Wendreth Court

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We saw that care plans included people’s religious, spiritual and cultural needs. We found evidence of good partnership working and links with community services. Resident and family meetings were held, and relatives told us that the manager was very quick to resolve any issues. We found discussions regarding end-of-life planning recorded in care plans. We found information was accessible for people including how to raise a complaint or safeguarding concern. We observed the environment was suitable for people with mobility needs and the service was working to make the home more dementia friendly.

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.

People told us that their likes and dislikes had been followed. Relatives told us that they were made aware of any concerns or incidents and told us that the staffing levels meant that staff could spend time individually with people. People and their relatives told us how staff had made them feel welcome when they moved in and gave examples of how they had worked with staff to make improvements to their care. For example, by considering alternative food options and activities.

Staff told us they were encouraged and enabled to provide person- centred care to people. Staff said staffing was sufficient to allow them to get to know people and understand their wishes and needs. Staff also told us their training had incorporated person-centred care practice. For example, 1 staff member told us, 'I know the [people] well, I think we provide person-centred care here because we know [people] so well.' Another member of staff said, '[Staff are] really good at asking questions. [Staff] are all learning what people can and can't do, and where assistance is needed. Managers share information with us and care plans are in place. This helps in building our confidence up. We know how to support people in a person-centred way, we had training.' The registered manager said when people move in they speak to them and the whole team supports them through their transition. They advised that after 2-3 weeks they review the care plan and gather feedback from the person and their relatives regularly.

We observed people were treated in a person-centred way. Staff approached and communicated with people appropriately, and empowered people to make decisions about how they wanted to spend time, and how they wanted their support to be provided. During the head of department and clinical meeting, reviews were individualised, and staff knew people well. Staff came to the meetings equipped with feedback from people and their families, where appropriate. The registered manager followed up specific tasks with staff to ensure person-centred care was taking place which considered people, and their needs, in a holistic manner. Staff supported people when their needs changed, and ensured their preferences and wishes were sought. Staff were observed always saying hello to people, being jovial, kind and attentive. One person who was recovering from an accident and was not hungry was supported by a staff member who showed empathy and understanding. After their interaction the person said they would like to try some pudding which they said was 'lovely'. We observed the activities coordinator liaising with people and their relatives about personalised activity ideas. During the visit the dementia champion showed me the folder with the 'About me' documentation in.

Relatives told us about their experiences when their family member moved to the home. They were positive about the support from the management team with completing documentation, arranging medication and discussing the support required. People were happy with the way staff went about helping them with mobility and personal care. One person and 1 relative raised concerns regarding the responsiveness of the service to make referrals for suitable equipment and continence aids. However, we saw evidence of the referrals made and actions taken.

Staff told us a stable team was being built at the care home. Staff told us they were able to provide a service of continuity as they knew the people well. The registered manager told us they book agency staff in advance to ensure continuity of care to people.

We saw feedback from a local authority brokerage officer praising the registered manager for their response to new referrals. However, feedback from partners was limited due to them having minimal involvement with the care home so far.

We saw evidence that staff discuss continuity of care for people. For example, meeting minutes included a referral made to a dietitian due to someone's weight loss. There were also records of a mental health referral for 1 person due to low mood and because staff had identified symptoms of dementia. Requests of reviews for medication were viewed and any changes recorded.

Relatives told us that they had meetings where information was shared. However 1 relative said that they thought a relatives notice board would be really useful for information and contact numbers. One person and a relative raised concerns regarding communication from staff when they have asked for information. When we discussed the feedback with staff they were aware of their concerns and had recorded the actions taken.

Information provision did require some review and improvement at the care home. Leaders told us they were in the process of improving signage within the service which would support people with orientation to their environment. Leaders told us a dementia specialist had been involved in this review. The registered manager told us how someone with poor sight had audio books and a magnifying lens and information could be printed in larger and clearer font if required. They said that they assess individual needs and would adapt to ensure people could access information.

