Wood Hill House

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

Whilst improvements had been made since our last inspection, some care records could be further improved to contain more detailed, person-centred information. Care plans were regularly reviewed, and staff knew people well. Some improvements were required about how staff recorded incidents relating to behavioural distress. People received input from external professionals and staff supported people to live healthier lives. At our last inspection it was identified improvements were required about how the service assessed people’s capacity to consent to their care. At this inspection, this concern remained.

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 were unable to gain people or relatives feedback about how the service assessed their needs. People had their communication needs assessed and recorded, and staff knew how to communicate well with people.

The management team understood their responsibilities to assess people's needs prior to them receiving support from the service. Staff told us they had access to online care records, a staff member said, “The care plans are detailed, there is enough information. People also have positive behaviour support plans.”

Peoples care records had improved since our last inspection and these were regularly reviewed. Some improvements were required to ensure care plans were detailed and person centred. For example, we found care records with little information relating to a person's family.

Where people displayed behaviours of distress, care plans were in place to guide staff about peoples triggers and calming techniques. Improvements were required about how staff recorded incidents of distress, staff used a recognised tool to record these, however they contained little information. Meaning it could be difficult to monitor and recognise where changes were required to people’s support. The manager had recognised this and was working closely with the staff team to improve this.

Staff told us they followed advice from professionals. Nursing staff were in place 24 hours per day and staff told us they could go to the nurses for advice. One staff said, “We inform the nurse straight away if there is any changes in people.”

Audit systems were in place to monitor people’s daily records, however, these required improvements, to ensure audits identified concerns we found. Whilst we received no negative feedback from staff regarding delivering evidenced based care. Staff had not always maintained robust records, to ensure effective oversight of some people’s support.

Records evidenced people received support from external professionals, such as social workers, advocates and healthcare professionals.

Staff told us they worked with external professionals to meet people’s needs. Staff also told us the current staff team had improved how they communicated and worked together. A staff said, “There is good communication between the staff, the managers are approachable, it wasn’t like that before, but now we are supported.”

We received mixed feedback from partners about how the service managed people’s needs and worked with them. Most partners told us staff met people’s needs and care records had improved. Comments included, “There has been improvements with care plans.” Whilst another partner said, “Behavioural incident logs are not very detailed. I have had to ask for further evidence and records.”

Daily flash meetings had been introduced and had improved how the team communicated on a day-to-day basis, including any concerns and current care needs.

Where people have nutritional monitoring, records evidenced this was appropriately monitored and people had weights monitored and input from external professionals. We saw people being offered a choice of drinks throughout the day and we observed staff kindly encouraging a person to eat.

Guidance about people’s dietary needs was contained in care and kitchen records, to guide staff about people’s needs. Kitchen and care staff knew people’s likes and dislikes. Where people required a gluten free diet, this was provided, and the cook told us they provided visual offers of food to encourage people to choose their meals.

Peoples oral health needs were assessed and monitored. One person with complex needs, was being supported to receive dental treatment. Staff had explored ways to enable this person to receive treatment and best interest decisions had been made. This would improve their health and well being.

The provider was planning to move people to a newly refurbished part of the building, people had been involved in choosing their rooms, furniture and personal effects. Improvements were required to ensure people were involved in making the communal environments less clinical, such as choosing how the communal areas would be made to feel more homely.

We observed a lack of stimulating activities for people to be involved in. Staff told us activities required improving. One staff member said, “Because of the building works, we no longer have an activities room or sensory room, we are waiting for the building work to finish.”

Care records did not contain any detail about peoples long or short-term goals or aspirations. There was a lack of monitoring about how good outcomes were achieved for people. It could not be evidenced people had been involved in discussions about their care and what they would like to achieve.

Improvements were required to ensure where people lacked capacity, appropriate documentation was in place. Whilst we found people had Deprivation of Liberty Safeguard (DoLS) authorisations in place, not all capacity assessments or best interest decisions were in place. The provider had recognised this and was currently working to embed this into practice.

Staff were trained in the principles of the Mental Capacity Act (MCA) and understood their responsibilities to gain people’s consent with their day to day care. One staff member said, “We make sure where people lack capacity, we always ask if we can do things, such as helping someone to shower, we let people know what we are doing, we encourage people nicely.” We saw staff seeking consent from people, such as asking if they could enter people’s rooms.

DoLS information was not updated in the online care records, which could be confusing for staff about who was subject to authorisations and what conditions were attached. Where people had conditions attached to their authorisations, these were being met.