We carried out a review of the data available to us about Cowbridge residential care home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Cowbridge residential care home, you can give feedback on this service.
Cowbridge Residential Care Home is a residential care home providing personal and nursing care for up to 30 people. At the time of our inspection there were 24 people using the service.
People’s experience of using this service and what we found
People were protected from the risk of abuse and avoidable harm. People told us that they felt safe in the home and risks in relation to people's care were identified and managed to keep them safe. A relative told us, “I visit most days and always leave confident [person’s name] is safe”.
Staff had been recruited safely and during the inspection we observed there were enough staff to respond to people's needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff did tell us that staffing levels could fluctuate but that they always felt they were safe.
People’s medicines were administered and managed safely. We looked at infection prevention and control and were assured the provider was protecting people, staff and visitors from the risk of infection.
Accidents and incidents were recorded and monitored to ensure trends and patterns were identified and action taken to reduce risks occurring. The registered manager took appropriate actions to improve the service.
The environment was spacious and there was equipment available to support staff in providing safe care and support. Health and safety checks of the environment and equipment were in place. There were certificates in place to evidence this. Systems were in place to support people in the event of an emergency.
The systems in place to monitor the quality of care within the service were effective. The registered manager promoted a positive person-centred culture and fully understood their responsibilities as a registered manager
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was good (published 19 December 2017)
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cowbridge Residential Care Home on our website at www.cqc.org.uk
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice.
The management team were continuing to support staff to contain the COVID-19 outbreak at the service. Daily oversight and careful management of staffing levels had meant staff shortages had been managed effectively. Staffing levels were being supported by the use of the services own workforce and their internal agency system, Cornwallis Extra. Staffing absences, due to COVID-19 infections and other issues had not impacted on staffing levels or the quality of support people received.
The service was following current guidance in relation to visiting care homes during outbreaks of COVID-19. People understood the need for these restrictions and were confident staff were taking appropriate steps to manage the outbreak of the infection. All five people we spoke with were happy with the care they received. Their comments included, “I can’t fault them, they [staff] look after me well”, “My wife visits me” and “[The staff] wear their masks, we are used to it now”.
Two relatives were visiting the service to see their loved one during the inspection. They told us they understood the need for the restrictions in place, were confident staff were taking appropriate steps to manage the outbreak of the infection and felt their family member was being cared for well. They told us “When we visit, we wear PPE and do a test before we come” and “Staff keep in touch, they keep us up to date”.
The service had a committed staff team to ensure people received care and support in a safe and hygienic environment. People were supported in the service in accordance with national guidance. The staff team supported people and their relatives to understand the policies and procedures surrounding protection against COVID-19.
Additional cleaning protocols were in place to ensure all high touch points were regularly sanitised.
Personal protective equipment (PPE) was available to all staff and visitors. Staff and people living at the service were regularly tested for COVID-19.
Cowbridge nursing home provides accommodation. The majority of bedrooms are on the ground floor where communal areas are also present. In the older part of the home bedrooms are on the first floor which is served by a lift. Staff are present on both floors of the home at all times to ensure people’s needs are met.
There was a registered manager in post who was responsible for the day-to-day running of the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager of Cowbridge came into post in May 2017.
We carried out this unannounced inspection on 13 November 2017. At the last inspection, in June 2015, the service was rated Good. At this inspection we found the service remained Good.
At the previous inspection the caring section was rated outstanding. However, it was noted at this inspection that following a change of management some additional support services were no longer in place. We found that staff’s caring approach to people remained very committed as was their skill and knowledge base. Due to these changes the rating of this section no longer meets the criteria for Outstanding and is now rated as Good.
On the day of the inspection there was a calm, relaxed and friendly atmosphere in the service. We observed that staff interacted with people in a caring and compassionate manner. People who were able to talk to us about their views of the service told us they were happy with the care they received and believed it was a safe environment. Comments from people included, “All the staff are brilliant”, “The staff are kind and fun” and “They look after me so well.” Relatives commented “[Person name] this is their third care home and this one is the best; [person name] is well looked after”, “All the staff are brilliant”, “The staff are kind and fun” and “I would like to have [person’s name] home but I know this is the best place for her.” Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time.
Where people were unable to tell us about their experiences we observed they were relaxed and at ease with staff. People’s behaviour and body language showed that they felt cared for by staff. Staff said they were proud to work at Cowbridge and told us “I wouldn’t be here if the care of people isn’t good” and “At the end of the day we are all humans and need to support each other. We love the people here.”
People were protected from abuse and harm because staff understood their safeguarding responsibilities and were able to assess and mitigate any individual risk to a person’s safety. People said they felt safe at Cowbridge.
