Wray Park Care Home

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 amend as required 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.

The service was in breach of legal regulation in regard to people’s rights and consent.
 

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 provider did always not make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The registered manager told us staff were allocated as key workers to people. They told us this involved checking people had enough toiletries, checking people’s clothes, any mobility equipment and speaking with their relatives. However, there was no focus on discussing the skills, strengths and goals of people which would enable them to continue living fulfilled lives.

People’s care plans were not reviewed regularly to include their health needs. There was a lack of review of people’s overall wellbeing and communication needs to enable them to receive person centred care bringing best possible outcomes.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

There were no tools used to assist in the in the assessment of pain in patients who are unable to clearly articulate their needs, such as the Abbey Pain Scale. This meant that people may not be provided with pain relief medicine when needed. Care plans did not contain information or guidance around how to assess when a person was in pain. Despite ‘as and when’ pain relief guidance stating, ‘pain levels need to be ascertained first.’

We saw ‘MUST' tools and Waterlow scores being used in people’s care plans. Malnutrition Universal Screening Tool is a five-step screening system used by healthcare professionals to identify adults who are malnourished, or at risk of malnutrition, and Waterlow scores are used to predict the risk of developing pressure ulcers or sores. However, there was a lack of guidance for staff where people were determined to be at risk in these areas.
 

The provider did not work always well across teams to support people.

Leaders told us there was no formal structure to how frequently people cared for in bed were checked or repositioned by staff. They told us, and the care plans confirmed, that this could be anywhere between 2-4 hours. When staff do not know how frequently to check or reposition a person this risks the person getting pressure sores, dehydrated and experiencing unnoticed medical emergencies. Care plans demonstrated people cared for in bed had very low fluid intake.

When activities were taking place with the activity coordinator in the lounge, we observed care staff stood at the door not interacting with people. One member of staff was seen leaning against the door frame of the lounge door. Staff did not take this opportunity to spend meaningful time with people cared for in bed.

However, we did see from the staff communication book, that prompt referrals were made to health care professionals where staff had identified a concern. One external professional told us, “Interventions [by staff] are timely and staff proactively support the changing needs of [people].”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Most people living at the service were living with dementia. The care plans lacked details of how people can be supported with their wellbeing in relation to their dementia diagnosis. Care plans did not provide guidance for staff on how to support them and what to do if their mood was low or if they were anxious.

However, we did see that senior staff regularly spoke with the GP when they had concerns about people’s health. We saw people were also supported with other health care including dental, opticians and hearing appointments. One external professional told us, “If requested by myself, a member of staff will join me to help support the [person] while I treat [people] who have become advanced in their dementia. Enabling myself to provide safe, preventative and effective care.”

People told us they enjoyed the food at the service. One person said, “The food is really good.” A relative told us, “[Family member] rates the food. She eats more now she’s come in here.”

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.

People’s fluid intake was not routinely being monitored, this meant they were at risk as changes in their condition may not have been noticed. The provider failed to ensure people’s high levels of anxiety were monitored, so they could look at ways of reducing these for better outcomes for people. We also identified that people at times were regularly being administered ‘as and when’ laxatives. This was not being monitored by leaders to establish why this was necessary.

However, we noted 1 person’s regular medicine for severe agitation had recently reduced due to them being unsteady on their feet and confused. There were records in the staff communication book that this was being monitored to determine whether this was effective for the person.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

Leaders did not always act in accordance with the Mental Capacity Act (2005) to ensure people rights were respected and they had the lawful process for obtaining consent.

For people that lacked capacity and were living at the service, capacity assessments were partially completed by the registered manager but did not include any evidence of a best interest decision.

We also identified that the GP had also requested staff administer a sedative to a person, who lacked capacity to make decisions, before they attended the home to take a blood test from the person. We saw from the person’s medicine record staff administered this. This was not challenged by leaders or care staff. The registered manager told us that they were aware of this practice. However, a capacity assessment or best interest discussion had not been taken place in relation to this to determine whether this was the least restrictive option. Asking care staff to administer a sedative before a blood test is highly concerning and considered poor practice. It raises serious issues regarding consent and the person’s safety. We have reported this as a safeguarding concern.

People were not consulted in relation to the blanket use of sensor alarms in their bedrooms. The service also had closed-circuit television (CCTV) operating throughout the communal areas. Consent and records of discussions, including MCA assessments were not in place for people. This meant there was a serious risk the service was not acting in accordance with the MCA and people’s rights were not being taken into account.

However, staff understood the need to seek people’s consent before providing care, as observed during medication and mealtime support. People and relatives told us staff always explained what they were doing.