Cholwell House 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.

However, processes around consent to care were not always followed consistently. The provider said they would review all their mental capacity assessments.

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.

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

Pre-assessments were carried out before people moved to the service. Care plans we looked at included a range of assessments covering people’s physical and mental health and well-being. Regular reviews of care plans were carried out with people and their families. The provider confirmed a process is in place for relatives to review care plans. One relative confirmed they were involved in providing information to support their relative’s care planning.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. People’s nutrition and hydration needs were assessed. Evidence based tools such as Waterlow risk assessments and Malnutrition Universal Screening Tools (MUST) were used in care plans. Records showed that people’s weight was monitored and that concerns about potential weight loss were raised with the GP. When people’s nutritional or dietary needs changed, specialist advice was sought. Records showed staff had recently liaised with the speech and language therapist (SALT) when staff had observed one person coughing when eating.

The provider worked well across teams and services to support people. Staff told us they had good relationships with other healthcare professionals. For example, one staff member said, “The GP is absolutely brilliant. They come every Tuesday and often on a Friday as well if we are worried about anyone before the weekend. We have a good relationship with the community intervention team for those people with mental health needs as well.” A visiting health professional said, “I trust the team here. I’ve always had a really strong relationship with the home. They [staff] know people and are very quick to tell us if people are unwell. It’s not unusual for me to come back if someone isn’t quite right.” We saw staff meetings were held regularly in the service to ensure staff, and the leadership team were aware of changes in people’s needs and staff were updated on new practices.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured outcomes were positive and consistent, and they met both clinical expectations and the expectations of people themselves. Records showed staff monitored people’s health and liaised closely with other health professionals when needed. We looked at wound records and saw staff monitored wounds regularly, including taking photographs so staff could easily identify if a wound was improving or deteriorating. Leaders had developed a system to monitor and have oversight of wounds in the service.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured outcomes were positive and consistent, and they met both clinical expectations and the expectations of people themselves. Records showed staff monitored people’s health and liaised closely with other health professionals when needed. We looked at wound records and saw staff monitored wounds regularly, including taking photographs so staff could easily identify if a wound was improving or deteriorating. Leaders had developed a system to monitor and have oversight of wounds in the service.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Some people had sensor mats or other sensor alarms in place to alert staff if they stood or tried to walk unaided. This was to reduce the risk of people falling. However, there were no records of people being assessed for their capacity to consent to their use, and no records of any best interest decisions being made where appropriate. Some people had been assessed as being able to consent to their care and staff had documented that staff should respect when people sometimes made unwise decisions. For example, one person was advised to have a specific diet due to a health condition, but on occasion, the person chose to deviate from this. However, there was nothing documented to show staff had discussed the risks and assessed the person as being able to make the choice or the person understood the associated risks. We fed this back to leaders who advised us they would review all mental capacity assessments.

However, some people had been assessed for their capacity and in some cases, there were records of discussions about the decision. During the inspection we saw and heard staff asking people for their consent and offering choices. For example, we saw staff asking people where they would like to sit, and if they needed some help with their lunch. We observed staff knocking on people’s bedroom doors before entering.

The provider had not followed their own policy in relation to record-keeping around vaccine consent for people. The provider confirmed this was because they had changed their recording systems and said they would update their policy to reflect this.