Waverley 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

Effective - The service has been rated inadequate. We reviewed 6 quality statements. People’s needs were not always appropriately assessed and subject to regular review. People’s care plans were not robust to guide staff. People’s consent was not always sought and paperwork relating to Deprivation of Liberty Safeguards was not always up to date. Documentation had not always been completed to assess what decisions a person could make, and how staff could support them in their best interests and least restrictive way. The staff team were not always responsive to people’s healthcare needs. Records to demonstrate compliance with the Mental Capacity Act were not in place. There was a lack of quality monitoring checks and reviews by management that failed to identify the concerns found at the assessment and were ineffective in supporting people to receive positive outcomes.

This service scored 25 (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 had been assessed on admission. A person described how staff had helped them access podiatry services. However, on observation of the person it was evident they had not received the service for some time and care records did not reflect the frequency of care needs.

Gaps were identified within care records due to the provider transferring from paper based to electronic care records. The manager acknowledged, the gaps but could not confirm what action was planned to make the necessary improvements to care plans and related risk assessments to ensure they met people’s needs and requirements.

Care plans were not always cohesive or consistent with other care records. For example, care plans and associated records gave conflicting information about medication and weight monitoring. People’s care plans had not been reviewed or audited for some time and there was a lack of monitoring in place to ensure care records were up to date and a true reflection of peoples care needs. There was inconsistent and inaccurate information within care records and risk assessments, for example, for one person, we saw conflicting information about their dose of insulin in their care plans. Also, one person’s diet record showed incorrect information about their dietary needs.

People did not always experience care which adhered to best practice guidelines or recognised standards within health and social care. For example, one person’s care plan stated they were fed via percutaneous endoscopic gastrostomy (PEG) and required weekly weight monitoring to ensure a stable weight. The person told inspectors their meals were required to be pureed, and their fluids thickened. One person was administered medicines via an enteral feeding tube following NEWT guidelines. NEWT guidelines are for the administration of medication to people with enteral feeding tubes or swallowing difficulties. NEWT guidelines were not in place for all medication being administered and there was no evidence of weekly weights to ensure the person’s weight was being monitored.

The manager was unable to explain the inconsistencies identified within care plans and advised audits had yet to be completed as there were other areas of priority to focus on. This evidenced a lack of oversight with regards to delivering evidenced based care and treatment. There were no plans in place to review care plans or risk assessments.

There were no systems in place to assess the quality and safety of care records or to review the clinical care needs of people. As a result, inconsistencies and shortfalls were identified within the assessment and care planning records. For example, care records on the day of the visit referenced people had received nail care. On observation, people had not received nail care for some time and looked unkempt.

We received limited feedback from people regarding how staff teams and services worked together. However, people were impacted by a lack of teamwork between leaders and other staff. They told us they were not involved in their care planning or reviews.

People were not well supported by an effective team. There was a lack of effective oversight and poor leadership which meant people did not received the expected standard of care. The deputy manager told us they had recognised gaps within care records and had raised with the manager who had failed to respond. The staff member highlighted a lack of teamwork and leadership from management.

The provider did not work well with partners, who reflected ongoing improvements where needed to the service and the progression of the action plan was slow.

Systems and processes were inadequate in ensuring effective working across teams, both internally and externally. They were ineffective in ensuring care plans, risk assessments were up to date. People nursed in bed were observed without call bells on the first day of the assessment and this was fed back to the manager. On the second visit people remained without access to call bells. One person told us, “I can't reach my call bell so I just shout for staff when needed, this may take some time when the door is shut.”

People gave limited responses when asked how they were supported to live healthier lives. One person told us they had no oral care products such as toothpaste and a toothbrush and they could not remember how long since they had received support with oral hygiene. We observed other people without oral hygiene products. Care records observed reflected oral care had been provided, however, this contradicted with the observations completed during the assessment. People were not supported to manage their health and well-being to maximise their independence. People did not have choice and control over their care. Observations showed people were not offered choices at meal times and they were not supported to live healthier lives or participate in activities to support their well-being.

Staff did not have access to the information they needed to appropriately assess, plan and support people to live healthier lives as care plans were out of date. One staff member when asked how families are included in reviews and changes to peoples care needs told us, “I’m not sure what is discussed with family members.” There was no evidence to reflect people, and their relatives had been consulted or had taken part in reviews. There was no evidence to suggest leaders and staff spent time with people discussing their health and well-being needs.

Systems and processes were inadequate in ensuring people were supported to live healthier lives. The provider failed to ensure outcomes for people were positive and consistent and that standards of care were good.

We received limited feedback from people regarding monitoring and improving outcomes. However, our observations of care plans evidenced people were not receiving the standard of care described in the quality statement and there was a lack of monitoring to improve people’s outcomes.

Leaders had limited knowledge of people’s care needs, and their oversight and monitoring of the care people were receiving was poor. There was a lack of response to concerns identified during the assessment.

Systems and processes were ineffective in ensuring routine monitoring of people’s care and treatment. The provider failed to ensure outcomes for people were positive and consistent and that standards of care were good. Staff did not receive the necessary support, training and supervision to provide positive and consistent care.

We received limited feedback from people regarding consent to care and treatment. People’s consent was not always obtained when providing care and support. There was a lack of evidence that relative, advocates and other professionals had been consulted on decisions.

Staff had not completed training in the Mental Capacity Act. (The manager did not fully understand or consistently follow the principles of the Mental Capacity Act.

People were subject to blanket measures through the use of bed rails which had not been fully considered within the MCA. One person was assessed as requiring bed rails and a risk assessment was completed. There was no Mental Capacity Assessment (MCA) or best interest decision in place for the safe use of bed rails and the risk assessment had not been reviewed for some time. This meant consideration had not always been given to least restrictive options. Systems and process were not effective in ensuring the principles of the MCA were implemented for all people. The provider failed to ensure staff provided support in line with the principles of the MCA.