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.