Wadhurst Manor

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 remained Good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (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.

People's health and social care needs were assessed before coming to live at the service; the impact of these had been fully considered and there was clear information about what was important to people and how they would like their care and support to be delivered. This had also ensured the service could meet the identified needs of the person and that staff had the necessary training to keep them safe and well. There was evidence of family involvement within the documents.

People’s communication needs were assessed regularly and different methods of communication tried and reviewed to ensure people were offered every opportunity to participate in their care decisions. During discussion with staff, it was evident that staff knew people well and had developed understanding of individuals’ communication needs, especially around monitoring of pain. One staff member described how a person would use facial and hand gesturing to indicate that they were experiencing pain.

People’s care records were reviewed regularly to ensure they remained an accurate reflection of people’s needs. The provider's processes for assessing and reviewing people's care and support needs were effective and regularly reviewed. People’s assessments included sufficient detail about their individual care needs and preferences, which had ensured their needs were met consistently and effectively.

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.

Records included guidance for staff relating to people’s health conditions, medicines support, nutrition and mobility needs. Recognised tools and guidance, including the Malnutrition Universal Screening Tool (MUST) and International Dysphagia Diet Standardisation Initiative (IDDSI) guidance were used to support the delivery of safe nutritional care.The management team had oversight of these and planned action appropriately with the involvement of family and the staff team. The service had links with other organisations such as tissue viability services and speech and language therapists (SaLT).

Staff were given training which followed current good practice guidance. Staff told us they worked alongside GPs, social workers and other health and social care professionals. They made referrals when needed and acted on recommendations. For example, people’s ability to eat safely and maintain a healthy weight was assessed and monitored and appropriate action taken. Staff were knowledgeable regarding people’s eating requirements, and this was clearly recorded to ensure all changes were shared. Where needed, advice was sought from healthcare professionals on how people’s diets should be adapted to suit them. Information was available in the kitchen to ensure people received appropriate drinks, meals and snacks. Food and fluid charts were completed to monitor people’s intake, which allowed staff to provide support and encouragement to people who were struggling to eat and drink. We saw evidence of a monthly analysis of infections, wounds, weight loss and gain, and falls, which recorded action taken. People’s care plans showed the service worked in conjunction with external health care professionals, to ensure people received the care they required in line with their changing needs.

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.

Care plans and risk assessments showed evidence of regular review that had ensured they remained an accurate reflection of people’s needs. Care records were detailed. People’s needs and preferences were documented and shared appropriately with staff involved in their care. The team understood the importance of working with other professionals. This meant people could be confident their needs and well-being were a priority. During our assessment we received written feedback from healthcare professionals who supported people. Feedback about the home was very positive, the team were praised for how they managed good relationships with other external teams. One health professional said, “I am delighted to see how staff adapted their communication style according to each resident's individual needs, ensuring people were involved as much as possible in discussions about their care. The outcomes of the medicine reviews were communicated by secured email, and the agreed action plans were implemented promptly. This demonstrated good communication between the care home and healthcare professionals and helped maintain continuity and consistency of care.”

There was evidence of regular interactions between the clinical staff and other healthcare professionals, the GP conducted a ward round every Friday, and this was led by the clinical lead nurse. There was documentation within the care plans of involvement from podiatry, OT and hospice teams. Staff report that the engagement with other professionals includes family involvement to ensure people’s needs are supported and care plans are reviewed. A staff member stated that residents’ needs are always changing therefore care plans were updated to reflect this on a regular basis. This highlighted that there was an engaging and collaborative approach to people’s care.

Continuity was maintained through the use of regular staff and regular bank staff. There is no reported agency use. Staff members told us that this ensures the people know the individuals who are looking after them. The impact of this is also that the staff interact well with one another and communication is effective.

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.

Staff understood people’s health and wellbeing needs and provided support in line with people’s preferences and assessed needs. Staff supported people to attend healthcare appointments and liaised with external professionals, where required, to help maintain people’s health and wellbeing. For example, dermatologists and dentists.

People’s changing health needs were recognised and acted upon quickly and appropriately. Where concerns about people’s wellbeing were identified, staff sought advice promptly to help prevent deterioration and support positive outcomes for people. We saw positive outcomes regarding people arriving with pressure wounds including evidence of healing and ongoing monitoring.

Staff encouraged people to remain as independent as possible and supported people with routines and daily living in a way that reflected their abilities and preferences. We saw staff supporting people patiently and providing reassurance and guidance, where needed. We also saw that there were exercise sessions and visits out. This helped people maintain their health, independence and overall wellbeing.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Organisational systems monitored people’s care, wellbeing and safety needs, including reviews of care plans, risk assessments, incidents and audits. The provider used information from monitoring systems, feedback and day-to-day oversight to identify areas for improvement and act where required. The management team monitored people's health outcomes and took further action when required. For example, when an ongoing skin condition had not improved, the registered manager sought additional medical advice and arranged further investigations. This led to an alternative approach to care being identified and implemented, which resulted in an improvement in outcomes. Records showed action was taken when people’s needs changed and staff were updated promptly to support consistent care, which helped maintain positive outcomes and reduce the risk of deterioration.

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

Staff described in detail the importance of gaining consent and during a witnessed care episode we observed consent being obtained in a person-centered way. The staff member asked, "Is it ok for me to do your eye drops now before lunch". The person was then able to make this decision for themselves, and it was a respectful interaction.

Choices about activities and food were given to people and staff were seen to be respectful of decisions. Even those who were deemed to lack capacity were still given options to make decisions for themselves.Staff offered different plated options and allowed the person to choose.

MCA and best interests’ decisions were documented within the care plans. When staff members were asked, they were able to describe the principles of MCA and DoLS. Several people were supported on continuous bedrest, the rationale for this was sought and evidence gained on whether people were encouraged or supported to move from their beds if their medical needs allowed for this. The registered manager was taking this forward on an individual person basis following this discussion. A staff member said that one person chose to remain in bed, but they were offered support at each interaction to move to the chair should they wish to.

Staff further commented that listening to people is an important part of the care given, relatives were involved where appropriate or in line with best interest processes.