Watermoor House

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

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 Requires Improvement. At this assessment the rating has remained Requires Improvement.

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 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Meetings, handovers and care plan reviews were held to help ensure people's needs were documented and reflected any changes in people's needs. However, we found, care plan reviews were not always up to date or clearly identified changes or concerns in regard to people's needs. For example, where people had identified risks, such as falls or skin integrity, there were no corresponding risk assessments in the care plans. This meant people were at risk of not having their needs met as staff did not have accurate and up to date information. We received mixed feedback from relatives about their involvement in care plans and reviews with some feeling very well informed and others not so, but this was also dependent on how involved relatives were in their family member’s care. Records did not clearly show who had been consulted in the design and update of the care plan. The registered manager told us, “I have a task list, so I know the staff members who are allocated on each shift. I check the system to make sure the documentation is relevant. I've instructed the staff to relate all concerns to us in the office, but on our system, staff can use a function to inform us if there is a concern a staff may wish to raise about a person.”

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

We found records required to monitor people were not always uploaded onto the electronic system and in 1 instance staff were using both paper records and electronic systems to record fluid intake. This meant there was no way for the staff or managers to have effective oversight of how much fluid the person was consuming. We found some letters from healthcare professionals were not scanned into their electronic records, meaning staff would need to look for the paper records which could potentially delay support. We found risk assessments were not in place for people with assessed risks. The manager believed this was an error from when the electronic care plan systems had been changed. This change was occurring during our last inspection in January 2024; however, this oversight had not been picked up by the current systems and processes in place. The registered manager had not completed care plan audits where these issues would have been picked up.

The service 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.

Systems and processes were inconsistent and not always appropriately applied, such as how records and information should be shared with people, staff and other healthcare professionals, and staff lacked skills or training to coordinate care and support.

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.

Whilst people were able to make choices, care plans did not give sufficient details on how to support people to live well. We were not assured staff sufficiently empowered people to maximise their opportunity to manage their own health, care and wellbeing needs as much as possible. Staff did not always fully understand people’s needs, preferences and abilities, which enabled them to identify and enable as many opportunities as possible for people to be independent. For example, the service supported a person with a learning disability, whose main support need was not their learning disability, but their care records did not include information for staff regarding how to recognise changes in their presentation, emotional state or distress, which may show a deterioration in their health or wellbeing. Reasonable adjustments were not clearly identified, planned for and communicated so people could attend planned and unplanned appointments. Care records did not include how the person could confidently access emergency health care if needed to ensure their disability would not prevent them from accessing prompt care and treatment.

The provider did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We were not assured people had appropriate risk assessments when they had a recognised risk, such as needing their fluids monitoring. We found 1 person’s fluids were inconsistently monitored and they had developed a urinary tract infection which may have been prevented. The service did not have effective processes to monitor people’s care and treatment and their outcomes.

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

Staff did not take some people’s views and wishes into account when their care was planned. For example, we viewed care records which did not contain information about how people who refused care may be supported or different ways staff could approach people who were distressed. Care records did not include information about whether people had viewed their care records and consented to the information within. Mental capacity was not always recorded in the care records for people who lacked capacity but were mentioned in care records for people who did have capacity.