Westhope Place

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

During our assessment of this key question, we found concerns around the assessments of people’s needs and the skills and knowledge of staff which resulted in shortfalls in the quality of people’s care and treatment. People’s needs were not always assessed in line with Right Care, Right Support, Right Culture guidance which increased the risks of people not receiving effective person-centred care and support. The provider had failed to ensure staff understood their responsibilities within the Mental Capacity Act 2005 when working with people who may lack the capacity to make some decisions. Shortfalls and concerns about a person’s care had not always been identified and when this had occurred there was insufficient action taken to ensure service users received effective support to meet their needs. You can find more details of our concerns in the evidence category findings below.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Westhope Place supports people with a learning disability and autistic people who may not be able to tell staff about their needs and choices and therefore the information gathered in initial assessments and care plans was essential to ensure staff have enough information to provide effective support. Care plans lacked detailed assessments of people’s needs or guidance for staff to follow to manage them. For example, records relating to one person stated they used a “Zimmer frame “to mobilise whilst staff told us they used a wheelchair. The available records were from their previous service and they had moved into the Westhope Place in December 2023 due to increased mobility needs. The lack of accurate contemporary information increased potential risk of the person not receiving effective support.

Staff relied on other staff to share information about people’s needs. They told us information in care plans was often contradictory and confusing. This increased potential risks of harm to people and staff. We sought assurances from senior staff about support plans in place for people which demonstrated gaps and contradictions about support needs. Plans lacked basic safety and communication information and no or poor considerations for people with Autism in relation to communication, self-injury and sensory needs. They confirmed the plans were not what they would expect and told us, “I will take this back to my team as these are not good enough”.

Records did not provide relevant information for staff. For example, risk assessments had not offered guidance to support a person when they experienced distress and carried out self-injurious behaviours. This meant essential information was not always available to staff and resulted in people not always receiving support in an holistic manner in line with the person’s choices. For example, staff had noted an increase in incidents of self-injury for one person. There was no corresponding support plan to provide staff with tools and strategies to manage these needs. Positive Behaviour Support (PBS) plans had not been completed with people and staff lacked understanding of the principles of PBS. This increased the risk of people not receiving care and support which maximised their quality of life.

People had not always been actively involved in assessments of their needs and preferences. One person told us “They liked puzzles”. Whilst this information was in the persons support plan, staff had failed to include this preference when considering their support. A number of people experienced behaviours that challenge others. People had not been referred for Positive Behaviour Support (PBS) assessments and existing support plans lacked detail and failed to provide staff with guidance to support people when they experienced distress. People with a learning disability and Autistic people were not always supported in line with current evidence - based practice. The British institute of learning disabilities (Bild) describes how the positive behaviour support (PBS) approach promote people’s quality of life. PBS is about working in partnership with people. Treating them with dignity and respect and enabling them to have a better life. All behaviours have a meaning… Positive behavioural support is an approach that put the person at the centre to make systems work for the person. (Bild definition of PBS).

Following our assessment visit the provider told us they were reviewing people’s needs and taking action where they find the service is not equipped or skilled to meet peoples needs.

Care management processes in operation did not always contain information in relation to current evidence- based good practice. Support plans had not always focused on a person’s strengths and abilities or considered the persons preferences to maintain independence or control. For example, one staff member told us about one person being, “Keen on cooking”. There was limited information regarding this preference in their records and this potentially increased the risk of the person not always being supported with activities that were important and mattered to them.

People were not supported by effective assessments of their needs. We observed people being supported by staff who lacked access to relevant information in relation to health, emotional distress and sensory needs. For example, one staff member told us about a person’s support plan which included the following conflicting information, “Epilepsy plan says they should avoid sensory lights but then says they like them”.

Following our assessment visit the provider told us how they were working with commissioners and health professionals to review people’s needs and ensure peoples assessments contained adequate and accurate information to ensure people received effective support.

Partners who spoke with us told us about challenges they experienced working with Westhope Place. For example, “Most recently we have had some difficulties with appropriate referrals to the team. They lacked details and there were inconsistencies in what has been reported … My experience with staff members and their knowledge of service users, their support needs and in particular eating, drinking and swallowing recommendations/IDDSI advice has been variable. Some staff members seem more aware than others, we have provided IDDSI information to the team previously and I have been told this is part of new staff members e-learning but I am not sure how effective this is/if it is applied at mealtimes consistently or that there is consistent implementation of recommendations”. Partners were currently working with the provider to review peoples needs to ensure guidelines were in place and followed by staff.

Staff skills with care management systems have not always supported information sharing. Records were disorganised and contained conflicting and often historic information. The organisations audit process was not robust and had not identified the significant concerns with people’s assessments. The provider was required to share information with multiple agencies and were not assured they had access to accurate information in respect to peoples needs and as a result arranged for people to have reviews with health professionals to ensure the information they held was accurate.

People were generally supported to manage their health and wellbeing effectively. People who were unable to verbalise their needs relied on staff to support them to manage health appointments and people were supported to access healthcare and dental appointments, however records of changes were not always available, for example, evidence of medicines being reviewed were not readily available.

People's needs had not always been fully assessed or regularly reviewed. The director spoke of action they were taking to improve access to people’s current health information and had contacted General Practitioners (GP) to carry out reviews of their health and medicine needs.

Systems and processes had not always supported people to manage their health and wellbeing. Care records did not always contain accurate information relating to peoples health and wellbeing and as a result the provider, health partners and the local authority were carrying out reviews of peoples needs to ensure assessments contained appropriate information to meet people's needs effectively

People were not always supported to achieve positive outcomes. For some people, staff did not have access to SaLT guidelines and recommendations and as a result failed to review or monitor the risks associated with eating and drinking.

Leaders provided feedback on changes implemented following a person’s death and told us about the work with SaLT team, and how everyone had been referred for new assessment whilst interim advice was in place. The provider had taken immediate action to review staff awareness and practice to ensure people were supported and staff understood clinical expectations.

Processes in operation did not always direct staff to consider how to support people with monitoring outcomes. For example, staff told us how they had not been aware of eating and drinking guidelines for some people. Records were disorganised and staff had not recorded consistencies of meals provided to people potentially increasing the risk of harm.

People were not always supported by staff who understood people’s rights around consent. Peoples experience was inconsistent, for example, one person was observed being moved and handled by a staff member without any form of communication; however, another staff member asked a person what they wanted to do and offered support with personal care in a quiet, gentle respectful manner.

Whilst some staff told us they had not seen details of peoples Dols or Mental Capacity Assessments they were able to demonstrate they understood the principles of the Mental Capacity Act. One staff member understood the use of bed rails would be considered as potentially restrictive and therefore their use would need to be assessed as part of a capacity assessment and considered in the persons DoLS.

The majority of staff had received training in Mental Capacity and DoLs, however, the provider’s processes and working practices did not ensure an adequate level of scrutiny and oversight of staff practice to ensure people were protected from the risk of harm, and received consistent support which respected their rights around consent.