Waxham House

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 service since registration under the new provider. 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 relation to need for consent.
 

This service scored 58 (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.

The provider assessed people’s needs before they moved into the service to ensure their individual needs could be met. Managers regularly reviewed these to ensure people received effective support.
 

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Nationally recognised tools had been used; however, these were not always effective as they were not always completed correctly. For example, a tool designed to identify people at risk of developing pressure ulcers was in use, however, some of the information entered was incorrect. This meant the level of risk was not correct and the provider could not be assured that all actions were taken to prevent the risk of avoidable harm.

The provider could not be assured people were receiving fluids in line with their assessed needs. For example, a person had been advised to drink 1500mls daily. However, records did not always show the person had been offered fluids in line with their daily target. There was no effective monitoring of people’s hydration needs, including actions taken when a person’s fluid intake was reduced and below the amount advised. There were no detailed risk assessments providing guidance to staff about the risks of dehydration.
 

The provider worked well across teams and services to support people.

The provider worked effectively with external healthcare professionals to support people. People had access to health care professionals, such as GPs and chiropodists.
People told us they had health appointments they attended routinely, and the district nurse visited the service.
 

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.

The new provider was making changes to support people to manage their health and wellbeing to maximise their independence, choice and control. They were really thinking about people, putting them and their quality of life first, including facilitating trips out locally.

People told us they knew the provider had just taken over the service. They were happy with the changes, in relation to the quality of food, the recent implementation of fresh vegetables and being able to go out and experience increased independence.
 

Leaders 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.

The new provider was committed to improving outcomes for people. However, systems and processes did not consistently and effectively monitor people’s outcomes and experiences. For example, where people had fallen, the provider’s post falls monitoring tool did not reflect recognised good practice in post falls monitoring and did not encourage staff to consider possible deterioration in people’s health conditions. The provider’s ‘meeting needs’ policy referred to the use of a tool used to detect early signs of deterioration in people. However, the post falls monitoring forms in place were not effective and there was no evidence this tool was being used to identify soft signs of deterioration in a person’s condition, meaning the person’s condition was not monitored effectively.
 

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

The provider failed to ensure the correct procedure was followed in relation to the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework for supporting people who may lack the ability to make certain decisions for themselves.

The provider did not always assess people’s mental capacity to make specific decisions in line with the MCA. This included decisions such as moving rooms within the home, consent to admission, sharing a room and having photographs taken. It also included the use of restrictive measures, such as sensor mats and regular checks throughout the night. Some mental capacity assessments identified 2 specific decisions on 1 assessment which was not in line with the code of practice.

Practice in relation to best interest decisions did not meet MCA requirements. The provider failed to show they had considered less restrictive practices when they were making best interest decisions in relation to restrictions on people. Therefore, the decisions made may not have been proportionate and the least restrictive option.