Cow Lees Care Home

Cow Lees Care Home is a residential care home providing personal and nursing care to up to 73 people. The service provides care to disabled people, people with mental health needs and dementia. At the time of our

inspection there were 69 people living at the service. Care and support were provided across 3 separate buildings. One of the buildings specialises in providing care for people who may express distress or agitation due to their cognitive disability, which can arise from dementia.

People’s experience of using this service and what we found

Risks to people’s health and wellbeing had been identified, but records did not always support staff to manage these risks safely. Risks related to the premises and environment were not consistently identified. We were not assured by infection, prevention, and control practices within the home. There was limited oversight of the use of restrictive physical intervention to ensure this was used appropriately, and to reduce the need to use these techniques again in the future.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Some improvements to governance had been made and a variety of quality assurance checks had been implemented. However, these did not always operate effectively.

Staff received safeguarding training to help them recognise and report potential safeguarding concerns. Staff were confident those concerns were listened to and taken seriously. There were enough staff to provide safe care and staff were recruited safely. Improvements had been made to the management of people's medicines. Accidents and incidents were reviewed by the registered manager to identify any trends or patterns.

People's needs were assessed before they moved to the home to ensure their needs could be met safely. A combination of mandatory and more specialised training was provided online and face to face, from a variety of sources, to equip staff with the knowledge and skills needed to carry out their roles effectively. However, additional monitoring was needed to ensure training was effective. Relatives gave positive feedback about the staffs' approach and skills, and that their loved ones looked healthier since moving to Cow Lees. Staff ensured people had enough to eat and drink and promoted hydration during hot weather. The registered manager and staff worked closely with external professionals to improve people's outcomes.

Staff spoke positively about the management team and changes in the home and felt well supported in their roles. The registered and deputy manager were committed to improving the care provided and creating an inclusive workplace culture. They worked in partnership with external health professionals, organisations, and agencies to improve people's outcomes, access additional staff training and contribute to research in care homes.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 requires improvement (published 20 July 2022) and there were breaches of regulations. The provider was issued with a Warning Notice and completed an action plan after the last inspection to show what they would do and by when to improve.

The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

Why we inspected

We carried out an unannounced inspection of this service on 18 May 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to check whether the Warning Notice we previously served in relation to safe care and treatment and good governance had been met. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains the same. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cow Lees Care Home on our website at www.cqc.org.uk.

Cow Lees Care Home is a residential care home providing personal and nursing care to up to 73 people. The services provides care to disabled people, people with mental health needs and dementia. At the time of our inspection there were 69 people living at the service. Care and support were provided across three separate buildings. One of the buildings specialises in providing care for people who may express distress or agitation due to their cognitive disability which can arise from dementia.

People’s experience of using this service and what we found

Risks to people’s health, safety and well-being had not always been assessed, monitored or managed safely. Some infection prevention and control risks had not been identified. Medicines were not always stored or administered safely.

Governance systems failed to effectively monitor people’s health conditions and had not enabled the provider to identify concerns we found in relation to the management of diabetes, urinary tract infections and wound management records relating to a pressure sore. This placed people at risk of potential harm. Oversight of the premises had not ensured environmental risks were always identified and steps taken to mitigate risks to people’s health and safety. Some important events and incidents had not been reported to us as per regulatory requirements.

Improvements were needed ensure all areas of the home were dementia friendly with the use of signs to help orientate people to their environment. The provider understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 and carried out mental capacity assessments for those identified as needed them. However, improvements could be made to ensure people with dementia were provided with visual choices. People were not always supported to have maximum choice and control of their lives. Staff supported them in their best interests; however, the systems and policies meant some choices were removed from people, such as having free access to their bedrooms.

Relatives felt their loved ones were safe and well looked after. Staff received safeguarding training to help them recognise and report potential abuse or neglect. Staff were recruited safely, and we received positive feedback about staffing levels. Overall, accidents and incidents were reported, recorded and a system used to audit them identified any potential trends or patterns.

The provider understood their responsibility to provide food and drinks which met people’s nutritional needs. The views of people, their relatives and health and social care professionals were considered when people’s care needs were assessed. People received specialist external support from healthcare professionals including tissue viability nurses, chiropodists and dieticians. Records of healthcare visits were maintained. Staff felt supported and told us they received training and support to meet the responsibilities of their role.

