Whittington House Nursing 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 assessment we rated this key question good. At this assessment the rating has changed to 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 58 (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.

The provider used an electronic care records system that included assessment tools to support staff in assessing people’s physical and mental health needs. However, these records were not always completed accurately or updated in response to changes in people’s needs. For example, bowel charts for one person did not match their daily records, meaning there was an inaccurate overview of a person’s bowel habits. This person was at risk of constipation and took multiple medicines that increased their risk of constipation.

Information about peoples’ specific needs was not clearly identified. For example, information around how to support people relating to specific eating risks and use of equipment was not clearly reflected in care plans. One person’s constipation assessment stated they were a fulltime wheelchair user However, their care plan stated they walk short distances using a 4 wheeled walker.

Staff told us they had access to updates about changes in health care needs and people’s communication needs, through care records and staff handover meetings.

Some people’s health needs were assessed by visiting healthcare professionals to ensure care and treatment were appropriate. Timely referrals to healthcare professionals were made when needed. Some elements of healthcare for some people, including the assessment and management of pressure ulcers and wounds, were provided by community nursing services.

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

Staff used clinical monitoring tools for people at risk in areas such as malnutrition or pressure damage. These were reviewed regularly. Where people were assessed at risk of pressure damage, they had skin integrity care plans. However, clinical governance meeting minutes for April, May and June showed concerns with how staff were recording people’s wounds. However, these minutes did not reflect a comprehensive action plan on how this would be improved.

People assessed as requiring specific diets had plans in place to reflect these. However, where people may chose not to follow guidance from health professionals there was not a robust risk assessment in place. Whilst there was information about people’s dietary requirements, and any allergies, an up to date version was not available for staff to view in the kitchen.

Feedback from people about the quality of food was not always positive. “The food is not good. On a liquid (soft) diet so difficult to make it appetising. Mashed potato is full of lumps, supposed to be puree.” Another person told us “We’ve asked for semi skimmed milk but there’s never any in the fridge in the kitchen area.” And “Quality is not there. It’s a repetitive menu, with sausage rolls and cheese and onion rolls twice or three times a week, all shop bought.”

A staff member told us people who were supposed to be given finger foods were given sausage rolls.

Another staff member told us “There are good options but no choice within those options like would you like chicken curry or vegetable curry? The show plates at lunch are basically the same. 9 out of 10 times it is a meat dish or the vegetable version of it.”

We observed several people’s drinks and water jugs not in reach in their bedrooms. We were told people had access to fluids regularly through the day and during hot weather were offered ice lollies and ice cream.

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 worked with various healthcare professionals to ensure continuity of care. Staff were aware how to refer people to other services such has mental health teams and community nurses. Care records demonstrated that health care professionals were involved in providing clinical support to people.

We observed a GP round during the assessment, each week a list was compiled for the visiting GP and discussed with the relevant shift lead at the time. Whilst this was a good system and showed communication between staff and visiting health practitioners was positive, sometimes the meeting with the GP interrupted other parts of care provision, such as medicine rounds.

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 helped people to attend healthcare appointments. A GP and other health care professionals involved in people’s care and wellbeing visited the care home on a regular basis and was able to speak with people individually about their health needs or any concerns highlighted by staff.

There was a wellbeing coordinator and activities took place daily. One person told us “I like meeting other people and going out in the garden in the afternoon. I like the activities. The singer was good yesterday. The staff are quite kind.”

However, another person told us “I feel like I’m penned in, can’t go out without people to help you. Can’t get a taxi they say. I’ve got my bus pass.”

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 andconsistent, or that they met both clinical expectations and the expectations of people themselves.

Systems to monitor people’s care and treatment were not always effective in identifying opportunities for continuous improvement. Audits and reviews were not consistently identifying or addressing gaps in care planning and delivery. For example, we found observations for people who had fallen were not being completed in line with the providers policy. This meant people were at increased risk of harm through a lack of consistent observations to help identify deterioration in people’s presentation in a timely way.

Daily handovers were completed to share information to help staff remain informed about people’s health, wellbeing and any changes to their care needs.

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

Staff had received training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and in the most part sought consent before providing care and support. However, an incident document we reviewed did not reflect staff sought consent when carrying out personal care. This document was still being reviewed by management at the time of the assessment.

During the assessment we observed people going out with staff, some of these people used wheelchairs, these wheelchairs had tags attached to them clearly identifying who the people were this information was on display to the public. There was no explanation for this and if consent had been sought.

People’s care plans confirmed if the person had capacity. However, where people lacked capacity, we found mental capacity and best interest documentation was not always completed for specific decisions.