Bowes House

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.

This is the first assessment for this newly registered service. This key question has been rated Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 75 (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’s care documentation contained person centred details about their health, care, wellbeing and communication needs. People’s needs were assessed before they began using the service. These initial assessments identified and documented the support people required, including for example, support with personal care, medicines, communication, and diet and nutrition. Information gathered during the assessment process was used to develop personalised care plans and risk assessments. This supported staff to maintain a good understanding of how people wanted and needed to be supported. People’s care needs were routinely reviewed to make sure they were up to date. Guidance about people’s healthcare needs contained a good level of detail to support staff to recognise signs of increased risk or became unwell quickly.

People using the service, their relatives, and relevant health and social care professionals were involved in these discussions to ensure individual needs and preferences were fully considered and met.

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.

Staff received training aligned with current good practice guidance. They described working with GPs, social workers and other health and social care professionals to make appropriate referrals and implement recommendations.

Nationally recognised assessment tools were used to assess people’s risks of malnutrition and their risk of skin deterioration. Where staff identified risks, they implemented appropriate control measures such as pressure relieving equipment and modified diets. The management team maintained oversight and planned appropriate action with input from relatives and staff.

People’s ability to eat safely and maintain a healthy weight was assessed and monitored, with action taken where required. Staff understood people’s dietary needs. These were clearly documented and updated and changes were communicated. Where specialist input was required, this was followed. For example, guidance from Speech and Language Therapists (SALT) was clearly documented and reflected in care plans, including specific instructions on food and fluid consistency to reduce risks such as choking or aspiration. People’s nutritional needs were shared immediately with the catering team to ensure meals, drinks and snacks were suitable to meet individual needs. Food and fluid charts enabled staff to monitor intake and support people who had difficulty eating or drinking. The chef understood people’s preferences and the specialist diets needed to support their health.

We found supporting evidence that infections, weight changes, and falls were analysed monthly, with records detailing the action taken and referrals made to appropriate health professionals.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff attended regular Multi-disciplinary Team (MDT) meetings which helped ensure all parties involved with supporting people were aware of up-to-date needs and developments.

There was evidence of regular interactions between the clinical staff and other healthcare professionals, the GP service conducted a ward round every week, and this was led by a registered nurse or team leader. Feedback from health professionals was in the main positive regarding recent changes to the management structure, and they felt communication had improved. There was documentation within the care plans of involvement from podiatry, mental health team, and the tissue viability team. Staff reported that engagement with other professionals included family involvement to ensure people’s needs were supported and care plans were reviewed. This highlighted that there was an engaging and collaborative approach to people’s care.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff told us about the various ways in which they helped people to monitor their day-to-day health and wellbeing. Most people and relatives we spoke with felt they were supported to achieve positive outcomes. Care records detailed what people could do for themselves to promote their own wellbeing and what support they might need from staff. For example, people were supported to do what they could to provide their own oral healthcare, but if they needed support or prompting this detail was included. This helped people to take an active part in promoting and sustaining their own wellbeing.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Established processes gave the registered manager effective oversight of people’s care and support. Care plans were reviewed monthly, or sooner when people’s needs changed, so staff had current information and could provide effective care.

The electronic care system enabled required updates to be made promptly, helping staff access accurate information without delay. People and their relatives were involved in care planning, and people were supported to maintain their independence.

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

People were supported and encouraged to make decisions about their daily lives. They could choose when to bathe or shower, what food and drink they wanted throughout each day, what clothes to wear and where they wanted to spend their time around the home. In relation to food and menu choices, people felt that there was a “Great range of food and always cakes available.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. Staff had a good understanding of the need to gain consent, and that people had the right to decline care. We reviewed assessments which were completed in line with the principles of the MCA.

Staff knew about the importance of gaining consent from people before supporting them and never forced people to do things they did not want to. We observed staff seeking consent before carrying out tasks and staff knocking on people’s doors before entering.