Wood Hill Grange

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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment of effective for this service under the new provider. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. The service was in breach of legal regulation in relation to person-centred care.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. People’s current care needs were not always reflected in their care plan. For example, one person was getting out of bed by climbing over the bed rails, but staff did not review the changes to ensure the persons current needs were assessed and the risk was managed. We also observed staff did not communicate effectively with people to ensure their health care and well-being was considered.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Care records showed people had been referred to appropriate professionals for support and advice, but our observations and care records did not always show this advice had been followed. For example, people at risk of choking were given cups with spouts when assessed as requiring an open cup and people at risk of weight loss did not have their food recorded effectively to be able to review and monitor their food intake.

The service did not always work well across teams and services to support people. They did not always share up to date assessment of people’s needs with staff and professionals. We observed staff did not work together as a team, they were task orientated and did not ensure information was shared. The manager had identified this and was working with professionals to ensure information was shared to support people effectively.

The service did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. People were not supported with their food or drinks. For example, people were left with meals in front of them, some people could not reach the meal, and others were given a tray on their lap and were struggling to eat. People were not offered alternatives if they did not like the meal. One person refused the meal and pudding they were given, staff said they always did this. Records showed the person liked yogurt, chocolate and milk shakes, yet none of these were offered. Food charts we saw did not accurately record food eaten, so they were not able to be effectively reviewed or evaluated. Therefore, it was not clear if people were supported to live healthier lives and achieve positive outcomes.

The service did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. We saw records in care plans that healthcare professionals were contacted for clinical interventions and advice. However, we found advice was not always followed. Care plans were not always reviewed, monitored or evaluated to show any changing needs were monitored to consistently improve outcomes for people. For example, one person was at risk of falls, however, they wanted to be independent. We witnessed they had a fall waiting for their meal, the outcome could have been improved if they had been served their meal earlier, staff did not learn from this as at another meal we observed they again had to wait, putting them at a higher risk of falling.

The service did not always tell people about their rights around consent and staff did not always respect their rights when delivering care and treatment. We observed people were not consulted before care and treatment was delivered and when people requested assistance, this was not always given.

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 make particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Assessments of capacity varied, we found some people’s capacity was recorded in their plans of care, others did not clearly record their capacity. The management team had identified the shortfalls and were working to improve care records. They had also identified that deprivation of liberty safeguards (DoLS) were not up to date and there was lack of records available. The manager was in the process of reviewing people’s DoLS to ensure all information was captured and any authorisations required, requested.