Woodroffe Benton House

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

The overall rating for this key question is good. People received care which was person-centred as staff followed people’s wishes and got to know them as individuals. People were provided information in a format and way they understood and their communication needs were met. For example, pictorial aids were used and staff would watch for gestures and facial expressions which indicated if people were happy with the support they received. Care reviews did not always directly involved people but staff provided feedback about how people reacted to support to inform people’s care plans. Relatives, meetings were held so to ensure they were kept informed and give their views, however, these were poorly attended. Relatives were given opportunities to provide feedback through surveys, their opinions were listened to. A suggestion box was in place for people and their relatives to give their views and remain anonymous should they choose. People were mostly supported to overcome barriers to health and social care. Staff and management usually made appropriate referrals for people who were at risk of inequalities in care. Provisions were made to ensure people had access to care and support services and access to community services, such as, chiropody and hairdressing. Staff had received training to support their understanding of end of life care. People’s relatives contributed to future care planning so staff were aware of people’s end of life wishes.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People received individualised care and support; this was through telling staff what they required. When speaking about planning their ongoing care, people told us they did not have the opportunity participate and had not seen their care plans. A person told us, “The family are involved although I would like to be involved too.” Although people were not always involved in the documentation, staff involved people in their care as much as possible and where they were unable to contribute, staff consulted those who knew them well. When asked what the service does well, a person said, “I would say, treat us all as individuals.”

Most staff knew people well and delivered support tailored to their needs. Where some staff worked across the provider’s two services, they told us they were not always well versed in people’s needs so would ask them directly. A staff member described how they helped to ensure any changes to people's needs were updated in care records. They said, “Normally the team leaders will ask us if there are any changes, we have to identify the changes and mood, then they are updating.”

We observed people received person-centred support. Staff supported people in their preferred way and communicated with people well to make sure they were comfortable with the support. One person required additional time to process and reply to staff, we saw staff communicating well with the person in line with their needs.

People mostly received joined up and flexible care as staff and management generally worked with other agencies for good outcomes. People told us they could access health services when needed. A person told us about health appointments and said, “They make all the arrangements and make sure I am ready at the right time.”

Staff worked with professionals and provided feedback when treatment plans did not provide the desired outcomes. The registered manager gave examples of working with the speech and language therapy (SaLT) team but made changes based on people’s wishes and feedback.

Visiting professionals told us people’s health needs were mostly met by the staff. Comments included, “All actions I recommend have been discussed with management and have, to date, been implemented. I provide a detailed report after each visit which is followed up.” And, “With the care staff I do have concerns with the staff because a lot of the staff has no knowledge, we focus on skin integrity, a lot don’t have knowledge what it is.”

Staff provided handovers with current and accurate information about people. Care plans were being worked on to provide up to date information about people’s needs following professional input.

Information was provided in a way that suited people. Photographs of food were added to a pictorial menu to help people chose meals and a pictorial activity schedule was displayed so people could decide if they wanted to join in. One person liked to keep their talking clock by them so they could tell the time without having to ask staff, staff made sure the clock was by them.

Staff gave examples of how they supported people with communication needs. A staff member told us about a person who had hearing difficulties and said, “They (people) have hearing aids, we check they are on and the batteries are charged. We speak clearly and make sure we are in front of them to help them hear properly.”

People's communication needs were identified within their care plans. For example, if people needed hearing aids or glasses, this was clearly recorded. Where some people did not use words to communicate, it was documented in their care plans for staff to use gestures, watch for their body language and facial expressions which may indicate their mood. Newsletters were produced and circulated so people and their relatives could look back on what activities they had participated in and keep up to date with events within the service, such as, new staff appointments.

People told us they could talk to staff if they had any issues. During our assessment, a person wished to make a complaint to the registered manager, the registered manager went to see the person, listened to what they had to say and offered a resolution. There was a suggestion box for people to voice their opinions and ideas, anonymously if they wished. A person told us, “I haven’t needed to complain but I would go to the manager if I needed to.”

The registered manager told us they had received two complaints and explained how they were addressed to the complainants' satisfaction. When speaking about how they understood their responsibilities under the duty of candour, the registered manager said, “We go and speak to the person and their relatives to say sorry or I have sent letters. Even if it’s not our fault, we think it’s important to say sorry and explain what we have done for it not to happen again.”

The provider’s complaints policy was shared with people and their relatives. The registered manager did not hold a file with complaints but said as they had only received two complaints there were no trends and themes to complaints. They shared plans of complaints trackers so themes could be identified in the future. People’s relatives were invited to complete questionnaires on the service. Relatives had provided feedback about hairdressing visits; their views were listened to and regular hairdressing was arranged for people. Meetings had been arranged for people’s relatives to attend, however, they were poorly attended. Compliments were received from people and their relatives; the registered manager shared a recent compliment with us. This read, ‘Your staff go out of their way to smile and engage with my mother in conversation despite her dementia.’

