Westroyd Care Home

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• 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 service since it was registered under the new provider. This key question has been rated good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Family members told us they were involved in key decisions about their relative’s health and wellbeing. A family member told us, “The staff are very good, they always tell me how [person] is getting on.”

We asked an external health care professional of staff followed their advice. They told us, “Yes, staff consistently follow the advice and recommendations I provide.”

People’s care needs were documented in written care records. All staff had access to people’s assessments, risk assessments and care plans. Care records were reviewed and updated, however, we found improvements were needed to ensure all care records were updated as and when a person’s needs changed as referenced within the safe section of this report.

Staff said people’s needs were assessed and reviewed by a member of the management team or senior carers, and where people’s needs were changed their care plan would be updated. Staff told us they were verbally informed of changes in people’s needs at handover meetings.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People and family members spoke positively about the meals. A person told us, “The food here is always good, there’s always a variety and a choice. The portions are good as well.” A second person said, “No complaints about the food, I had the pork it was lovely and a nice pudding.” A family member told us, “My [person] loves the food, they eat very well. They always have a choice.” In some instances, family members joined their relatives for a meal. A relative told us. “I’m here 7 days a week, I have my dinner here, the meals are nice.”

Adjustments were made to people’s foods where they were at risk of choking or had difficulties swallowing, a family member told us, “My [person] eats pureed food, there’s a lot of choice.”

Referrals were made to speech and language therapists when people experienced difficulties in swallowing. People’s care records included a food passport, which outlined their likes and dislikes and any dietary requirements.

A lively and engaging conversation involving people and staff took place at lunchtime, where they discussed their views about the Haggis which had recently been added to the menu at some people’s request. One person said, “I tried the Haggis, but I wouldn’t have it again.”

Dining tables were set with flowers, cutlery and condiments. The atmosphere was jovial, with people interacting with each other and staff. A choice of drinks was offered, and staff brought meals to people based on their earlier choices.

Staff including the chef gave a good overview of individual’s dietary needs and risks, including prevention of choking, weight loss and diabetes.

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.

Processes were in place to update family members to any changes to people's needs. Staff had gained consent from relatives if they wished to be updated.

People’s care records confirmed referrals to external health and social care professionals were made when required. The outcome of appointments had been recorded and acted upon as required. There were weekly visits from the local GP where they carried out regular checks with people.

We asked an external health care professional how they would describe communication with staff at the service. They told us, “Communication with staff at the service is excellent. I carry out a weekly ward round at the care home, and both the care staff and senior management are always prepared. They provide an organised list in advance, and all relevant clinical information is readily available.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People told us they had access to a range of external health care professionals. A person told us, “I did have an eye and hearing test.” A second person said, “I saw the doctor a couple of months ago, and I had an eye test last year.”

Family members spoke of the involvement of health care professionals. A family member told us, “If [person] needs a doctor they come pretty promptly, and the optician visits once year.” Family members spoke of staff’s promptness in seeking assistance when their relative’s health needs changed quickly. A family member said, “Staff got [person] to hospital with a catheter problem, they were very prompt in their response, and they told me straight away.”

We asked an external health care professional if staff made appropriate and timely referrals to them when people wanted or needed access to other health care support. They told us, “Yes, always. For example, during the winter months when rates of flu and chest infections increase, symptoms are communicated to me promptly and staff seek medical attention in a proactive manner. Another example is with residents who have dementia and present with distressed or changed behaviours. Staff maintain behaviour charts, rule out common underlying causes such as infections (e.g., UTIs), and appropriately seek my assessment before escalating to in-reach mental health teams.”

Staff we spoke with understood the signs of a urinary tract infections and demonstrated a good understanding as to people’s health and wellbeing. Staff confirmed timely referrals to external health care professionals were made.

People were seen independently mobilising around the service, and family members spoke of staff encouraging their relative’s independence in support of maintaining health and wellbeing. A family member said, “My [person] likes to be independent, they know them and give assistance when its required.”

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.

We found improvements were needed to the quality and consistency of information within people’s care records to ensure their care was monitored effectively, as referenced in other areas of this report. For example, nutritional and dietary needs, and weight loss. The registered manager had shared the action they had taken following our initial feedback to bring about improvement.

Clinical care governance meetings were held for the purpose of reviewing care standards. These focused in part on reviewing the analysis of clinical incidents and audits, including pressure ulcers, weight loss, falls and urinary tract infections. The regional area manager considered these factors as part of their monthly reports of the service and had identified themselves improvements were needed in key areas as previously referenced. The senior management team provided assurance of the actions being taken to bring about improvements.

We asked an external health care professionals if staff followed their advice. They told us, “Yes, staff consistently follow the advice and recommendations I provide.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People’s views were mixed as to whether staff gained consent prior to care interventions. A person told us, “Staff just give me the care, they don’t ask my permission.” Whilst another person said, “As a whole staff do ask my permission to do things.”

People’s capacity to make their own decisions had been considered. A mental capacity assessment had been undertaken for most care decisions and interventions. The registered manager was bringing about improvements in response to an external organisations assessment of the service, which had identified some improvements were required.

Staff had a basic knowledge of MCA and said they had completed MCA training. They highlighted they treated people as they had capacity unless told otherwise. Staff were aware if people’s capacity was limited a DoLS referral was made for assessment. Staff were aware that people should be encouraged to make decisions where they had the capacity to do so. A member of staff gave an example as how they encouraged people to make decisions. “We think everyone has capacity unless assessed not to have. All people should be given the chance to make decisions about their care and life. We ask, show clothes, when getting people dressed in the morning.”

Positive interactions between people and staff were observed throughout the day, including staff seeking people’s views and opinions on a range of areas.

An external social care stakeholder informed us, they had completed quality support sessions with the management team, and the registered manager and other members of the management team had attended face to face training on the MCA.