The service was warm, comfortable and appeared clean with no unpleasant odours. The service was well maintained by a maintenance team who completed any faults in a timely manner. Bedrooms were personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.
Some people living at Cowbridge were living with dementia and were independently mobile around the service. However, the service did not have clear pictorial signage to help people who need additional support recognising areas of the building such as the toilet and shower rooms. The registered manager agreed to immediately address this by resourcing signage to display on doors to support people to access these rooms independently.
While safe arrangements were in place for the storing and administration of people’s medicines, there were some gaps in Medicine Administration Records (MARS). There were some missing signatures where two staff had not signed to confirm the accuracy of handwritten entries for prescribed medicines. This was immediately addressed at the inspection.
Staff were recruited in a safe way. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes.
Staff were supported by a system of induction training, one-to-one supervision and appraisals. The induction and on-going training of staff ensured they were effective in their role. Staff knew how to ensure each person was supported as an individual in a way that did not discriminate against them. People’s legal rights were understood and upheld.
People received care and support that was responsive to their needs because staff were aware of the needs of people who lived at Cowbridge. Staff supported people to access appropriate healthcare services. Relatives told us the service always kept them informed of any changes to people’s health and when healthcare appointments had been made.
Care plans were well organised and contained personalised information about the individual person’s needs and wishes. Care planning was reviewed regularly and whenever people’s needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted. Risks in relation to people’s care and support were assessed and planned for to minimise the risk of harm.
People were able to take part in a range of group and individual activities. An activity coordinator was in post who arranged regular events for people.
Staff supported people to maintain a balanced diet in line with their dietary needs and preferences. Where people needed assistance with eating and drinking staff provided support appropriate to meet each individual person’s assessed needs.
Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff demonstrated the principles of the MCA in the way they cared for people. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements. Applications for DoLS authorisations had been made to the local authority appropriately.
There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong leadership and led by example.
People and relatives all described the management of the home as open and approachable. Relatives told us, “I can talk to the manager or staff at any time.” There were regular meetings for people and their families, which meant they could share their views about the running of the service. People and their families were given information about how to complain. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.
Cowbridge Nursing Home is a nursing care home which predominately provides nursing and personal care to older people. The service is registered to accommodate up to a maximum of 30 people. On the day of the inspection 27 people were living at the service. Some of the people at the time of our visit had physical health needs and some mental frailty due to a diagnosis of dementia.
The service is required to have a registered manager and at the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
We carried out this unannounced inspection of Cowbridge Nursing Home on 23 and 25 June 2015. Our findings were that people were being cared for by competent and experienced staff, people had choices in their daily lives and their mobility was supported appropriately.
People told us staff were; “fantastic,” “caring,” “marvellous” and “I am looked after very well”. They told us they were completely satisfied with the care provided and the manner in which it was given. Relatives told us “Not only did they save Mums life, they saved mine,” “fantastic care,” “Staff genuinely care,” “we cannot fault the care, nothing is too much trouble” and staff were “competent and professional.”
The registered manager said “We tell the relatives let us do the hard bit, you can live well with dementia.” The activity coordinator along with relatives and carers had arranged informal weekends away. This provided an opportunity for relatives to form supportive relationships with other relatives. It also gave a time for discussion to understand the impact dementia has on the person and those around them. These weekends were popular and very positive for people and allowed a greater understanding of the impact dementia could have. The service also held a relative’s support group throughout the year. This was open to relatives where people were currently or had lived at the service. One relative told us, “I’m still welcome here even though my husband is no longer with us, the support is so valuable.”
People felt safe living in the home, commenting “I feel safe here, very safe.” One person commented “This is my home now and I’m happy here.” Relatives told us they felt their family member was cared for safely. Staff were aware of how to report any suspicions of abuse and had confidence that appropriate action would be taken.
People’s care and health needs were assessed prior to admission to the service. Staff ensured they found out as much information about the person as possible so that they could; “Really get to know them, their likes, dislikes, interests, they wanted to know all about their life.” Relatives felt this gave staff a very good understanding of their family member and how they could care for them.
People chose how to spend their day and a wide range of activities were provided. Activities were provided by the service in a group format, such as for arts and crafts and through outside entertainers coming into the service. The service had participated in a national project to look at making activities more individualised and meaningful to the person. This was done by gathering views from relatives and the person about their interests, such as flower making and the place they were born, and a memory box was then filled with items associated with these for that person’s use. Visitors told us they were always made welcome and were able to visit at any time.
The registered manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Where people did not have the capacity to make certain decisions the home involved family and relevant professionals to ensure decisions were made in the person’s best interests.
