Priscilla Wakefield 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

At our last inspection in May 2022 we did not look at the question of effective. We found the rating for effective was good during this assessment. Informative records were in place reflecting people’s needs and the risks they faced were assessed. However, we found some gaps in the records documenting certain aspects of the care provided such as systems to monitor scheduled appointments. The service informed people about their right to consent to care and followed clear policies and procedures with respect to people’s Mental Capacity assessment.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The needs and choices of individuals were assessed and we saw evidence of the care plans being reviewed on a regular basis. This meant records continued to reflect people’s needs. Although people told us that staff knew them well, we found limited evidence to demonstrate people using the service were involved in the assessment of their needs or developing their care plan and risk assessments. We found this was mainly linked to people’s capacity to make decisions about their care and support. People and relatives told us they were not always involved in the planning of their care and support needs, but they did receive updates if they asked the service for information.

Routine risk assessments were in place for key areas such as falls, pressure care, oral care, malnutrition, personal emergency evacuation plans and so on. The care plans involved information indicating the assessment by relevant professionals for specific areas of health care such as speech and language needs and physiotherapy. However, we found there were gaps in some assessment records that were in place. For example, in the records we looked at we did not find any depression or pain assessment tools in place. We brought this to staff’s attention, and they responded they observed people for signs of pain to decide if analgesia was required but this was not regularly documented. We recommend the service includes all necessary assessment processes in their practice and records.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service has systems in place to monitor people's care and treatment to ensure continuous improvement. For example, we saw evidence of improvement in the area of pressure care which was managed appropriately with detailed care plans and other healthcare professionals involved when required. Staff were very knowledgeable and where there was deterioration, they were able to explain why this was in relation to the persons’ condition and lifestyle choices. However, we found some care plans lacked information to support specific health and social care outcomes. Although we were informed by staff these areas were monitored, the care records did not always detail how they were monitored or what a progress would look like. Examples were the areas of mental health and well-being. Staff recorded trackers of care actions, for example we saw records of people being supported to reposition in timely intervals. However, some care plans did not indicate the frequency repositioning should take place for people. The service had a system in place to identify the need of more frequent opticians and dental care appointments for people, however it was not always clear in people's care plans whether these appointments were taking place and if not, why. Staff and leaders shared positive outcomes where individuals' quality of life had improved during their time at the service.

The service informed people about their rights regarding consent and respected these rights while providing person-centred care and treatment. In the care plans we reviewed during our assessment there was evidence of mental capacity assessments. For people who lacked capacity there were mental capacity assessments in place which were decision specific for areas such as living in the home, medication, personal care, bed rails, people’s photo being taken and so on. We saw evidence that best interest meetings had taken place, even though it was not always clear in the records whether next of kin had been involved in the process.

For people who had capacity advance care plans were completed. Staff we spoke with understood the principles of the Mental Capacity Act (MCA) and how to apply them in practice. Staff said they had recent training in this topic, and this was discussed in team meetings. All records reviewed had notes in the care plan about DNACPR (Do not resuscitate) decisions. There were also paper records on each ward which staff were able to refer to. Staff told us that DNACPR plans were discussed daily in the staff handover.