Wollaton Park Care Home

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

We assessed 6 quality statements in the effective key question and found areas of good practice. The scores for these areas have been combined with scores based on the rating from the last inspection, which was requires improvement. The assessment of these areas indicated areas of good practice since the last inspection, our rating for the key question has improved to good. Peoples needs and rights were supported. Peoples care and treatment was effective due to their health, care, well-being, and communication needs being assessed with them. Peoples care plans were kept up to date with any assessments completed in a timely manner. Staff were aware people’s preferences and respected these in a person-centred way. People were aware of their rights around care and treatment. Staff have a good knowledge of the mental capacity act, including capacity and consent. Staff were aware of how to support someone with fluctuating capacity.

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.

Some people told us that they were involved with planning their care. Other people we spoke with could not recall any involvement with their care plan or were unaware of any family attending a review meeting. Relatives we spoke with had been involved with admission processes but had no direct involvement themselves with a care plan subsequently. One person said, “I was talked through some paperwork when I arrived, and it was all about me. My relative takes care of all the paperwork now.” A relative we spoke with told us, “I did the initial paperwork when my family member arrived and they are waiting to be assessed properly to see if they can stay here. No one has spoken to me about the financial side of things yet. I’ll talk to our social worker about it also.” People were confident that their needs were understood by the staff team. Relatives who also care for people, told us that staff also understood their needs and how best to support them. One relative said, “Staff are responsive. My family member has got a rash on their chest today, so they’ve arranged for the doctor to drop in.”

Staff told us that they had time to review care planning documents, so they could keep up to date with people’s changing needs. Staff had good knowledge of how to support people’s needs, and what action to take if the person’s needs appeared to have changed. Staff knew people well and could understand if they had changed in their presentation or behaviours.

A range of national assessment tools were used, to understand people’s needs and how best to support them. For example, the use of the Braden scale for the management of skin integrity and the use of the MUST tool to identify people at risk of weight loss and malnutrition who required dietary management and support. Staff had easy access to documents on how to support people using hand held devices. Where people’s needs changed, these care planning documents were updated so staff understood people’s changes in needs. For example, a person’s mobility needs had reduced, and staff had updated the plan whilst awaiting input from the occupational therapist. People’s communication needs were recorded and understood by staff. This allowed staff to communicate with people, to have a clear understanding of the persons needs.

Talking to people and their relatives, the service provided sufficient access to healthcare professionals when required. People told us that they received support to manage their health conditions. This allowed them to be as healthy as possible. One person said, “I get milkshakes now too as I need ‘building up’.”

Staff had a good knowledge of tools that the service used, and how they impacted the care given. For example, staff members explained that a malnutrition risk tool identified how likely a person was to be malnourished. The cook could explain what measures were in place to ensure how people were being supported with good nutrition management. The care plan told staff how best to support this risk. Staff understood how to work with external health and social care providers, to provide support for people in the most effective way.

Care plans followed national guidelines on how to support people most effectively. For example, a person’s care plan followed NICE guidelines for the management of diabetes, with information for staff to follow around hyper and hypoglycaemia. People’s nutrition and hydration needs were supported in line with current standards. Staff had identified people at risk of weight loss and were monitoring how much food they were consuming. Where needed, staff had supported people to source additional weight gaining supplements. Some people at the service found it difficult to eat their food. This was due to their diagnosis of dementia. Staff had provided adapted plating, and this alternative dining experience effectively supported people to eat independently again.

People were unable to fully explain how the impact of staff working with external teams affected their experience in the care home. However, due to effective processes and good staff knowledge, we assessed that people had a positive experience. One relative gave positive feedback about their family members recent admission to the service and how well they had settled since moving in, saying, “They had never seen them laugh so much.”

Staff were competent with responding to falls experienced by people. Records showed staff members had acted appropriately following falls incidents at the service. The registered manager had a robust system in place to regularly check the moving and handling competencies of staff once they had completed their training. People were referred onto relevant external teams for health and social care needs following an incident or any changes in their needs. This information was updated in their care records.

Feedback received from partner agencies regarding the service and their responsiveness and implementation of advice and guidance given was positive.

People's needs were documented accurately to ensure consistent support. For example, staff had relevant information about people's diabetes management; what to look out for when blood sugars were too high or too low and the relevant action to take if these were out of range.

People told us they felt the service accessed health and social care teams when they required them. One person said, “I feel I can speak up if things don’t go to plan with helping me.”

The service had a robust pre-admission process in place. This considered if they could meet the needs of people and assessed the impact of people’s needs on others already receiving the service. People’s assessments were sufficiently detailed to enable effective and safe, quality care planning. This ensured people’s needs were being met. For example, we found a number of people who required specific diets for diabetes management. Recording of the daily intake of food and fluids for people was clear and detailed and staff knew how to complete these to ensure people’s diabetes was safely managed.

Referrals had been made to external teams to help mitigate risks effectively. For example, people who had experienced falls and injuries had been referred to professionals for specialist input to help mitigate this risk. Where referrals had been made, these had been followed up in a timely manner by the service. This ensured people received appropriate, effective support. Allergies and specific dietary requirements were recorded on the front page of people’s food planner, along with their likes and dislikes. People were routinely weighed monthly with any severe fluctuations reported to their GP and the Speech and Language Therapy Team contacted when appropriate. If needed people were then weighed weekly to ensure robust oversight of weight management. The MUST tool was utilised in people’s care plans, along with daily records of food and fluid intake.

People were unable to understand and respond to questions about improved outcomes. Records showed that people’s needs were being regularly monitored to support positive outcomes.

There was effective communication and co-ordination between the service and external health and social care teams. This ensured people achieved positive outcomes. For example, where people required review of equipment, we saw this had been actioned by the management team.

People’s identified needs from their care plan were translated into a risk assessment for each identified area of risk. Each section showed evidence of regular review, with details of the next required review dates.

People we spoke with told us that they were able to make day to day choices on where to spend their day, bedtimes and their preferred clothing. No one we spoke with could recall staff waking them early or assisting them to bed before they wished. We observed staff asking people make a choice over the provision of drinks, snacks and lunch choices. However, we saw minimal evidence of people choosing where to sit for lunch or where to sit in the lounge. There appeared to be habitual locations used by staff for this. One person said, “It’s up to me when I go to bed or wake up.” Another said, “The staff will help me plan my bedtime and getting up as I have to be hoisted. I choose to spend time in my room as I don’t like to be in the lounge as I find it’s noisy.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, for people to make their own decisions and be helped to do so when needed. When people lack mental capacity to take decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. People with capacity should be involved in their care planning and decisions around their care and treatment had been consulted in planning or review of their care plans. Where people lacked capacity to make decisions, their families or advocates had been given the opportunity to inform the care and treatment in the best interests of their relative. We found the service was always working within the principles of the MCA as people's capacity had been assessed and this had been recorded in their care plans. We found that practices were the least restrictive and the impact of decisions made had been assessed. For example, multiple people had sensor mats in place in their bedrooms. There were appropriate documents in place to assess if these measures were proportionate and in their best interests. There were effective systems in place to ensure that people’s capacity was being assessed.

People were being deprived of their liberty with the relevant legal authorisations in place. For example, people at the service had sensor mats in place which alerted staff when they got out of bed. This restricted people's liberty. This required either legal authorisation through a Deprivation of Liberty Safeguards (DoLS) or consent from people if they were able to give this. We found relevant documentation was in place. The provider had ensured mental capacity assessments and best interest decisions had been completed to support appropriate decision making for people.