People’s care plans, identified the person’s care and health needs in depth and how the person wished to be supported by the service. They were written in a manner that informed, guided and directed staff in how to approach and care for a person’s physical and emotional needs. Records showed staff had made referrals to relevant healthcare services quickly when changes to people’s health or wellbeing had been identified. Staff felt the care plans allowed a consistent approach when providing care so the person received effective care from all the staff. People that used the service and their relatives told us they were invited and attended care plan review meetings and found these meetings really helpful.
People told us staff were very caring and looked after them well. Visitors told us; “Staff are fantastic.” We saw staff providing care to people in a calm and sensitive manner and at the person’s pace. When staff talked with us about individuals in the service they spoke about them in a caring and compassionate manner. Staff demonstrated a really good knowledge of the people they supported. Peoples' privacy, dignity and independence were respected by staff. At this visit we undertook direct observations using the SOFI tool to see how people were cared for by staff. We saw many examples of kindness, patience and empathy from staff to people who lived at the service.
There were sufficient numbers of suitably qualified staff on duty to keep people safe and meet their needs. People said, “When I call the bell for help staff come quickly,” Relatives echoed this view commenting staff were always available if they had any queries at any time. Staff felt there were always sufficient staff on duty.
Staff told us they were supported by managers. They attended regular meetings (called supervision) with their line managers. This allowed staff the opportunity to discuss how they provided support to people, to ensure they met people’s needs, and gave time to review their aims, objectives and any professional development plans. Staff also had an annual appraisal to review their work performance over the year.
We saw the home’s complaints procedure which provided people with information on how to make a complaint. People and relatives told us they had, “No cause to make any complaints” and if they had any issues they felt able to address them with the management team.
The registered manager promoted a culture that was well led and centred on people’s needs. People told us how they were involved in decisions about their care and how the service was run. The management and running of the service was ‘person centred’ with people being consulted and involved in decision making. People were empowered by being actively involved in decision making so the service was run to reflect their needs and preferences.
The registered manager emphasised the importance of engaging with the local community, had invited people to visit Cowbridge and had got the service involved in all kinds of community celebrations and festivals. Due to this engagement with the local community the reputation of the service had been further improved to become very positive. This had been achieved by various initiatives. For example; the registered manager is holding relative and carers support groups at the local tea shop. These are open for all who have or are providing a caring role, also joining in the local carnival and heritage day, providing coffee mornings and attending the maypole dancing all help to promote the service. The service is now highly thought of in the local community.
The provider organisation is keen to gain the views of people’s relatives and health and social care professionals. Some of this is completed via a questionnaire and the results of these were compiled in a report which identified areas for improvement and any actions the provider needed to make. For example some people wanted the garden area to be used more, and so the service was actively making this area a more pleasant place to use. People that used the service had purchased new furniture and had planted sensory plants.
There was a management structure in the service which provided clear lines of responsibility and accountability. There was a clear ethos at the home which was understood by all the staff. It was very important to all the staff and management at the service that people who lived there were supported to be as independent as possible and to live their life as they chose. The provider had an effective system to regularly assess and monitor the quality of service that people received and was continuously trying to further improve the quality of the service.
The home was comfortable and clean on the day of the inspection. There were a number of seating areas in the home, and there were a small number of people in other areas although most people were in the activity lounge where they participated in the activities. We saw some people remained in their rooms, with several people staying in bed due to their health care needs.
People were protected from abuse and cared for in a clean, safe environment. The manager showed us the new courtyard garden at the rear of the home, which could be accessed by people who were independent with their mobility or for people who used mobility aids.
The care records we saw were detailed, regularly reviewed and showed the involvement of the person who received care or their representative.
The home was comfortable and clean on the day of the inspection. There were a number of seating areas in the home, with most people congregating together in one lounge. We saw some people remained in their rooms, with several people staying in bed due to their conditions, where they were regularly checked by staff.
The home was set in large grounds, but there was nowhere that people could access the outside unaccompanied and safely. The registered manager told us there were plans for a courtyard area at the rear of the home which could possibly be turned into a secured garden area, which could then be accessed by people who were independent with their mobility or used mobility aids.
The care records we saw were detailed and regularly reviewed. Medication administration systems in place were robust and in line with laid down guidance.
One person told us that they were happy spending time on their own in their room. They also told us that they had access to a call bell at night, but not during the day, during which they had to shout if they needed assistance from the staff.
Another person told us that the staff were kind and helpful. One person told us that they liked the food provided to them.
We observed staff supporting people who use the service and noted that people were treated respectfully by the staff.