Wombwell Hall

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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

We found that the service Requires Improvement in relation to the Effective domain. We found one breach of the legal regulation in relation to Need for Consent. Care and support was not always provided in line with legislation such as the Mental Capacity Act 2005 and best practice guidance. We also found people’s needs had not always been fully assessed and guidance for staff to follow was sometimes contradictory. This impacted on the services ability to demonstrate they were supporting people to live healthier lives. Staff worked well together across the service. However, we received mixed feedback from healthcare professionals about the service’s ability to provide safe, effective care for people.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us they had been involved in their loved one's care plan and assessment. External healthcare professionals told us that Wombwell Hall always completed an assessment of a person before they moved into the service to ensure they could meet their needs. We received mixed feedback from professionals about their involvement with the assessment of people’s needs from their admission. The local GP surgery spoke positively and told us they were always involved in the initial assessments of people. However, concerns were raised by a healthcare professional regarding the inconsistency in communication from the service when a new person had been admitted or readmitted to support a timely joined up assessment.

The management team told us that people’s needs were assessed prior to them moving into the service this was to ensure their needs could be met. The management team said that any equipment the person required was ordered and obtained by Wombwell Hall prior to the person moving in. They said that if a person was admitted to hospital a new assessment would be completed prior to their discharge and that if a person’s needs changed the relevant healthcare professionals would be contacted to be involved.

People’s care records were reviewed on a regular basis however, when changes were identified and made it had been recorded on the review sheet and not the person’s care plan. People’s care records remained unchanged and contained the incorrect information even though changes had been made. Some people’s care plans included inconsistent information. For example, one person’s care plan recorded that the person was incontinent whereas later in the same care plan it was recorded that the person was continent and required support to access the toilet. Nationally recognised assessment and screening tools were used to assess things such as, the risk of malnutrition, the potential low mood of a person living with dementia and the risk of people’s skin integrity. However, these had not been used effectively to ensure appropriate action was taken to reduce any identified risk. A risk assessment detailing what action to take and the support the person required had not been completed following completion of the assessment and screening tool. Some people’s communication needs had been recorded in their care plan. However, this information was basic and contradictory. For example, one person’s care plan recorded they were unable to communicate their decisions however another part of the same person’s care plan recorded the person was able to express themselves and give their consent with reassurance from the care staff.

People’s feedback was mixed about how their nutrition and hydrations needs were met. Comments from people included, “The food is going downhill. I’m sure they are trying to economise. For example, we used to get a nice piece of chicken breast, now it’s bits in a casserole, cheaper cuts of course. I requested that I get boiled, not mashed, potato. They constantly forget, so I send it back”, “The food comes across to us, so can be lukewarm at best, especially the vegetables”, and “The food is good, just what I like.” People also told us they found choosing their food 24 hours before difficult as they would often forget what they had chosen however, people did say they were able to choose an alternative. People told us their food preferences were recorded however, these were not always remembered or respected. People told us they felt staff understood their needs, worked well as a team and with external healthcare professionals. Comments from people included, “The carers seem to have a good understanding of the support I need” and “[Staff] know I can’t walk on my own, so I get the right support.”

Staff and leaders, we spoke with felt they delivered care that was appropriate for people’s assessed needs and had the skills to do so. Nursing staff maintained their formal registration and liaised with other healthcare professionals when required to deliver evidence-based care and treatment.

People’s needs had not always been assessed and managed to reflect best practice guidance or legislation. For example, people who experienced anxiety and distress did not always have a Positive Behavioural Support Plan or similar in place. The registered manager told us they didn’t support anyone who displayed challenging behaviour. However, care records showed there were people who became verbally and physically aggressive, although there was information about this in the care plan, it was not sufficient to make sure all staff, including agency staff were consistent in their approach. People’s nutrition and hydration needs had not always been assessed or recorded effectively to ensure people were kept safe and had their needs met. For example, one person’s care plan contained two different nutritional dietary levels. The person could have received meals that were the incorrect consistency for their needs, posing a choking risk.

People thought the staff were good. One person said, “The carers get on with each other and work as a team.” People told us they were able to access external healthcare professionals such as the GP, when they needed to. Comments from people included, “I’m confident they would get a doctor if I am ill” and “The nurse comes in once a week and responds to needs” and, “If I need a doctor, [staff] set up a video for me to talk to him.”

