Cow Lees Care Home

Updated 21 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of 4 inspectors and a specialist nurse advisor. 3 inspectors visited the home and 1 inspector made telephone calls to relatives.

Service and service type

Cow Lees Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under 1 contractual agreement dependent on their registration with us. Cow Lees is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection and sought feedback from the local authority and clinical commissioning group. Due to technical problems, the provider was not able to complete a Provider Information Return (PIR). A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We gathered feedback from 9 relatives on their experiences of care provided at the home and used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with 17 members of staff including nurses, care workers, a senior care worker, an agency nurse, an activities coordinator, a housekeeper, the registered manager, deputy manager, learning and development manager, human resources manager and the lead learning disability nurse. We looked at 7 people’s care plans, multiple medication records and other records relating to the care that was provided to people, and incidents that occurred within the home. We looked at a variety of records relating to the management and governance of the service including audits, recruitment files, training matrices, spot checks, and a service improvement plan.

Updated 21 July 2023

About the service

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.