White Rock Nursing Home Limited

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 71 (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 needs were assessed before they moved to the service. This was usually done by the registered or deputy manager. One person’s relative said, “The manager came to the hospital and undertook a thorough assessment of [relative’s] needs.”

Staff told us they were informed of people’s needs. One staff member said, “[Registered manager] puts messages on [electronic care planning system] so we see that before new residents arrive. When they do come in, we get a detailed handover from the nurse.”

Regular care plan reviews were carried out. People and their relatives were invited to attend these. One person’s relative said, “I feel so involved even though it’s hard and I miss my loved one so much. The staff help me feel a part of the home and a part of my [relative’s] care. I am always asked about the care plan and told of any changes.”

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.

The provider used nationally recognised tools to assess and monitor people’s needs and risks, including the risk of malnutrition and skin damage. Staff working at the service understood the importance of good nutrition and fluid intake for people and staff supported people with this where required. People’s relatives told us staff monitored and acted when people lost weight. One person’s relative said, “[Relative] has a care plan. Staff and I discussed a meal plan for [relative], including [supplement] drinks. The staff weigh [relative] regularly; [relative] is a poor eater; [they] put weight on and then lose it. There is a nurse allocated to [relative] and if she’s there when I visit, we will have a catch up.”

There was a nominated ‘nutrition champion’ who was responsible for ensuring people were weighed in line with care plan guidance and that weight concerns were recorded and acted on.

Kitchen staff were aware of people’s dietary needs and preferences. They told us they were informed when people’s needs changed.

We observed lunch on both days of the inspection. People and their relatives told us the food was “fine”, with “choice” and “always ample to eat.” One person’s relative said, “I always have Sunday lunch here and I am made to feel so welcome it’s wonderful.”

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.

Staff had access to people’s care and support plans to understand people’s needs and deliver their care. There were weekly visits from the local GP. Health professionals we spoke with told us the staff were proactive in making contact for advice and followed any recommendations. One health professional said, “The team are very responsive and know exactly when to escalate concerns. They [staff] would rather ask for advice than not, which is better for people living here.”

People’s relatives told us staff contacted the GP or other health professional if needed. Several people told us the service had accessed dental services for people. One person’s relative said, “If they need to get specialists in, they do. [Relative] has been seen by the skin specialist and the staff also got the dentist to sort [relative’s] teeth out.”

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 monitored people’s health and escalated concerns appropriately. One health professional told us, “I do both on site and telephone reviews with the staff here. When staff refer to me, I come and do an onsite review, then go and create a plan with the doctor. I then do a review and a follow up. Today, the nurse and I are reviewing a medication change for one person.”

Records showed staff monitored people’s health needs and used a national early warning score tool to escalate concerns. This tool helps healthcare professionals determine the urgency and scale of a clinical response based on a patient's physiological measurements. One health professional said, “If someone is poorly, they do the observations and share them with me.”

Records showed people were supported to access eye and dental care. One staff member said, “We help to keep people healthy. We have one person who wants to lose weight, so they are on a low-calorie diet.”

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.

There was oversight of people’s needs and records showed that wounds, weight loss and falls for example were monitored and analysed. Appropriate referrals had been made for people who required additional clinical support, such as the tissue viability nurse, the older people’s mental health team and speech and language therapy (SALT).

The GP carried out weekly reviews. They told us, “The staff here do follow our advice and if they’re not sure, they do ask. I have no concerns about the care here.” One person’s relative said, “When [relative] was poorly a little while ago, they called in the doctor and while he was there, they put me on the phone to him so he could talk me through his findings. They are very good like that; they wouldn’t do something without me.”

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

People we spoke with were not able to tell us if staff asked for their consent prior to supporting them. However, people’s relatives told us they had seen and heard staff asking for consent. For example, one person’s relative said, “I have seen staff talk and explain things to [relative], even if [relative] is unresponsive. The staff will say for example, ‘it’s time to move you [name]’.”

In the main, mental capacity assessments had been carried out in line with legislation. For example, people had their mental capacity assessed in relation to consenting to live at the service, to have bed rails in use and for staff to support them with their care. However, some people were using tilt chairs. These are chairs that tilt backwards slightly, meaning people are unable to get up by themselves. People had not had their mental capacity assessed for their ability to consent to the use of these chairs. Additionally, some people who were at risk of falls had sensor mats in place to alert staff if they tried to stand up unaided. Although some people had mental capacity assessments and records relating to best interest decisions for the use of sensor mats, this was inconsistent. We discussed this with the registered manager who told us they would address this with immediate effect.

We observed people being offered choice throughout the inspection and heard staff ask for people’s consent before they supported them. One person’s relative said, “They treat [relative] with respect; the staff always ask if [they] want something done and the staff go away if [relative] doesn’t.”

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care services, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. All legal applications had been made in accordance with DoLS. This meant people’s rights were fully respected. The registered manager kept a record and tracker of DoLS applications and authorisations. None of the authorised DoLS had any requirements attached.