Witnesham Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last inspection we rated this key question good. At this inspection the rating has changed to requires improvement: This meant people’s needs were not always met.

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.

‘The provider did not always ensure care records and care planning documentation accurately reflected people's current needs, preferences and desired outcomes. Changes in people's needs were not always consistently recorded or translated into personalised care planning.

Care records addressed routine risks and documented the completion of care tasks; however, there was a predominately task-focused approach to recording, which did not always provide sufficient detail about the care delivered or the outcomes achieved for people. For example, records frequently stated that "personal care" had been provided, but lacked person-centred information about the support offered, how the person engaged with the intervention, or whether their individual preferences and needs had been met.

We found that information within care plans was not always accurate, up to date, or reflective of people's current needs. For example, one person's care plan did not accurately reflect their current treatment requirements. Although staff told us care plans were evaluated monthly, changes in people's needs were not consistently captured within care records. This meant that care planning was not always fully personalised and staff did not always have access to clear, current guidance to support people in a way that reflected their individual circumstances, preferences, and desired outcomes.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

People had access to a range of healthcare professionals, including GPs, chiropodists, district nurses and Speech and Language Therapists (SALT), when referrals were required. This helped to ensure people received specialist advice and support to meet their changing health and care needs.

However, improvements were needed to ensure records consistently captured the outcomes of referrals and any guidance provided by external professionals. As a result, the provider could not always demonstrate how professional advice had been communicated, implemented and monitored to support continuity of care.

The provider did not always ensure information was available in accessible formats to support people to make informed choices and maintain their independence.There were opportunities to improve pictorial/easy-read information that was available to people.

People's care records included information about their communication needs, and we observed staff communicating with people in ways that reflected their individual preferences and abilities. Some accessible signage was available within the home, including clear pictorial signs for toilets and bedroom doors, and some people had personalised name signs displayed on their rooms. This helped people to identify key areas of the home and supported orientation.

However, there was limited accessible information available throughout the service. For example, meal choices were displayed on a small whiteboard in the dining room, which was not accessible for everyone. There was also a lack of pictorial and easy-read information, including information about menus. As a result, the provider could not be assured that all people were able to access information in a format that met their needs and supported them to make informed choices independently.

The provider had opportunities for people and relatives to share feedback and raise concerns; however, communication and engagement were not always consistently effective.

Most relatives told us they felt comfortable raising concerns and were confident they would be listened to and that appropriate action would be taken. One relative told us, “I have never made a complaint but if I did, I would be listened to. I would speak to the manager; they have been absolutely first class. I completed a survey about the service seeking my views.” Another relative said, “I have never complained but if I needed to, I would speak to the [registered] manager. I have attended a relative’s meeting at the home and have completed surveys.”

This demonstrated that relatives had opportunities to share feedback and generally felt able to approach the management team with concerns. However, some relatives felt communication could be improved. One relative told us, “I can’t fault the face-to-face communication that I get when in the home but feel that the family don’t generally get enough information about [family member].” While systems were in place to gather feedback and involve relatives, there were opportunities for the provider to further develop communication and engagement arrangements to ensure people and those important to them were consistently informed and involved in their care and support.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

The service environment was accessible for people with physical support needs, and people were provided with equipment to promote independence and enable access to different areas of the home and community. However, the environment was not always designed to fully support people living with dementia. For example, there was a lack of clear signage and visual prompts to help people orientate themselves and navigate the service independently. This meant opportunities to further promote independence, reduce confusion and support positive outcomes for people living with dementia had not been fully maximised. Despite this, people had access to communal facilities and shared spaces within the home, helping to promote inclusion and participation in daily life.The provider was committed to enhancing the environment and told us they were making the necessary improvements including repainting walls/doors and refurbishing communal areas and bedrooms to improve contrast, orientation and dementia-friendly design. They also told us the existing décor pre-dated acquisition of the service and was already being progressively addressed.

People were supported to access healthcare services and attend routine and specialist appointments to help ensure their health needs were appropriately assessed and managed, including when their health had deteriorated.

Some people using the service were living with dementia. The environment had not been fully adapted to meet their needs or to promote independence, orientation, and safe navigation throughout the home. For example, there were no handrails along corridors to support people when mobilising, and signage throughout the building was limited, making it more difficult for people to independently identify key areas such as toilets and communal spaces. Although no concerns were observed during the inspection regarding people's ability to navigate the environment, the absence of dementia-friendly signage could increase confusion and anxiety for some individuals.

Staff had received equality, diversity and human rights training to support their understanding of inclusive care practices. This helped staff to recognise and respond to people's diverse needs, supporting more equitable experiences.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Whilst staff had supported people to begin considering and discussing their wishes for the end of their lives, end-of-life care plans lacked sufficient detail to fully reflect individuals' preferences and choices. Greater consultation with people, and those important to them where appropriate, was needed to ensure plans were truly person-centred and clearly documented personal wishes, medical treatment preferences and boundaries, comfort measures, and emotional, spiritual, and cultural needs. This would have supported a more consistent approach to delivering care that respected people's choices, reduced uncertainty at the end of life, and provided reassurance to people and their relatives.