building up relationships with people through consistent care delivery, and information sharing. Staff had a clear understanding regarding the people they provided a service for, their needs, and how best they could be met. Staff explained it was attention to details, and the little things that made all the difference. This could only be achieved by bonding, and building relationships with people which cannot be achieved if the care, and support is rushed. They gave examples of people’s routines, what order they liked to do things, and when. What type of television programmes they liked to watch, and checking when they were being broadcast. New staff introductions to existing people using the service were facilitated by staff or the registered manager whom the person was already familiar with. Additionally, the new staff’s profile was shared with the person and their family. The impact of this was to ensure a smooth and comfortable transition.

People and their relatives confirmed that consent to treatment and care, and support was sought prior to a service being provided. A person told us, “Staff always explain what they are doing and ask if you are happy for the care, at all times.”

The management team told us that people were consulted, and their views and wishes taken into account when care was planned. People and their representatives received information about care and treatment in a way they could understand and had appropriate support and time to make decisions. Staff confirmed this. A staff member explained, “[Registered manager] put guidance in the care plan to say “we” a lot. We will go to the bathroom, and look at her body language. We will go in here together, instead of saying toilet. We are going to lower you down as her mobility is good, but not cognitive, you must guide her. We will count to three, then place her hand so she realises there is a chair. If she pulls away, you have the answer. Reading her body language for consent. Offering her your hand if she pulls away that’s no.

There were systems and processes to ensure that people and their representatives understood the care and treatment being offered or recommended. Consent to care and treatment was recorded in people’s care plans by themselves if they had been assessed as having capacity to do so or by people appointed to make decisions on their behalf.