Country View Nursing Home

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

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people's care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

People and their relatives told us they were involved in planning and reviewing care, which helped ensure support was tailored to each person's individual needs and preferences.People's needs were assessed before they moved into the home. Pre-admission assessments were completed to ensure the service could meet people's needs safely and effectively. These assessments gathered important information about people's health, care, wellbeing, and support requirements, which was then used to develop care plans.

People told us they were involved in discussions about their care and support needs before moving into the home. One person said, “My (relative) and I had an assessment with (named manager) and I was shown a video of the rooms available, and I chose the one I wanted.” This showed people were involved in assessing their needs and planning their move into the service.

The provider did not always plan and deliver people's care and treatment with them, including what was important and mattered to them. While recognised assessment tools were used to assess and monitor people's needs, care plans did not always provide staff with enough information to deliver safe and consistent care.

The provider used recognised assessment tools, including the Malnutrition Universal Screening Tool (MUST) and the Waterlow tool for assessing the risk of pressure ulcers. These were completed as part of people's care assessments and helped identify areas where support was needed.

However, we found some care plans did not contain sufficient guidance for staff. One person was on a soft diet and required full assistance with eating. Their nutrition care plan stated they could hold food in their mouth, but there was no clear guidance for staff on how this should be managed safely. There was also no choking risk assessment or choking management plan in place. This meant staff may not have had enough information to support the person safely with eating or respond appropriately to the risk of choking.

Another person's behavioural care plan stated they could become aggressive, but there was very limited detail about the behaviours staff might observe, possible triggers, or how staff should respond safely and consistently. No behavioural monitoring records were available. The person was prescribed Lorazepam as a PRN medicine; however, the care plan stated it should be given at a "permanent time", which was unclear and inconsistent with PRN use. There was also no evidence showing whether the medicine was effective or whether its regular use had been reviewed by the GP.

The provider worked well across teams and services to support people and help ensure they received joined-up care. Information about people's needs was shared appropriately to support continuity of care and reduce the risk of important information being missed.

The provider worked closely with a range of healthcare professionals, including GPs, district nurses, and phlebotomists, to help ensure people received the care and treatment they needed. Staff made referrals to external professionals when required and worked with them to support people's health and wellbeing.

Staff told us the handover was detailed and well structured. These handover meetings ensured important information was shared between staff shifts. Staff told us communication within the home was generally good. Relatives told us that they are kept informed of changes in people's health and any involvement from healthcare professionals.

The provider supported people to manage their health and wellbeing and helped them maintain as much independence, choice, and control as possible. Staff supported people to live healthier lives and access the healthcare services they needed.

Staff monitored people's health needs and reported concerns promptly. People were supported to attend healthcare appointments. People were supported to maintain adequate nutrition and hydration, including access to modified diets where these were required to meet their needs. Staff understood people's health needs and any associated risks, such as diabetes, and encouraged healthy eating while respecting people's choices and preferences. During the assessment, we observed people being offered a variety of meals and refreshments.People and relatives spoke positively about the food provided and the choices available. One relative told us, "It's brilliant, he is like a proper chef. If you don't like what's on, they will give you a choice of something else."

We observed the chef speaking directly with people during mealtimes and asking for feedback about the food. This helped ensure people's views, preferences, and choices were listened to and considered.Staff also supported people to stay active and take part in meaningful activities. A range of activities was available, including light exercise sessions and visits from external entertainers. The service had two vehicles which were used to support people to access the local community, including parks and other outings.Activities were person-centred and reflected people's individual interests, helping to promote wellbeing, independence, and social inclusion.

The provider did not always routinely monitor people's care and treatment to continuously improve outcomes. While some health monitoring was taking place, records were not always accurate, complete, or used effectively to ensure positive and consistent outcomes for people.

Vital signs and people's weights were checked regularly, which helped staff monitor aspects of people's health and wellbeing. However, meal charts for people requiring modified diets did not always clearly record food consistency or dietary requirements. For example, two people were on level 4 diets, but meal charts did not clearly record the food consistency offered. For another person, the meal chart recorded a normal diet while the care plan stated the person required a soft diet. This created a risk that people may not always receive food that met their assessed needs.

Fluid monitoring records showed inconsistent fluid targets and limited oversight where people regularly failed to meet their targets. Bowel monitoring records showed occasions where people had not opened their bowels for several days without clear escalation or evidence of action being taken. Care plans did not provide clear guidance for staff on what action should be taken if a person became constipated or when medical advice should be sought. This increased the risk that changes in people's health may not be identified or responded to promptly. Catheter care records for one person lacked detailed monitoring information. Records stated the person did not tolerate a particular catheter size; however, the care plan had not been updated to reflect this change. Urine output was also not always recorded when catheter bags were emptied.The provider acknowledged these concerns and told us the actions they would take to address them.

The provider did not always ensure people's rights around consent were fully reflected in records and decision-making processes. While staff understood the importance of gaining consent and people told us their choices were respected, records did not always provide assurance that decisions were being made fully in line with the Mental Capacity Act (MCA).

Mental Capacity Assessments we reviewed were basic and lacked detailed evidence of the decision-making process or best interest discussions. Assessments did not always clearly record how people had been supported to make decisions or how their communication needs had been considered. Responses were often limited to simple "yes" or "no" answers without further explanation or supporting detail.

This reduced assurance that decisions were always being made in line with the principles of the Mental Capacity Act and that all reasonable steps had been taken to support people to make their own decisions where possible.

However, people told us staff always asked for their consent before providing care. Staff had received training on the Mental Capacity Act and demonstrated an understanding of the importance of gaining consent. During our assessment, we observed staff explaining things in a way people could understand, giving them time to make decisions, and respecting their privacy by knocking on doors before entering people's rooms.

Although day-to-day practice showed staff respected people's choices and sought consent, improvements were needed to ensure assessments and records fully reflected how decisions were made and how people's rights were protected.