In response to learning from a conference, the provider had introduced daily jellies to promote people’s fluid intake. The service worked with other health professionals to ensure people had access to specialist services to improve their health outcomes. Staff and relatives gave positive feedback about Cow Lees. They felt management were approachable, supportive and listened to their concerns.

Rating at last inspection

The last rating for this service was requires improvement (published 26 February 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to people's access to advocacy services and concerns regarding the conduct of some staff towards visiting professionals. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report. The provider took action during and immediately after our inspection visit to remedy some of the risks identified during our inspection and submitted an interim action plan to address the shortfalls in the service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cow Lees Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to regulation 12 (safe care and treatment) and regulation 17 (good governance) at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cow Lees Care Home is a care home providing personal and nursing care and accommodation for up to 73 adults living with dementia or mental health needs. The care home is made up of three sperate units. These include Cow Lees, a converted two-storey building with 18 bedrooms and communal facilities. Astley House, a purpose built two-storey building with 24 bedrooms. Sole End, a purpose-built three-story building, which specialises in supporting people with complex behaviours and early onset dementia. At the time of our inspection visit there were 69 people receiving care.

People’s experience of using this service

There were checks in place to ensure good standards of care were maintained, however improvements were required to ensure all checks were effective because they had not identified concerns we found during our inspection visit, including some environmental risks.

The registered manager worked in partnership with outside agencies to improve the service. Staff felt supported and valued by senior staff.

People felt safe using the service. Staff managed the risks to people’s health, safety and well-being and understood how to recognise and report abuse. Staff recruitment processes included background checks to review their suitability to work with vulnerable adults.

People received support from staff when needed. People were supported to have enough to eat and drink to maintain their well-being. They were supported with their medicines and to obtain advice from healthcare professionals when required.

Staff received training and guidance on how to support people, however, some gaps were identified in key areas.

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.

People were treated with dignity and their independence was promoted wherever possible. People were encouraged to take part in activities which interested them and which improved their wellbeing.

People and their relatives were involved in planning care in their best interests. People and their families understood how to complain if they wanted to.

Rating at last inspection and update

The last inspection was a comprehensive inspection. The service was rated Good in all areas (report published 14 July 2017). We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People continued to receive care in ways which helped them to remain as safe as possible. People were protected from the risk of harm by staff who understood the risks to people’s safety. There was enough staff to provide support to people to meet their needs and people received their prescribed medicines safely.

The care people received continued to be effective. Staff received training linked to the needs of people who lived at the home. People were encouraged to make their own decisions and choices and staff checked people wanted care before helping them. Support was available to people if they needed help making key decisions about their life. People enjoyed their mealtime experiences and were supported to access to health care services so they would stay well.

People had built caring relationships with the staff who spoke warmly about the people they cared for. Staff knew what was important to people and encouraged them to maintain their independence. People were treated with dignity and respect.

People and their relatives’ and staffs' views and suggestions were listened to when people’s care was planned. Systems were in place to manage complaints. Relatives we spoke with knew how to raise any complaints or concerns, and staff knew how to support people and their relatives to do this.

People, their relatives and staff were positive about the way the home was managed, and told us communication with the registered manager and senior team was good. The registered manager worked with people, their relatives and other organisations in an open way so people would enjoy the best well-being possible. Regular checks were in place to assess and monitor the quality of the service.

Due to their health conditions or complex needs, not all people were able to share their views about the care that they received. We therefore spent a period of time observing how people were being cared for within the home.

We found that the home had an open, friendly and lively atmosphere. Our observations throughout the inspection demonstrated that staff engaged in a positive way with people. We saw when people needed assistance staff were on hand to help them.

We found the service had a system of individual care planning in place which was regularly reviewed for each person.

We looked around the home and observed a good overall standard of cleanliness. We saw people's rooms and communal areas were clean and tidy.

Sufficient staff were available with appropriate experience and skills to meet the needs of people who used the service.

Staff we spoke with felt confident the care provided to people living at the home was good. They told us they received excellent support from the management team. A staff member told us, 'We can go to the manager or deputy for help and assistance at any time.'