Wyndham House Care

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• 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 assessment we rated this key question Requires improvement. At this assessment the rating has remained requires improvement. This meant people’s needs were not always met.

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.

The provider did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs. Care plans were reviewed periodically, but people and their relatives were not consistently involved in this process. We found evidence that some care plans had been updated but contained out-of-date or incorrect and confusing information. One family member told us they had not been contacted when their relative’s care plan was reviewed. We did observe some positive examples where staff showed genuine interest in residents’ well-being and spoke with them about their preferences, but this was not consistently embedded in the culture of the service.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity. We found that when people were admitted or returned from the hospital, care plans were not always updated promptly to reflect new clinical information or changes to their needs. People’s care plans did not contain behaviour management plans even though they had been identified as sometimes displaying distressed behaviour. We could not see that the provider used any recording charts to note any behaviours and consequently look for proactive ways to manage them.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. We found inconsistencies in care plan information, with some documents containing outdated clinical data. Relatives told us communication from the service about incidents was not always timely or comprehensive. One relative told us, “I found out about a fall when I visited and saw the plaster on his head – no one had told me.” We could not see that people were provided with information in accessible format.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result. We found that some relatives felt discouraged from raising concerns. One relative told us they tried to avoid the manager when visiting due to previous negative interactions. The provider had a complaints process in place, but there was no consistent evidence that complaints were acknowledged, investigated and responded to promptly. Agency staff on duty did not always listen to people’s needs and instead tried to get them to sit down in the lounge rather than explore what was causing them distress.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it. We found evidence that people’s access to timely clinical assessments and treatment was compromised. A Speech And Language Therapy (SALT) referral had been outstanding for over 58 days with no documented outcome. One person had a dental issue that had not been resolved despite a request being made before the Christmas period. Dental access had not been facilitated. People with mobility needs were not always supported in accessing communal areas or the garden. Staffing pressures, particularly on evening shifts, meant that people’s needs were sometimes not met in a timely way. One relative told us there were occasions when there were only three carers for the whole home in the evenings.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this. We found people living with dementia who had communication difficulties were particularly vulnerable to not having their needs and preferences heard. The provider had not put in place sufficient safeguards to ensure these individuals received equitable care. We observed that some residents living with dementia spent extended periods in communal areas without meaningful engagement. Where agency staff were deployed to support people with complex needs such as dementia, the lack of familiarity created additional inequalities in experience and outcomes. The provider had made some efforts to celebrate achievements and personalise care for some people.

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. We found some people’s care plans did not contain up-to-date DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) documentation or end-of-life care plans. For people who were approaching the end of their lives or had anticipatory care plans in place, the documentation was not always comprehensive or accessible to staff. We could not see consistent evidence that conversations about future planning were being proactively held with people and their families.