Cow Lees Care 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 requires improvement. At this assessment the rating has changed to good.

Good: This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 62 (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.

We reviewed care records and found staff completed assessments of people’s needs on admission to the home. We saw evidence of the person’s voice within the assessment and the voice of their family. People’s care plans were developed from an assessment of people’s needs. Care plans were regularly reviewed to ensure they reflected any changes in people’s needs or preferences. We spoke with a nurse who told us they completed assessments of people’s needs before they moved into the home. This staff member explained that if during the assessment, it was clear the person or others living in the home could experience any negative outcomes, they were confident to have discussions with potential to decline the admission if it was not supportive to the person and those in the unit.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The provider used recognised tools to assess and identify risks to providing people’s care and support. This included the International Dysphagia Diet Standardisation Initiative (IDDSI). IDDSI is a standard for describing food textures and drink thicknesses for people with swallowing difficulties. Using the IDDSI, care plans clearly identified how people needed their food prepared or to what consistency they needed their drinks thickened to reduce their risks of choking. However, we found improvements were needed in how staff recorded the texture of the meals people were given. For example, 1 person’s care plan said they had an IDDSI level 4 (pureed) diet, but records sometimes described their food as being ‘minced’. In another, it said they were level 6 soft and bite size but there was no information to tell staff, what ‘bite size’ was. For this person, we saw some of their records recorded soft and bite size and puree so we could not be confident they received their meals in a way they had been assessed.

People received care, treatment and support that was evidence-based. We reviewed care records for 1 person with epilepsy. Nurses completed care plans that clearly detailed the steps to take during and after the person experienced a seizure. Staff completed a falls care plan for another person identified as being at high risk of falls, this plan included actions for staff to reduce the risk of a fall.

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 told us they had handovers at the start and end of every shift, completed by a nurse where the whole team gathered to receive an oversight of changes. We observed handover from the morning to the afternoon shift in one of the buildings. Handover was attended by 1 outgoing nurse and 1 incoming nurse plus a nurse on induction. Each persons’ current state and events for the past 24 hours was handed over. Staff handing over made sure outstanding tasks were shared to be completed. We also observed external health and care professionals completing a Decision Support Tool assessment with the nurse for one of the people. [A DST is an assessment to determine if a person is eligible for NHS funding]. A nurse told us how they had involved key personnel at George Elliot Hospital in decisions on how to manage a person’s risk of choking, whilst awaiting for speech and language therapist input. A senior staff member said, “If I notice someone is going off their feet, I will tell [nurse’s name] as she is the moving and handling expert, or if their behaviour has changed or their dementia is increasing.” Staff gave us examples of suggestions they had made which had been listened to such as arranging for chiropodist, a dentist and optician when they thought people needed something. In one example a staff member prompted for a GP review for a person with low mood.

Staff told us the electronic system [Person Centred System] enabled them to share information about people which ensured people’s needs were met safely and effectively. One staff member told us, “Everything is on the PCS so if you need to know anything about anybody you can check their care plans on there."

The provider supported people to manage their overall health and wellbeing.

Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. A nurse described how they spoke with a GP about a person they knew was losing weight. Following this review, this resulted in a change of medicines which meant the person’s weight stabilised.

A senior staff member said ,“They [people] are our family, we are their voice.” Where people had specific health needs, advice had been sought from external health and social care professionals. For example, 1 person had sustained some skin damage and advice had been sought from an advanced nurse practitioner. Staff told us they supported people to attend healthcare appointments when needed. The provider was promoting good oral healthcare in the home. Regular checks were carried out to ensure people received appropriate support to maintain the health of their mouth, teeth and gums.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were consistent, or that they met both clinical expectations and the expectations of people themselves.

Care staff explained how nurses reviewed people’s weights and people’s blood pressure so they would have the information they needed to escalate any concerns to staff or other health professionals. However, there was inconsistency in the completion of records to demonstrate safe practice and enable effective monitoring to take place. Where people could demonstrate distress and anxiety, this was being recorded on charts to identify any patterns so information could be shared with other healthcare professionals involved in people’s care. One staff member explained, “We have what are called ABC charts where we have to record everything. We write it all down, what the outcomes were and then we give it to the nurse.” However, 1 person needed to be regularly repositioned to promote healing of a pressure area. Whilst we did not identify any detrimental impact on the person, records did not evidence this was being done in accordance with their risk management plan. Improvements also needed to be made in the oversight of monitoring charts to ensure timely action to promote positive outcomes for people. For example, 1 person’s bowel monitoring charts indicated they had experienced a prolonged period of constipation. There was no evidence this had been identified by senior staff which meant no action had been taken to address the situation or to review the person’s prescribed medicines for this condition. We also found the monitoring of people’s modified foods needed further improvement to ensure people received their meals in a consistency that remained safe.

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

Where a person's capacity to understand information related to their care and support was questionable, care plans included a mental capacity assessment (MCA) relating to the decision that needed to be made. However, capacity assessments contained either no or very limited information about how people had been supported to understand the decision to be made so they had the best chance possible of making their own decision. For example, being given information in an accessible format or at different times of the day.We received some information that people could not always return to their bedrooms during the day because of safety reasons. Staff assured us this was not the case and that although they encouraged people to spend time in communal areas, they would respect people’s requests to return to their bedrooms if they wished to do so. One staff member told us, “The nurse tells us when we come in who needs to go for bed rest in the afternoon whether they have a sore or who have not slept well. Others if they request it can go. They do have a choice whether they want to go or not.”All staff without exception, told us people could not go into the courtyard without staff supervision. Staff and management said it was not safe but were not confident they understood the need to balance safety and supporting people to go into the courtyard without constant supervision.

We did see staff seek people’s consent for their daily choices. A staff member said, “We ask [people] for their consent. We assist them, if they refuse, we don’t force them.” A nurse told us “Covert medicines (medicines disguised in food or drink) are always agreed with people’s GPs.” Records showed us people’s families had been consulted as part of MCA and best interest decisions. A nurse explained where relatives had a lasting power of attorney for health and welfare, they involved them in decisions for medicines reviews and health reviews being planned with GP. A senior staff member gave us examples how they encouraged people to have personal care and said it was important to get things ready, for example for a shave, and gently encourage people. They said, “It should be in the care plan if they are resistive. You generally find after a few times they are okay."