Staff told us people’s needs were assessed prior to their admission to Wombwell Hall and then reassessed if they were returning to the service. Staff told us they planned their shifts during handovers between each care shift. Staff told us they made referrals to the relevant external health care professionals if people’s needs changed and as required. Staff told us they worked well as a team. One member of staff commented, “I love it here, I wouldn’t change it. They’re really good, the team works well.”

There were mixed views from external healthcare professionals regarding referrals and transitions between services. One professional commented the management team responded quickly to referrals that were made by the discharge team. However, another commented that communication was not always prompt and had led to inappropriate discharges or readmission to hospital.

People’s care plans were not always updated with people’s current and changed care needs. For example, one person who had spent time in hospital had returned to the service with changed needs however, the persons care plan had not been updated to reflect the current needs. Therefore, staff did not have the updated information about how to keep the person safe and meet their needs.

There were mixed views from people regarding the management of their health and care needs. Some people felt their health was promoted, their comments included, "My back was hurting and I asked for a doctor to see me. [Staff] did a video call and he prescribed me a stronger medication" and, "The carers seem to have a good understanding of the support I need." However, a number of people told us they felt using the hoist was painful, and they were fearful they may slip through and fall. Although no concerns were identified for safe moving and handling practices during this assessment, this had impacted negatively on people's wellbeing.

Staff felt that people had been involved in the review of their care needs. Staff told us that people’s needs were reviewed with the relevant external healthcare professionals when required. Staff told us they monitored people’s health and well-being and took action when there were concerns. One member of staff said, “we talk about residents and how they are doing if we have concerns about them, we tell the nurse in charge, and they checked them.”

Staff did not always have guidance to follow in relation to specific risks to support them to identify deterioration in people’s health and what action to take to promote improved health. For example, around safe management of catheter care. There was also no evidence within people’s care records to demonstrate how they had been involved in the development and review of their care plan and risk assessments to involve them in promoting their health.

People did not share any feedback with us about their outcomes or whether they felt they were improving or achieving things that were important to them.

A member of staff spoke about how their practice had changed following completion of the dementia training which had improved people’s care and treatment. They said, “The dementia training completely changed the way I see people and support them. It made me realise more about their conditions and how to support them. I have more empathy for them now.”

Systems were not in place to monitor outcomes that had been achieved by people. Care records failed to contain the outcome and goals that people wanted to achieve followed by how staff would support people to achieve their desired outcomes and goals. Where people’s preferences had been sought and recorded within their care records this had not always been followed. For example, some people told us their likes and dislikes were not always followed and responded to.

People told us that staff asked for their consent before any care or support tasks were completed. Comments from people included, “They allow me to make decisions, like when I want to go to and from my room” and “They allow you to make decisions as to whether it would be right to get a GP to look at me.”  However, records demonstrated that people who may not be able to give their consent did not have their rights protected as staff had not carried out all reasonably practicable steps to optimise understanding, maximise capacity or involve relevant others to ensure decision were in people’s best interest.

Staff had been trained in the principles of the Mental Capacity Act 2005 and understood the importance of gaining consent from people before any care or support tasks. Comments from staff included, “We have to get the residents consent before we do anything. After I did dementia training it helped me learn more about consent with people with dementia. If they say no now; for example, they say no to personal care now. You can come back again and try. Sometimes they will accept” and “If someone was refusing personal care for example, I will respect it at the time, but I will go back again to try or ask another carer to try. Consent is dependent on time and situation.” Staff told us that people’s views were sought and acted on. One member of staff said, “We implement suggestions relatives and residents make. Some residents want to stay up late, and some want to go to bed early. We listen to them and respect their wishes.”

The principles of the Mental Capacity Act 2005 (MCA) had not always been followed to demonstrate how people had been involved in decisions about their life. Mental capacity assessments had not been completed consistently. For example, some documents were not fully completed, they had no explanation as to why the assessor had made the decision the person lacked capacity and what action they have taken to determine this. For example, speaking to the person or going back at another time of the day. Decisions that had been made in the person’s ‘Best Interests’ lacked evidence of the person’s voice and did not demonstrate who had been involved in the decision making such as, family members or healthcare professionals. People’s views and wishes had not always been considered or recorded within their care records. Another person had ‘no psychological needs’ recorded within their care plan however, they had scored 6 on the Cornell Depression Scale (high for depressive symptoms). There was a risk that staff would not know how to support the person at times of anxiety or distress.