Archived: Westwinds - Care Home Learning Disabilities

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• 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

We identified two breaches of the legal regulations. Staff did not always assess people’s needs in line with RSRCRC. People were not involved in the assessment and this had resulted in 1 person no longer wishing to live at the service. Staff and leaders had failed to ensure people were supported to live healthier lives and that their health outcomes were monitored effectively. This meant 1 person’s recorded body weights were potentially inaccurate which could impact on the pressure-relieving equipment they had prescribed. Healthcare professionals told us they did not always feel confident staff would follow their instructions. The provider had policies and procedures in place in relation to mental capacity, consent and restrictions on people’s liberty. People’s care records included mental capacity assessments and best interest decisions where people lacked capacity. People’s representatives and the local authority were involved in the process.

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.

People’s needs were not always assessed in a way that ensured needs and preferences could be met, and was not in line with RSRCRC. One person did not wish to live at the service as they felt they did not fit into the social community and their pre-admission assessment did not take this into account. A relative told us that this had impacted the person as they did not wish to join in activities that other people were taking part in and resulted in them becoming more isolated.

Staff and the interim manager told us they knew that one person did not wish to live at the service. They told us that this had been raised with the provider but no action was taken. Staff described the impact this had on the individual which included the person becoming withdrawn and choosing to stay in their room for the majority of the day. Other people had lived at the service for a long time and the interim manager was unable to present their pre-admission assessments. When we made the provider aware, they organised reviews of people’s needs by working with the local authority to assess whether they were still able to meet these.

People’s care records did not always include person-centred assessments of their needs which then formed the basis of their initial care plans. Whilst some assessments included information on the range of communication tools that could be used to ensure staff could effectively communicate with people, we found that this was not being followed by staff and we did not see staff deploying any communication aids. Staff told us that they were not aware of people using communication aids to help them communicate, such as Makaton or pictorial aids.

People were not involved in making decisions about their care and treatment in line with national guidance such as RSRCRC. We observed staff did not offer people a choice of meals or where they wished to go. Daily notes completed by staff included brief references to the activity that was undertaken, such as that the person has been assisted with personal care, but these were not person-centred and did not include information on people’s choices and emotional wellbeing.

Staff were not aware of national guidance, such as RSRCRC. Staff were unable to describe what the guidance entailed and how to ensure people were supported to make independent choices in line with it. Staff were unable to recognise that the meals they offered people provided little nutrition and were not balanced. For example, one full lunch time meal consisted of only baked beans. Another person’s meal consisted of baked beans and a sausage. There was a culture of acceptance from staff which was recognised by the interim manager but steps taken to address this were insufficient and had not resulted in meaningful change by the time of our assessment.

Staff did not consistently follow best practice guidelines and nationally recognised tools such as the Malnutrition Universal Screening Tool (MUST) to monitor body weight and skin integrity risk tools. Training undertaken by staff did not equip them to recognise the importance of recording measuring accurate weights and escalate concerns appropriately. There were no competency checks undertaken to ensure staff understood their responsibilities. Staff had requested and received people’s medical history from their GPs. This helped staff to write care records and provided them with historical information on people’s medical conditions.

People were impacted by a lack of coordination between staff and external organisations. People were unable to attend a local day centre regularly because the manager had not ensured sufficient staff were available to support people to use transport. People did not always have access to information and advice about health, care and support in a way that was accessible for them. This was not in line with the statutory guidance RSRCRC as people were not empowered to make as many choices as possible by providing them with accessible documentation. We also found that staff worked well with other external organisations. For example, on the day of the inspection, a music therapist attended the service and we saw the positive impact this had on people.

We received mixed feedback from staff in relation to how well they felt they worked together to achieve positive outcomes for people. Two members of staff told us that they had regularly raised concerns in relation to the staff culture, how staff worked together, and how information was shared across the service and externally, but that this was not addressed by management. We found staff spoke to each other in an abrupt manner in the presence of people who used the service and there was a culture of blame.

