Moss Cottage 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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The provider had admitted several people shortly before our inspection visit, and there was limited information available about their needs to guide staff in delivering care. For some people, important risk assessments and care plans were not implemented until several days after admission. On the first day of our inspection, we requested that the provider ensure an evacuation plan was in place for a recently admitted person.

Staff told us that information relating to new admissions was discussed during handovers and that a summary of people's needs was available within the care records. However, we found these summaries lacked the detail required to ensure staff could consistently provide safe and effective care.

We found necessary equipment was not always available when people were admitted to the home. For example, one person was very tall and required a bed extender; however, this was not in place for more than two weeks after their admission, although the provider advised that it had been ordered. Another person told us they did not have access to a call bell when they were first admitted and had to telephone the reception desk whenever they required support. We raised this with the home manager, who took immediate action to ensure the person had access to a working call bell.

The provider did not always plan and deliver people's care and treatment in partnership with them, including considering what was important to them and their individual preferences.

There was mixed evidence regarding how the provider ensured people received evidence-based care and treatment. We found that people with wounds were receiving the support they needed to manage these, including regular dressing changes, and wounds were generally stable or showing signs of improvement. However, documentation relating to wound management required improvement, particularly in relation to wound assessments, repositioning, and the application of creams to maintain healthy skin and prevent deterioration.

Further work was needed to ensure accurate records were available to staff and records reflected that appropriate care was being provided.

The provider worked well across teams and services to support people. They shared their assessment of needs when people moved between different services.

Permanent staff demonstrated a good understanding of people's needs, preferences, and risks, and felt confident in their ability to provide appropriate support. People and their families generally spoke positively about the permanent staff and described them as caring and committed to meeting people's needs. They felt staff worked well together and provided consistent support.

Staff told us information about people's needs and any changes in their circumstances was communicated through handovers and team discussions. Staff also reported positive working relationships with other health and social care professionals, and the provider had established effective links with a range of specialist services to support people's care and treatment. One person commented, “’I can get a haircut in the home from a visiting hairdresser, and a podiatrist comes to do my toenails.”

The provider supported people to manage their health and wellbeing and access the services they needed.

People were supported to access a range of healthcare services. Kitchen staff demonstrated a good understanding of people's dietary needs and preferences. One person told us, "The food here is good. I enjoy the chips, two veg and fish, but I wish they would vary the food. They had curry once quite recently which I very much enjoyed. It would be nice to have little changes like this in the menu from time to time. I enjoy breakfast and lunch particularly."

There was limited evidence to demonstrate how people had been involved in developing menus or making decisions about the food provided. The provider told us they completed annual surveys in this area.

Some people described very positive experiences of care and support and had been enabled to access a range of services, including privately funded healthcare. One person told us, "I don't want to move from here. I am determined to get myself up one day so that I can use the wheelchair to go out into the fresh air, visit places and see what's going on in the community again."

The provider did not always routinely monitor people's care and treatment to drive continuous improvement. They did not consistently ensure that outcomes were positive, person-centred, and in line with both clinical expectations and people's own preferences and needs.

Clinical oversight of people's care and support was not always effective. Although systems and processes were in place to monitor care delivery, these were not consistently effective, partly due to the high reliance on agency staff. We found gaps in care records, including records relating to repositioning and people's nutritional and hydration needs.

Records were not always completed accurately or consistently, which limited the provider's ability to effectively monitor people's wellbeing and care outcomes. In addition, information shared with staff at handover did not always demonstrate a clear overview of people's current needs, risks, and circumstances. This meant we could not always be assured that staff had access to the information required to provide safe, consistent, and effective care.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

The home had clearly documented consent forms, which people or their families completed when they first came to live at Moss Cottage.

Where people lacked capacity to make specific decisions, mental capacity assessments and best interest decisions were in place. We discussed with the provider how these records could be more detailed, and the provider was receptive to this feedback.

Staff generally sought people's consent before providing support. However, this was not always observed in practice, and this was discussed with the provider during the inspection.