Wall Hill Care Home Limited

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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

People did not always have appropriate assessments in place to ensure they could be effectively supported by staff with specialist training in place. People and staff told us the food was regularly poor and our observations confirmed this. Improvements were needed to the recording and monitoring about people’s health conditions. The principles of the Mental Capacity Act 2005 (MCA) were not always being followed so people were not always being protected.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

We were consistently told the food was of poor quality and our observations confirmed this feedback. One person said, “The food is awful, it is not cooked well. The presentation is acceptable, but it tastes poor.” Another person said, “It’s awful food.” Another person said, “The food is nice sometimes, and sometimes not.”

Staff feedback confirmed people did not always have access to food of an acceptable standard. One staff member said, “Sometimes it is not very good, it is not cooked to a good standard and the presentation is not good.” Another staff member said, “It’s [food] mostly good, but there could be more choice.” Multiple other staff members also told us they felt the food was often poor.

We asked the provider about this, and they said the usual kitchen staff had been absent on the first day of our visit. However, the feedback we received did not only relate to one day when staff were absent, but an ongoing concern.

The assessments carried out by the service prior to a person moving in failed to fully consider people’s needs. This meant people moved into the service when staff did not have the training or the specialist knowledge to support them. This meant people may not always be in the most appropriate service for their needs.

People did not always have easy access to drinks outside of meal and tea trolley times. Staff told us people could ask for drinks, however due to the needs of some people they may not have been capable of asking for this. This left people at risk of not always having enough to drink. In response to feedback, the registered manager purchased some jugs to leave throughout the home, so people could access these. Staff were recording what people were having to eat and drink, if needed. Two people who had this recorded also had a modified diet, which meant the consistency of their food needed to be softer. However, staff were not consistently recording the food being offered was in line with those people’s dietary needs. This meant the provider could not always demonstrate they were supporting people appropriately.

A district nurse had been to visit a person to check a wound, however the instructions from the district nurse had not been recorded by the provider or staff in the person’s care plan or daily notes. This meant there was a risk this professional advice would not always be followed.

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.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

One person said, “I choose what I do, no one tells me to do things I don’t want to.”

Staff did not have any feedback about Consent to care and treatment.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

The provider failed to follow the principles of the MCA. Some relatives had signed as giving consent on behalf of people and there was no evidence they had the legal right to make those decisions. There was not always a clear assessment of a person’s capacity in relation to some decisions. For example, a person was being given medicine covertly (so they didn’t know they were taking it). There should have been an assessment of the person’s ability to decide whether they took their medicine or not and, if it was determined they did not have capacity for this specific decision, then a best interest decision should be agreed involving relevant parties. A member of the management team told us they thought these were in place but were unable to provide these. Another person had been given alcohol as a present by visitors. This was not given to the person and there was the intention to return it. We were told the person was not supposed to have alcohol due to their medicine. The person had not been given the choice to make an unwise decision, as was their right. Their ability to make this decision had also not been assessed. There was confusion in some people’s care plans about their capacity and consent. This meant we could not be sure the provider had a clear understanding of the MCA.