Archived: Westwinds - Care Home Learning Disabilities

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We identified two breaches of the legal regulations. People were not consistently treated with kindness, empathy and compassion; and people were not always supported to have a good quality of life by staff. Staff did not always support people to do what they enjoyed and did not promote people’s independence, choice and control. The provider had implemented plans for supporting workforce development and retention in relation to upskilling staff, equality, diversity and inclusion, and supporting staff wellbeing. Our findings showed that the service was not meeting the statutory guidance RSRCRC because people were not treated with dignity and respect and were not empowered to be as independent as possible.

This service scored 35 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not always treated with kindness, empathy and compassion by staff. Whilst individual staff showed kindness in their approach to people, the culture within the service meant that people did not always have a positive experience. People were not always communicated with prior and during tasks. People’s wishes were not always respected, such as if they wished to go out into the local community.

Several members of staff told us that they did not know how to ensure people’s right to dignity and privacy is upheld. When we asked staff why they were discussing people’s needs whilst assisting them to eat in front of other people, they did not recognise that this was inappropriate and undignified. Staff told us they did not know if people could benefit from using communication aids to ensure they could understand their views. Care plans for 2 people stated that people could benefit from communication aids which we did not observe.

We received mixed feedback from partners in relation to the way staff approached people with some commenting that staff had always appeared kind, and others commented that there was a task-orientated culture which did not take into consideration people’s views.

Whilst individual staff showed kindness when they interacted with people, there was a culture within the service that meant people did not always have a positive experience. We observed staff walking past people who appeared to be struggling to walk, we observed staff wiping people’s faces without asking for their permission, the meals were presented in an unpleasant way and were served cold, and staff were having personal conversations and discussing people’s needs in relation to personal care whilst there were other people present.

People were not always treated as individuals as staff did not always understand people’s needs and preferences, including their communication needs, in line with their care plans. People’s specific cultural needs had not been considered and people were not supported to undertake activities in line with their cultural preferences. People were not always treated with respect and dignity and relatives were not always involved in the care and support.

Staff did not always have a full understanding on how to consistently treat people with respect. Staff did not always understand what it meant to treat people as individuals. The culture amongst staff was to ensure that tasks were completed and this did not ensure that the task was completed in a dignified way. This included mealtimes and assistance with walking around the premises. During mealtimes, staff did not understand why it was important to assist people to eat and drink at a pace that suited the individual. We also observed one person smoking immediately outside of the front door whilst the door was kept fully open. This meant that the smoke entered the house and other people were exposed to smoke. Staff did not understand why it was inappropriate to ask a person to wait for a hot drink because there were specific times for tea and coffee to be offered. This meant that the person was offered a cold drink which they did not want.

Whilst there was a generally positive atmosphere at the service, we observed several examples of poor practice in relation to maintaining people’s dignity and respect. We observed people being assisted to eat by staff who were stood up next to the person whilst holding the person’s head back via their forehead with each spoonful. This was undignified and also meant that the person’s swallowing may have been impacted. The person appeared to be uncomfortable while this was happening. Staff did not communicate with people whilst they were assisting them to eat and people were not offered a drink during meal times. We observed where a person asked for a hot drink, staff persuaded them to have a cold drink as it was inconvenient for staff at the time.

Whilst there were care plans, policies and procedures in place for staff to follow, a culture had become embedded in the service which saw people as an inconvenience. Staff were not always focused on people’s goals and individuals’ voices were not heard. Activities were not tailored around people’s cultural and specific needs. As a result, people appeared to be disengaged with the few activities that were on offer during the day. Staff had completed training in relation to ‘person centred working’ but this was not effective due to the shortfalls we identified. This was not in line with RSRCRC as the culture we found in the service was one where people's requests were often seen as an inconvenience to staff.

Staff did not always support people to do what they wanted. People’s interests, choices and independence were not taken into account when activities were planned by staff. People were not involved in the planning of the activities and daily notes showed that people’s routine was similar on most days to what we found during the assessment. This was not in line with the statutory guidance RSRCRC as people were not empowered to make as many choices and decisions and as possible.

Staff were not aware of how to support people to be as independent as possible and protect their dignity, and how to make sure people felt in control of their support. Staff were unable to tell us what they did on a day-to-day basis to ensure people’s independence was maintained and encouraged. Staff did not involve people in the decision-making around the activities on offer in the service and people did not appear to engage in the activities. Staff told us they regularly used the sensory room for people but we found that once people were supported to sit in the room they were left on their own for long periods and without further guidance from staff.

Throughout the assessment, we observed instances where staff did not offer people the choice and did not encourage independence. The culture of the service was task-orientated and where people required support, this was carried out by staff but often without communicating with people prior or during the task. On several occasions, we saw people reacting to the lack of communication by flinching when staff were supporting them to clean their face.

The provider had processes in place for supporting people’s independence and encouraging choice and control but these were not followed by staff. Care plans provided information on how to maintain and encourage independence. Staff did not encourage people to do the things they enjoyed doing and that maintained their independence. The interim manager had identified this but told us they were not able to implement this at the time of our assessment due to other priorities.

People’s needs, views and wishes were not always listened to. Where a person wished to leave the premises, staff did not assist them appropriately and people’s needs were not anticipated by staff. There was a culture of acceptance by people and staff. We saw the progress staff had made in relation to recording people’s bowel movements. This was now being recorded and there were plans in place for staff on what to do if a person did not open their bowels for several days.

Staff did not always know when people needed support and there were delays in attending to people. Staff did not recognise signs of concerns such as coughing whilst eating and did not plan to ensure assistance could be found in a timely manner. There was potential for missed opportunities in recognising deteriorations. Other areas had improved such as the monitoring of bowel movements which was identified by the local authority prior to our visit. Staff generally understood their responsibility in ensuring that they recorded accurate information in relation to bowel movements.

Staff did not respond to people in a timely manner when they called out for help. Call bells were out of reach and we informed staff that the person was calling out. Staff told us that this was a regular occurrence and that this was because the person wanted to go out. We observed people walking in the corridors on their own despite the lack of hand rails and the person’s care plans stating that they needed these to walk. Several members of staff walked past the person without acknowledging them or identifying that they should be supported to walk. We found a catheter bag which was in use had fallen over and the pipes appeared to have kinks which could increase the risk of urine retention and subsequent infections. Several members of staff walked past this without acknowledging it until we raised it with the manager. The provider had implemented a bowel monitoring chart for staff to complete and we saw that this was generally being completed by staff now.

Staff told us they generally felt that the provider cared about their wellbeing. They told us that they were able to access information in relation to wellbeing by checking on the boards within the service. Staff told us they felt valued and supported by the interim manager. Whilst there were systems in place such as an employee assistance programme, staff also told us that they did not feel the provider actioned their concerns and their feedback in a timely manner.

The provider had considered workforce wellbeing as part of their strategy and had plans in place to expand this. There were plans to re-establish employee networks for staff to support each other such as the cultural diversity inclusion and disabled employees’ networks. Amongst other support offered to staff, the provider had a “Here for each other” initiative which includes regular wellbeing communication and information. Whilst these systems were in place, they were not always effective in hearing staff voice and acting on feedback as we identified.