Feedback from visiting health and social care professionals was mixed. Feedback included that staff did not always respond to people’s needs appropriately by seeking assistance in a timely manner, and that identified shortfalls were not always addressed in a timely manner. Several external professionals told us they found the service to be uncoordinated and unorganised with staff often lacking the basic understanding of people’s needs and how to escalate issues with equipment. Other feedback we received included that staff and managers were welcoming and friendly when they visited.

People’s care and governance records showed they were generally referred to other services when they required this but that this was not always followed up by staff appropriately. We found that staff were not always recognising when people required to be re-referred to a speech and language therapist in line with their care plans. The systems in place did not ensure that all relevant staff were involved in assessing, planning and delivering people’s care and treatment and they did not always work collaboratively to understand people’s needs.

People were not able to consistently access healthcare services when they needed these and staff did not support them in a timely way. We found staff did not always follow instructions left by healthcare professionals to support people to live healthier lives. We saw guidance from the NHS community speech and language therapist (SaLT) relating to the level of consistency meals should be to reduce the risk of choking for 2 people. We observed both people coughing during their breakfast and we noted they had been provided with milk in their cereal bowl which did not appear sufficiently viscous to be in line with the advice from their SaLT. We observed another person who was assisted by staff to eat their meal in bed but they were not supported to sit in an upright position by staff prior to offering a meal as advised by the SaLT. Where a person required to attend another service to take weight measurements, staff and managers did not work collaboratively with external organisations to ensure the person could attend, However, people were supported to register with their local GP and we saw staff had requested and received people’s medical histories to help in understanding and supporting people.

Staff told us they did not always feel supported by management to help people access healthcare services. This had directly impacted on a person as their weights recorded by staff were inaccurate. Staff were not aware of how to consistently identify risks to people’s health and how to support people to prevent deterioration, despite instructions from healthcare professionals. For example, in relation to people coughing during meals and the risk of choking. However, we also saw in records that staff had supported people to have their medicines reviewed by their GP.

People’s care records confirmed people had access to a GP and their medicines were reviewed regularly. However, the systems in place did not ensure people were always able to access specialist support such as for body weights or dental care. Staff held regular handovers but these were limited to tasks that were required to be completed during the day and were not completed in a person-centred way. People had information in their folders which could be shared with healthcare professionals in an emergency. People had care plans in place for specific conditions, such as where people were at risk of choking, anxiety, falls and epilepsy.

People did not consistently experience positive outcomes in line with current national guidance. For example, people were not empowered to choose the meals they wished to eat or the time they wished to go out; and people’s weight and skin integrity were not monitored in line with national guidelines.

Staff told us that there was a task-orientated culture which did not promote seeing people as individuals. Staff said they felt they had to prioritise other areas such as preparing meals and cleaning the premises. Staff told us they did not always monitor people’s quality of life outcomes and goals, including people’s risk of aspiration and wellbeing. However, we found that staff monitoring of bowel movements had improved and staff were following the systems in place to ensure the risk of constipation was escalated appropriately.

People’s care records were not regularly reviewed to ensure these were reflective of changes of people’s needs. Staff had not sought meaningful feedback from people and their relatives and people’s achievements were not celebrated. The support staff provided to improve people’s quality of life was not always effective. For example, where a person previously enjoyed going to the pub, this was no longer happening regularly due to the lack of a staff member who was able to drive.

People were not always given a choice prior to staff commencing tasks. For example, we observed multiple occasions when staff wiped people’s faces during a meal but did not ask the person or inform the person what they were about to do. On one occasion, a person appeared distressed from this and staff continued to talk amongst themselves rather than reassuring the person.

Staff were not always aware of how to support people in a way which respected their decisions and supported them to make choices. We spoke with several newer members of staff who told us they had completed relevant training in relation to MCA and DoLS but they did not understand the principles and how this would be applied to the care they provided. Staff told us they offered people a choice but we found that this was not always the case and there were several occasions when we observed staff assisting people without communicating with them.

The provider had policies and procedures in place in relation to mental capacity, consent and restrictions on people’s liberty. People’s care records included mental capacity assessments and best interest decisions when people lacked capacity. People’s representatives and the local authority were involved in the process. Whilst some processes were in place, staff did not always understand these and did not always seek consent before commencing a task.