West Wood 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 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 42 (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 not always make sure people’s care and treatment were effective because they did not always effectively check and discuss people’s health, care, wellbeing and communication needs with them or their representatives.

We reviewed the pre-admission assessments and care plans for 2 people who had recently moved into the service. We saw these were very basic and contained very limited information about people’s specific needs.

A person’s representative told us, “I have noticed from reading the file in [Name]’s room that they [staff] seem to have asked [Name] for some further detail which [Name] has answered incorrectly. I have said that I will sit and give them [staff] the correct information, but this has not been done yet. I have never been involved in a care plan review for [Name] and [they have] been there a year.”

Another representative said, “In the beginning, when [Name] went there, we saw [previous manager], who was very thorough and covered everything. It has been a bit hit and miss at times since then, with all the changes [of staff].”

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

For example, we expressed our concerns that the ‘Memory Floor’ did not currently provide an appropriate environment for people living with dementia. However, the management team told us they did not believe in having different coloured doors etc. They also told us they did not have things like memory boxes or tactile items because of infection control risks. This meant the provider was not working in accordance with evidence-based advice and guidance provided by dementia specialists, in respect of creating dementia friendly environments.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

We identified that the management team were often defensive, rather than being open and transparent, particularly when reviewing people’s support needs or when issues or shortfalls were brought to their attention by third parties.

Some people’s representatives also told us that the service delivery did not consistently meet their loved ones’ needs. A person’s representative told us, “[Name] has really struggled with the inconsistency in carers who just seem to come and go and really don’t understand what [Name] needs.” Another representative told us that information was not shared appropriately between the care home and the hospital for their loved one.

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

Staff did not always support people appropriately with their eating and drinking needs. This was because there were not always enough staff available to provide encouragement or assistance when needed. We also saw in some people’s care records that, due to weight loss, they had been prescribed nutritional supplements. However, records did not consistently show if and when people were being given these.

A person’s representative said, “I feel [Name] still needs more support [to eat] as [they have] lost quite a bit of weight.”

Another representative told us, “There was a situation where [Name] wasn’t well and when I went, I spoke to [carer]. It was 10.30am and [Name]’s breakfast was still on the side. Nobody had offered [Name] anything to eat and all [carer] kept saying was that it wasn’t [their] fault.”

We were not assured that people were being provided with adequate amounts of food and drink. We were also not assured that people’s choices were being consistently respected and upheld.

We found that important information regarding people’s dietary needs was not always clear or had not been recorded.

For example, we saw in most cases that staff automatically served people with large portions of food, even when their nutritional information stated they preferred small or medium portions.

A person’s representative told us, “[Name] is on a low salt diet and yet I regularly see packets of crisps that have been left by staff as a snack.”

Another representative said, “[Name] has had several urine infections which send [them] into a strange mental state, but [care staff] say that is what happens.”

The manager told us that mealtimes were breakfast from 7am, lunch upstairs from 12:30pm and from 1pm downstairs. Supper was served from 4:30pm. Information in people’s care plans and food consistently showed that food and drinks were only provided on these occasions, with some people’s records showing long gaps between supper and breakfast. In some instances, people’s daily records indicated gaps of more than 18 hours between meals.

People’s representatives made comments such as, “The portions have noticeably shrunk. The teatime meal is a snack of sausage roll, sandwiches, cake etc.” “There have been times when there is a 13hour gap between tea and breakfast, with no opportunity to request anything else in between.” “I have noted that there are always pastries, crisps and cakes with drinks available for visitors, but surely residents should be looked after first.” And, “There has been a high turnover of chefs during the months [Name] has lived there and we feel that this has contributed hugely to the issues around insufficient food and choices.”
 

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.

For example, during both site visits, we determined the upstairs environment (Memory Floor) was not ‘dementia friendly’. We identified the layout, design and colour scheme was not helpful for supporting people living with dementia with orientation. We saw that everybody’s bedroom door was plain white. Each door had the room number and people’s names were engraved onto a small metal plaque in the middle.There was a white square on each door, where a picture or something identifiable could be placed. However, virtually all of the occupied rooms remained blank.

We saw a person living on the 1st floor was confused during our visit on 2 December and was supported by an inspector to find their room, because they did not recognise it from the outside. We raised this with staff who responded that the person had written their name in pen on their door a couple of times and it had needed to be cleaned off. This indicated that the person had already tried to do something to make their room identifiable, but staff and management had failed to listen. This demonstrated the provider did not recognise or understand people’s needs and take action to ensure that outcomes were positive and consistent.

Another person’s representative told us that their loved one also got confused and it distressed them when they couldn’t find or identify their own room.

We saw that the downstairs environment was virtually identical in layout, design and colour scheme as the Memory Floor. We saw that people living on the Memory Floor were frequently supported to go downstairs when external entertainers visited the home. However, we also saw that some people got confused and distressed, because they could no longer find their rooms. This was because they did not recognise that they were no longer on the Memory Floor. Staff confirmed that this often happened, but no action had been taken to reduce people’s anxiety and improve the conditions for people living with dementia.

We found that daily care records and people’s food charts were not being completed in real time. This led to some information being missed out completely, recorded inaccurately or, as seen in some cases, being duplicated. This made it impossible to complete an accurate audit of people’s food and fluid intake or monitor people’s diets and ensure they met both clinical expectations and the expectations of people themselves.

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

We observed staff asking people for their consent prior to providing care, but we found that people’s care plans lacked clear information about how to promote choice and decision-making.

Where people may not have the capacity to make a specific decision, the provider had not always followed the Mental Capacity Act 2005 appropriately to assess people’s capacity. We also found that not all the capacity assessments we reviewed were sufficiently detailed about how decisions for people were being made.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005.

The provider had made DoLS applications where necessary, but staff did not have easy access to information relating to people’s DoLS and mental capacity, such as any conditions or guidance.

Staff and management also lacked understanding and failed to respect and uphold the rights of people who had mental capacity. For example, a person’s representative told us they had received phone calls from a senior member of staff, who wanted to update the care plan regarding wills and funeral arrangements. The representative said their relative had full mental capacity and could have given this information to the staff. However, the representative said the nurse told them staff were not allowed to ask the ‘residents’ and could only speak to the family member holding the Power of Attorney.”