West Ridings Care 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 inspection we rated this key question requires improvement. At this assessment the rating remained required 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 person centred care.

This service scored 42 (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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We saw inconsistency in the quality and level of detail of initial assessments carried out. Identified areas of need were not always reflected in care plans; this meant that appropriate guidance to staff on supporting people was not always in place.

People and relatives gave us mixed feedback about their involvement in assessments and setting up of care plans. Their comments included, “I have been here about 5 weeks. They didn’t talk to me about any care plans when I came in” and “[Person] came in Thursday last week for respite care. There’s someone who has been dealing with things, so I don’t really know.”

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

While we saw examples of the provider using nationally recognised tools to assess people’s needs, such as Waterlow (assessment tool used to identify people’s risk of sustaining pressure damage to their skin), we also saw examples of people’s risk of falls not being assessed.

The provided did not work to best practice guidance in relation to medicine management, care planning and risk management.

We found a lack of clinical meetings to discuss people’s clinical needs and improve the quality of care, as well as promoting registered nurses’ professional development.

Care plans were not detailed and we found several examples of these not being current to people’s needs. We found inconsistency in the provision of baths/showers and oral care. Some people and relatives raised concerns about the lack of choice and consistency in this area. People’s comments included, “I haven’t had a bath for 5 weeks, since I came, they do give me a strip wash everyday. I have asked on the odd occasion for a bath, but it hasn’t happened, I don’t know why. I don’t push them because there are a lot of people here who need their help” and “I have a maximum of 1 a week, that's my choice. They don’t have a strict regime, you have to calculate and ask in advance and you can have 1 sometime in the day.” Relatives said, “They were only bathing [person] once or twice a week, at the beginning. I asked them to do these things more now” and “Regarding [person’s] oral care I have noticed that the toothpaste and toothbrush have not been moving through use.” We shared our concerns with the management team.

The provider did not always work well across teams and services to support people. People were not supported by an effective team.

Communication between staff, the quality team and management team was not working well. We found examples were the quality team had identified concerns in specific areas of people’s care, such as skin integrity, falls or weight loss, and although this information was shared with management, appropriate follow ups were not completed to ensure people were referred to other healthcare professionals.

Feedback received before and during the assessment from visiting healthcare professionals, was that the staff team did not always work well with them to meet the needs of people. The interim manager had put in place regular meetings with district nurse team to improve the communication.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People were not always supported in a person-centred way with their nutrition. We found several people had lost weight and action had not been taken to increase the monitoring of people's health, such as weekly weights or a referral to the GP to discuss ongoing concerns. We observed examples of people living with dementia who required support or encouragement to eat, not being provided with this support in a timely way.

Records of food intake for people at risk of malnutrition or who were known to be losing weight were not always contemporaneous and we found little evidence of people being offered regular snacks throughout the day. We discussed these concerns with the interim manager. After our visits, we saw the provider had completed a review of the weights and nutritional support required to everyone living at the home. Actions had been identified and the provider told us these would be monitored.

We found there was inconsistency between the 3 units around the choices people had with their mealtimes. A person said, “I am enjoying the food. We have a choice and it’s always very good. The cook is very good.” Another person commented, “I am waiting for my breakfast, get up at 7.30 and they serve breakfast at 8.45 to 9.15 am, I seem to get mine about 9.30 am. It would be nice to a have cup of tea before then.” We shared our concerns with the interim manager.

People and relatives shared mixed feedback about the quality of the meals and people’s preferences being followed by staff. A person commented, “The food is cold, they are very busy. Yesterday, for the first time, my toast was perfect and I told them. I like it crispy and its usually half cooked and soggy with the butter. I made my own coffee as I like it weak and I ask but they always make it too strong.” Other person said, “Because I have a [medical device fitted], there are certain things, I can’t eat like peas, seeds and pips. They have been giving me these, since I moved in. I have had such a job trying to sort it out.” A person commented, “The meals are out of this world. I have all sorts of choices 3 everyday, it’s quite beautiful.”

The provider 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.

There was a lack of monitoring systems in place to identify and act on themes and trends. For example, in relation to which units wounds, skin tears and bruises were happening the most or that falls were occurring more often during periods of time when staffing levels were lower. The poor oversight of accidents and incidents did not ensure people were kept safe, or experienced improved care outcomes.

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

We found inconsistency in the application of the Mental Capacity Act (MCA) principles.Mental capacity assessments were not always decision specific and best interests decision were not always recorded. There was a lack of timely application of deprivation of liberty safeguards (DoLS) for people who required restrictions to their liberty as part the safe delivery of their care. We found several applications for people who had been living at the home between 1 and 6 months, only had this submitted on or after our first visit to the home and after we requested this information.