Church View - Princess of Wales Community Hospital Also known as Church View

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 people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The provider was in breach of legal regulation in relation to staff not always working within the legal framework of the Mental Capacity Act (MCA.)

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 accurately assess people’s needs and make sure their care, and treatment was effective.

There was an admissions process in place which included completing and assessment pack to obtain all relevant information prior to commencing care at the service.

However, gaps and inconsistencies in people’s records meant that care plans were not always reflective of people’s currents needs. Staff ensured that people had a risk assessment however these were not always followed up with a corresponding care plan. For example, we looked atcompletedfalls screening for two peoplethatidentifiedfalls prevention plans were neededbutthesewere not in place.Staffreported that one of the people was prone to falling and banging into objects, but the lack of a fall prevention plan meant there was noguidance for staff about how to support he person to avoid this as much as possible.Staff also told us one person had weighted furniture in place to reduce the risk of injury and propertydamage;however, this was notidentifiedin their environmental care plan as a need.

Staff used nationally recognised assessment tools to ensure people received the support they needed. For example, staff used Waterlow Score to assessment the risk of pressure ulcer development and MUST (Malnutrition Universal Screening Tool) Score to identify risk of malnutrition.

Care records included person-centred information about people’s nutrition and hydration needs, including preferred foods. However, referrals were not always made to the relevant professionals. For example, we saw in two people’s care records that it had been identified they required a modified diet to support with their eating and drinking, however, referrals had not been made to the SALT team preceding our assessment. Referrals were made in response to our findings.

Staff worked effectively together within the service to support people.

Staff told us information was shared amongst the team effectively and we observed systems in place to support this, including a notice board and staff intranet. We attended a shift change handover where people’s individual needs and risks were discussed. We observed care staff working well together throughout the visit to meet people’s needs without delay.

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.

Changes in people’s presentation, emotional state or distress which may indicate deterioration in their health or wellbeing was recognised by staff. One staff member told us, “[Person] is quiet and withdrawn when he is down or sad.” Staff completed regular physical health monitoring and escalated appropriately. For example, staff told us and records confirmed that they monitored a person’s insulin levels to reduce risk to their health.

People were supported to access the community and engage in activities that supported healthier lives. For example, one staff member told us, “A lot of our service users like to go out for a walk, we encourage this. We offer balanced meals and offer choices.” Another staff member said, “We always try and make sure [person] can do what they want to do.”

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.

Although staff were monitoring physical health for signs of deterioration, one relative told us, “[Person] had a high temperature, staff called [relatives] to come and get [person.]” We reviewed this person’s care records and found that it was documented any sign of physical deterioration should be escalated to the relevant health professionals. However, relative feedback suggests that staff may not be acting in line with guidance in care records, potentially delaying medical intervention.

Staff and leaders monitored people’s goals and wellbeing, there was a culture at the service of supporting people to live high quality fulfilling lives e.g., care records documented whether people wanted to access the community and provided details of how they could be safely supported to do so. One relative told us, “[Staff] will take [person] out for the day, that will come down to [person’s] individual care needs.”

Relatives had opportunity to get involved with care planning to ensure that people’s wishes and preferences were accurate. One relative told us, “We have a review annually, face to face, and if anything changed it is updated.” Another told us, “We went through and read them for accuracy and agreed them before signing them.”

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

Staff we spoke to had a good understanding of the Mental Capacity Act 2005 (MCA,) and could describe how the act was used, however, this was not always embedded into practice. For example, the service did not always work within the legal framework of the Mental Capacity Act (MCA.) Staff had completed mental capacity assessments, which are legal tests to determine if a person can make a specific decision for themselves. Under the act, mental capacity is “decision specific” and therefore each decision must be considered in its own right. We found examples in care records that mental capacity assessments were not always decision specific. The service had assessed people’s capacity for several decisions in one assessment.

Staff understood the importance of consent, and we observed staff asking before supporting people with their eating and drinking.