People are given a service user guide with information about facilities and services available in the home. Relative meeting posters are displayed in the home and meeting minutes include updates shared by the registered manager. There is an easy read abuse policy for people with clear guidance and contact details to report abuse. The home has a policy explaining how they meet the accessible information standard and adjustments available, for example, providing information in an audio file. Surveys are available in different formats and people are provided with important contact information, the safeguarding and complaints process and details on how they can share feedback.

People told us they were involved in their care planning and their likes and dislikes had been adhered to. Relatives told us they always felt they could talk to someone immediately if they were concerned.

Staff told us they gave people opportunities to feedback on their care and specifically say what assistance they would like, and how they would like it to be provided. Leaders were in the process of gathering and reviewing recent feedback from a quality assurance exercise completed. The registered manager evidenced how they sought feedback and encouraged people and their families to share their experiences with them. We saw evidence of how this was followed up directly with people, and their families where appropriate. The registered manager told us that staff made sure people felt listened to by spending time just with them and doing activities with them to build relationships.

The home has different ways of listening to and involving people. This includes completing person-centred care plans which people sign to show they were involved. People can take part in surveys which are provided in different formats and the staff team analyse the feedback and share any actions taken. Resident and relative meetings are an opportunity for staff to share information and for people to ask questions and give feedback.

Relatives told us that they had been involved in care planning. One relative told us about attending a relatives meeting, the home holding a 'lovely open fete' and felt that access to the home was really well thought out with an outside space and rooms that overlook the garden. However, 1 relative told us that they did not have an understanding of their family member's care. They said that staff had not provided this information and they had not been signposted to another agency.

Staff told us appropriate support systems were in place 24 hours per day. We spoke with staff who worked outside of usual business hours, and they told us they had good support from both managers and healthcare professionals. For example, 1 staff member told us on call manager support was available, and they would not hesitate to use it. Another staff member told us they had no concerns with contacting emergency services or district nursing services. Staff told us the premises were accessible for people who wished to go outside and was suitable for the services provided.

We saw feedback from a local authority brokerage officer praising the registered manager for their response to new referrals. However, feedback from partners was limited due to them having minimal involvement with the care home so far.

The home considers people’s individual accessibility needs and records any specific requirements, for example, someone’s need for text in larger font. We saw evidence that following complaints and survey feedback that actions had been taken to improve access. For example, following feedback from relatives, reception cover was arranged for weekends to enable easier access to the home. The equality and diversity policy states the home will monitor the premises to consider if they place anyone with a disability at a disadvantage and when required take steps to improve access. We saw referrals completed for consideration of appropriate equipment for people.

People and their relatives told us they were informed about the services the home had to offer. Relatives told us that their family member was given choices including what they wear and eat. They said that staff follow their family member’s routines. One relative felt that the food options could be better so discussed this with the registered manager who said they would liaise with the chef.

Staff told us there was equity in experiences with good outcomes for people. For example, the cook said specific dietary requirements could be catered for based upon need, and a person's chosen wishes. Staff told us, 'We have a range of availability [based upon needs]. We can do chicken alternatives, or vegetarian alternatives. We would cater for any specific diet.' Staff told us they recognised as time passes, people have differing wishes for the types of food they eat, that once may not have been a traditional choice.

We saw pre-admission assessments with details about people’s communication and access needs. Clinical staff meeting minutes provided evidence of staff making timely referrals to other services and consideration of barriers. For example, staff had discussed the impact of the table layout and television and radio noise levels for people with dementia.

Relatives told us they were involved in care planning and people confirmed that they had input to their care plans and that their preferences had been adhered to.

Staff told us, although they had not specifically provided end of life care yet at Wendreth Court they had completed face to face training, and generally staff had had previous experience. We spoke with the registered manager who explained how end of life planning took place as part of the general care planning process, and this was reviewed should the health of a person decline. The registered manager evidenced ReSPECT forms were in place, where people chose to make advance decisions about their health and what they would like to happen in the future. ReSPECT forms were held in the medicines room to ensure swift access was available for staff should they be required for the person in the event of hospitalisation, or health professional review.

Care plans recorded important discussions with people regarding their end of life wishes. They included details regarding contact with family and friends, preferences regarding treatment, religious needs and any pre- made plans. DNACPR forms were kept alongside the person's ReSPECT documents.