People were able to access care, treatment and support when needed. People were registered with the local GP surgery and were supported to access health and care services. Health and social care professionals visited people at the service when people were unable to attend outpatient appointments. Adaptations had been made in the service for people to access their bedrooms and communal spaces, such as, passenger lifts and handrails.

The registered manager gave an example of how they supported a person to access health services and how this improved the person’s quality of life. They said, “We discussed [person] having a bariatric bed with the community nurse. They agreed this would be better for as the usual bed was too narrow and uncomfortable for her. The nurse was unsure if they could get this for her and was bringing this up in her handover the next morning. We asked the GP if they could assist us with this as we were told that the nurses couldn't get a bed for us. The GP referred to occupational therapy (OT) for moving & handling and for a bariatric bed. The community nurses agreed that if we provided the bed for [person], they would provide a mattress. We purchased a bed and advised the community nurses when it arrived, they sent a mattress. The OT's visited and advised on the bed sheets and we purchased these. [Person] has more room in bed and is more comfortable and staff are able to move her more effectively.”

Health and social care professionals provided mixed feedback about staff and management engagement with them. A health care professional told us of improvements made since their input and said, "Recording of food intake was not detailed enough for those with a MUST of 1+. This has now changed. Bowel Movements were not recorded adequately. This has now changed. Hydration was not recorded in detail. This is much improved. Weekly weights are now implemented for BMI (body mass index) less than 20. Fortification of foods is monitored and recorded. Meals offered are balanced and meet guidelines. Diabetic alternatives are provided. A white board has been put in kitchens showing Allergies, International Dysphagia Diet Standardisation Initiative (IDDSI) levels, fortification, likes, dislikes, diabetes status.” Another healthcare professional said, “Some of the staff are team leaders, I asked for the weights of the residents, they could give current weights but 6 months ago they didn’t know the history, this is the same with falls, they don’t know. What you hear very often is 'I don’t know' there are team leaders with no knowledge of the system.”

Staff liaised with health and social care professionals to overcome barriers in people’s best interests and where people were unable to advocate for themselves. People that were living in the service had appropriate aids, adaptions and support to ensure their needs were met. Professional advice was included during shift handover so inform staff of changes and work was being carried out to ensure advice was updated in people’s care records.

People’s protected characteristics were not always considered. People did not always have opportunities to practice their faith as they wished, whilst there were in-house services held for people who were of Church of England faith, services were not held for those who practiced a Roman Catholic faith. People commented on this and said, “I am a Roman Catholic and would welcome a service, but they only have them for the Church of England and Baptists here.” 3 people we spoke with shared this view.

A staff member told us how they ensured people were not discriminated against and spoke about a person who had variable communication and could display emotions of distress. They said, “If [person] doesn’t want you, you are best to leave them as they can get very agitated. [Person] is not very easy going but they are happy if they are doing their own things. [Person] can’t help what they are doing, if they knew they would be horrified. If they are not happy, if you leave them they will go to their room and will lie down or sit down, if you give them a few minutes they will drink their tea and they will come round when they are ready. [Person] is their own person. If someone is angry then you don’t want to upset them.” Other staff we spoke with told us of similar approaches they took to support people who became distressed.

Staff were aware of and followed the provider’s equality and diversity policy when supporting people. Care plans were mostly completed to ensure people with protected characteristics needs were met. For example, people were consulted about the preferences of the gender of staff members supporting them, staff ensured people’s preferences were followed. However, processes did not always allow staff to ensure people had access to cultural activities, people’s care records lacked detail in relation to their faith and cultural preferences.

People were supported when nearing the end of their lives. Some people did not want to discuss their end of life planning, and their wishes were respected. A person who was being supported at the end of their life told us they were happy. We noted they had important items around them and drinks were in easy reach.

Staff had received training on how to support people at the end of their lives. A staff member told us how they showed compassion when caring for a person at the end of their life and said, “The other day I asked if [person] if they wanted their hair washed. I gave a beautiful bed bath and they wanted to stay in bed, I gave their breakfast, we are checking on [person] every half an hour but I check on them all the time to check they’re ok.”

During our first assessment site visit, people's future care planning documents did not include much information about how they wished to be care for when at the end of their lives. The provider made improvement and care records were updated following our first visit. We looked at a person's care plan and their wishes were repeated through all relevant care plans to guide staff on how to support them.