Wynhill Lodge Short Breaks Service

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.

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.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a care plan review system in place to assess people’s needs; however, we found this process was not always effective in identifying when people’s needs had changed or when care plans required updating. Records did not always demonstrate whether people, or their relatives where appropriate, had been involved in these reviews. This meant people were at risk of receiving care that did not fully reflect their current needs. The provider told us there was a system in place called pre stay calls where a telephone call was made to people or their relatives to share key information or discuss any changes in care. However, we were not assured the information shared was always updated in people’s care plans for staff to have clear guidance on people assessed needs

The provider did not always follow legislation and current evidence-based good practice and standards. People did have their nutrition and hydration needs met.

People did not always receive care and support in line with best practice guidance. For example, although staff had completed positive behaviour support training, incidents where people displayed distressed behaviour were not always recorded or reviewed. This meant staff and managers did not consistently analyse incidents to identify triggers, patterns, themes, or learning, which could have helped reduce or mitigate the risk of reoccurrence.

People’s nutrition and hydration needs were met in line with their care plans. Where people required modified diets to reduce known risks, staff followed relevant guidance. Where people required fluid monitoring, this was in place. During handovers, risks relating to hydration were clearly identified, and staff took appropriate action, including encouraging increased fluid intake where required.

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.

Professionals told us the registered manager and staff worked well with them and shared relevant information promptly when required. One professional told us, “Communication and cooperation with me, in my role as [professional’s role], have been consistently positive. We have developed a strong and respectful working relationship. Staff engage openly, communicate clearly, and approach our discussions in a professional and solution‑focused way. Their willingness to share information, respond quickly, and involve me appropriately demonstrates a genuine commitment to supporting the best possible outcomes for the individuals in their care. It has been a pleasure to collaborate with Wynhill Lodge staff in ensuring the delivery of high‑quality, person‑centred care.”

Staff told us they worked well as a team. We observed verbal shift handovers, which were effective and ensured information and concerns were clearly shared, with clear direction on actions that needed to be taken. This meant staff and professionals worked collaboratively.

Staff did not always support people to live healthier lives or, where possible, reduce their future needs for care and support. For example, following an incident where a person had a fall and ‘banged their head’, staff had not completed the required records in line with the provider’s policy. The incident had not been reported to the registered manager, and staff had not considered whether a healthcare professional needed to be contacted. This meant the provider could not be assured that people were consistently supported to manage risks to their health and wellbeing, or that appropriate action was taken following incidents to reduce the risk of harm and future deterioration.

The provider did not always routinely monitor people’s care and treatment to ensure continuous improvement. They did not consistently ensure outcomes were positive and person‑centred, or that care met both clinical best practice and people’s individual expectations.

Systems and processes were in place to review and monitor people’s care plans; however as showed in safe part of this report, staff had not always identified, recorded, or updated changes in people’s clinical health in a timely way. Incidents and accidents, not always been recorded, investigated, or reviewed. This meant the staff and management team would not always be able to identify themes, learn from incidents, and take action to reduce the risk of reoccurrence to improve people’s outcomes.

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

We did observed staff obtaining verbal consent before supporting people with any care tasks, however where people could not consent to their care, the Mental Capacity Act 2005 (MCA) was not always followed. The MCA provides a legal framework for making decisions on behalf of people who may lack the mental capacity to make specific decisions for themselves. The MCA requires that, as far as possible, people are supported to make their own decisions. Where people lack capacity, any decisions made on their behalf must be in their best interests and be the least restrictive option. We found the principles of the Mental Capacity Act were not always followed. Where people had been assessed as lacking capacity to consent to certain aspects of their care, mental capacity assessments had not always been completed, and the best‑interest decision‑making process had not consistently been followed or recorded. This meant the provider could not be assured that decisions were always made lawfully, in people’s best interests, or in line with least restrictive practice, placing people at risk of having their rights under the Mental Capacity Act not fully protected.