Westhope Place

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

People were not supported in line with Right support, Right care, Right culture guidelines in providing care and support which is person-centred, planned, proactive and coordinated. Peoples communication methods were not always proactively supported or encouraged by staff. There was a failure to ensure the care and treatment met people’s needs, reflected their preferences or maintained their independence. You can find more details of our concerns in the evidence category findings below

This service scored 45 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not always treated with compassion. Following a recent choking incident the provider had amended four people’s meal texture to level 4 pureed foods whilst a review was completed. Staff had misunderstood part of the SaLT guidance and in addition had stopped people accessing snacks. For one person, staff had not considered how by leaving snacks in sight but out of the persons reach might cause distress. Staff had noted a recent increase in the instances of this persons expressing self-injurious behaviours. We raised this with the director and they moved the snacks out of sight. Some people told us staff were kind, their comments included, “I like the staff” and “I like living here I don't mind people”

In general staff demonstrated genuine positive regard for people and understood people’s choices and preferences. Staff generally spoke about people warmly and recognised how people’s life history might impact them.

Health professionals who spoke with us told us staff did not always act on advice and guidance they had offered to support peoples needs. One told us on a return visit they were disappointed to find managers and staff had not followed or respected the instructions they had provided to keep people safe. .

Observations of staff practice did not always provide assurance they respected people’s privacy, for example, staff administered medicines in the communal area without checking the person was comfortable with this. Whilst not all staff respected peoples privacy we observed others treated people with sensitivity and compassion.

People did not always receive care and treatment which met their needs, reflected their preferences or maintained their independence. Care records identified some people having a diagnosis of autism. There were no referrals for functional assessments or adaptations to support people’s sensory needs. People did not have Positive Behaviour Support (PBS) plans, staff and managers CQC spoke with lacked knowledge about PBS. A positive behaviour support plan is a care plan to help understand and support people and adults who display behaviour that others find challenging. One person had experienced a number of instances of self-injurious behaviours and staff did not have clarity about how to effectively support or communicate with them. This meant effective pro-active strategies to reduce the reoccurrence of incidents were not in place.

Staff spoke about how they worked with people who might be expressing distress or confusion. Their responses did not provide assurance they had effective skills and understanding to always meet people’s needs. The director told us they had arranged for their PBS team to carry out training with staff. The provider told us they had taken a decision to work with people and commissioners to review whether they were able to continue to meet their needs.

We observed staff generally providing support with kindness; however, at times this was task focused, lacked positive interaction and people preferences were not always considered. For example, an agency staff member was observed not engaged with the person, not focused on their preferences and lacking direction from managers and staff to support the person with activities they preferred.

Care plans did not always contain information about people’s strengths or abilities or consider their preferences to maintain control and independence. Person centred language is about always respecting the dignity, worth, unique qualities and strengths of every individual this was not always apparent in care plans.

Staff culture and practice was focused on caring for people; however, they did not always promote independence or choice. Activity plans were generic and not communicated in a form understood by people. One person did not understand what was on their activity plan or have detail as to what their plans were for the day. Another person was noted as enjoying cooking, the kitchen was very small and not accessible for a number of the people living at Westhope Place.

Staff spoke positively about supporting people with activities they liked and encouraging them to develop. Some spoke of how they supported people to maintain independence and choice. One told us, “Person is quite independent, they are keen on cooking”. They went on to say how they helped the person to, “Mix things on the dining room table as the kitchen is very small”.

We observed staff not always promoting people's choices, for example a staff member was observed moving a person away from the dining table in response to hearing them make a noise without considering the persons wishes or what the person might be communicating. Generally, observations of staff supporting people were positive for example, staff taking people out for shopping and coffee. Staff stated that some people like to have walks so some activities were accessed by foot.

Care plans were not always person centred or demonstrate involvement of people in their choices and care planning. Care plan reviews had not been completed or evidenced staff had reviewed a person’s choice, control or wellbeing. The provider was in the process of completing reviews of peoples support plans and due to the level of concern with records they were focusing work on health and welfare risks.

Staff lacked the skills and techniques to deploy to respond to people when they were distressed. Managers and staff had not recognised people hitting or scratching themselves as a potential sign of distress and as a result had not always sought further advice from health professionals. Staff were not recording when incidents occurred or carrying out any form of analysis of the function of this behaviour for the person and as a result had not identified strategies to support them.

Some staff we spoke with were unable to explain how they responded to people when they appeared distressed. We observed a person self-injuring and staff were not aware of the potential this person was communicating distress or discomfort and as a result they failed to respond in the moment. Senior leaders told us they had arranged for their PBS (Positive Behaviour Support) lead to visit the service to offer support to people and staff to increase staff understanding. Staff demonstrated some awareness of people’s sensory needs and during our assessment visits were observed engaging people with activities which met their immediate needs for example a number of staff were aware one person liked staff touching their head and would hold out their hand to ask staff for this contact. Staff responded positively to their wishes.

Generally, people received kind and compassionate care from staff who used positive, respectful language which people understood and responded well to. Staff spoke respectfully of people and demonstrated genuine regard. They knew peoples likes and dislikes and supported them in a caring manner.

We did not look at Workforce wellbeing and enablement during this assessment. The score for this quality statement is based on the previous rating for Caring.