Witnesham Nursing 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.

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 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 did not always ensure care remained responsive to people's needs, as assessment and review processes were not consistently effective.

People's health, care, well-being and communication needs were assessed. However, they were not always reviewed and acted upon effectively. Records contained a range of assessments and information about people's needs, risks and preferences. However, these did not consistently translate into care and support that reflected those needs in practice. As a result, we were not assured the care people received was always based on accurate, up-to-date assessments.

Some assessments and care planning documentation was detailed and included guidance for staff on how to support people safely. However, these were inconsistently completed. This meant it was not always clear whether changes in people's needs, well-being or risks had been identified and acted upon in a timely way.The provider acknowledged these areas for improvement, which reflected findings from an independent review they had commissioned, and was open and transparent in sharing both the review outcomes and their improvement plans. Although action had been taken and progress was evident, further time was required for these improvements to become fully established and consistently effective in practice.

While processes were in place to assess and plan people's care and treatment, these were not always implemented consistently in practice to ensure care reflected people's current needs and associated risks.

People’s care and treatment were not always delivered in line with current evidence-based guidance, recognised best practice or the provider’s own procedures. Although the service used a range of assessment tools to identify and monitor people’s needs, these were not consistently reflected in day-to-day practice. This meant the provider could not always demonstrate that people received care and support in accordance with their assessed needs and associated risks.

Records relating to nutrition, hydration, repositioning and medicines management were not always completed accurately or consistently, limiting the provider’s ability to monitor care delivery and respond effectively to changes in people’s needs.

We also identified inconsistencies in the management of people’s dietary requirements. Meal planning records did not always clearly demonstrate that people requiring modified diets had been offered meaningful choices, and information relating to food and fluid consistencies was not consistently recorded across documentation. For example, some records did not accurately reflect people’s prescribed fluid thickening requirements, creating a risk that staff may not always have access to the most up-to-date information. In addition, kitchen staff had not received training or guidance in preparing food and drinks for people requiring modified consistencies, and there were no systems in place to evidence that food and fluids had been prepared to the correct prescribed texture or thickness. As a result, the provider could not be assured that people with swallowing difficulties consistently received care that minimised the risk of choking and supported their preferences in line with best practice.

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.

The management team held daily handovers and staff debriefs to share information and support continuity of care. People received coordinated support from a range of health and social care professionals, and records demonstrated effective partnership working with GPs and other agencies. Staff sought professional advice when people's needs changed, helping to ensure care and treatment remained responsive to current needs and reducing the risk of delays in accessing appropriate support.

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 received support to access healthcare services and maintain their health and well-being. Records showed staff monitored people's health closely and sought timely advice from healthcare professionals when concerns were identified.

The provider did not always monitor people’s care and treatment so they could consistently improve outcomes. There was evidence of audits, monthly governance meetings, provider reports, weights clinics, wound clinics and resident-of-the-day reviews. However, oversight was not always robust, and some systems remained at an early stage of implementation. Inspectors found examples where actions were unclear or incomplete, including resident-of-the-day records with no clear action owner or timescale, medicines audits that lacked full sign-off, and provider reporting that did not clearly evidence consistent validation or follow-through. This meant the provider had some monitoring systems in place, but they were not always effective in identifying issues promptly and driving sustained improvement. The provider acknowledged these areas for improvement, which reflected findings from an independent review they had commissioned, and was open and transparent in sharing both the review outcomes and their improvement plans. Although action had been taken and progress was evident, further time was required for these improvements to become fully established and consistently effective in practice.

The provider did not always ensure the principles of the Mental Capacity Act 2005 were consistently applied in practice. This meant people could not always be assured that decisions about their care and treatment were supported by appropriate consent, capacity assessments or best interest processes.

People's rights to make decisions about their care and treatment were not always fully supported in line with the Mental Capacity Act 2005 (MCA). While consent, mental capacity assessments and best interest decision-making had been considered for some people, these arrangements were not always consistently maintained or applied in practice.

For example, one person who had recently moved into the service was receiving medicines covertly. Although some documentation had transferred from their previous placement, there was no recorded mental capacity assessment or best interest decision in place to support this arrangement. The service had been informed that updated documentation would be provided; however, this had not yet been received despite efforts by the care staff to obtain the necessary documentation. As a result, the provider could not demonstrate that this restrictive practice was being delivered in accordance with the MCA.

The provider had identified the need for improvement and had included MCA awareness, training and governance oversight within its improvement plans. However, these actions were at an early stage and had not yet been embedded sufficiently to provide assurance that people's rights, choices and freedoms were consistently respected and upheld.