Archived: Cottam Road

An adult social care inspector carried out this inspection. Information for our inspection was gathered by speaking with the home manager, two team leaders and two support workers. We also reviewed four care plans, three staff files and other documents relating to staff training, supervision and appraisal.

We considered all the evidence we had gathered against the outcomes we inspected in order to answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Below is a summary of what we found. The summary incorporates what people using the service, their relatives and the staff told us, what we observed and the records we looked at :

Is the service safe?

We found that people's records provided accurate and up to date information about how to meet people's needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. The safeguards are part of the Mental Capacity Act,2005 (MCA) and aim to ensure that people are looked after in a way which does not inappropriately restrict their freedom. We noted that the provider had requested DoLS assessments following a Supreme Court judgement about the Deprivation of Liberty Safeguards (DoLS) earlier in the year. The outcomes of these assessments had been received and the provider was in the process of updating people's care plans with this information.

Is the service effective?

People's care records showed that care and treatment had been planned and delivered in a way that was intended to ensure their safety and welfare. Team leaders told us that they had spent a lot of time updating people's records. They and the support workers spoken with on the day of our inspection were positive about the changes this had made to people's records; they told us that the time spent had made it easier for them to identify the support people needed on a daily basis.

Staff had now received all key training courses to meet the needs of people living at Cottam Road. For example, each member of staff had now received moving and handling training.

Staff were also receiving regular supervision sessions and each member of staff had received an appraisal to discuss any personal and professional development needs.

Is the service caring?

Our inspection focussed on checking that improvements had been made in relation to supporting workers and people's records and therefore did not cover this question in any detail. However, during our inspection we visited one of the houses at Cottam Road in order to speak with staff. Two people were in the living room/dining area of the home. We observed that staff interactions with these people were positive and caring. One person told us that they were looking forward to going to see their favourite football team that night and a trip to Coronation Street which was taking place later in the week. They were complimentary about the member of staff who had arranged these outings.

Is the service responsive?

Our review of records showed us that care plans had been updated when people's needs had changed. For example, on the day of our inspection, a team leader was in the process of updating the care plan of a person who had recently returned from hospital in order to ensure that it reflected their changed needs.

We also saw that referrals had been made, and advice and guidance sought from relevant health and social care professionals when needed.

Is the service well-led?

Following our previous inspection, we saw that a number of paper and electronic documents had been introduced to regularly monitor and review staff records and records relating to the needs of people living at Cottam Road. These documents supported Cottam Road to ensure that records were accurate and helped ensure that people received a good quality service to meet their needs.

An adult social care inspector carried out this inspection. Information was gained by speaking with four people who lived at Cottam Road. We used verbal communication and Makaton to communicate with one person. Makaton is a recognised system of communication that uses signs and symbols to help people communicate. Some people were unable to verbally communicate their views to us. In order to help us understand their experiences we sat and spent time in the lounge / dining area of each house. Our observations and conversations enabled us to see how staff interacted with people and to see how care was provided.

Information was also gained by speaking with the registered manager, one team leader and two support workers. We also reviewed the care plans of five people and a range of other relevant records. Following our inspection we contacted the relatives of two people by telephone in order to gain their views about the care at Cottam Road.

We considered all the evidence we had gathered against the outcomes we inspected in order to answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Below is a summary of what we found:

-Is the service safe?

Throughout our observations we noted that people appeared relaxed with the support workers on duty and happy with the way in which they were meeting their needs.

One person gave a 'thumbs-up' sign when asked if they felt safe living at Cottam Road. When asked the same question, one relative commented, 'I always go unannounced and I've never seen anything untoward in all the years I've been visiting'.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA provides a framework to empower and protect people who may lack capacity to make key decisions about their care and treatment. The DoLS are used if extra restrictions or restraints are needed which may deprive a person of their liberty.

We spoke with the registered manager about the MCA and the DoLS and were confident that they were familiar with when to use these key pieces of legislation. Each member of staff was able to evidence how they involved people in day to day decisions and the action they would take if they felt that someone lacked capacity to make a specific decision. Our conversations with staff demonstrated a lack of knowledge about the DoLS and when these may be needed.

Our observations and conversations with people and staff showed us that people were supported to move safely. Our review of records evidenced that regular internal and external checks were undertaken to ensure that equipment was properly maintained and serviced.

Our last inspection identified issues about people's care records. Whilst it was evident that Cottam Road were in the process of updating people's care plans, the findings of our previous inspection remained in relation to two of the five care plans reviewed during this inspection. The lack of up to date information together with the conflicting and duplicate information within records meant that people may not be protected against the risks of unsafe or inappropriate care or treatment.

-Is the service effective?

People were positive about Cottam Road and the support they received from staff. One person commented the, 'they [the staff] know me very well; they pull my leg and make me laugh!' A relative described Cottam Road as, 'the best place [my relative] has ever been'.

People were keen to tell us about the range of social opportunities and community activities they accessed. One person stated, 'I go to the pub with my friend, go to Chapeltown shopping, we went to the cinema yesterday and I'm going to Cleethorpes next week'. Our conversations with people and observations on the day of our inspection showed us that people were supported to access a range of activities to meet their individual interests.

For the most part, we noted that people's care plans clearly detailed their moving and handling needs and corresponded with observations on the day of our inspection.

Our review of the training matrix evidenced that seven of the 21 members of staff had not received manual handling training within the provider's yearly timescale. Not receiving this key training within the provider's specified timescale increased the risk of people not being moved safely.

Conversations with staff and our review of the supervision matrix identified that supervisions were occurring less frequently than the providers expected time period of every six weeks. Similar concerns were identified with staff appraisals. Ten of the 21 members of staff listed on the provider's training matrix had not received and appraisal within the past year.

-Is the service caring?

One person stated, 'the staff are kind to me'. Another person told us that a member of staff had accompanied them on their recent hospital visit and told us, 'they [staff] know when I'm 'off it' and take me down to the doctors; they do care about me here'.

Throughout our inspection the atmosphere at Cottam Road was calm, supportive and relaxed. We saw that people were provided with support when they needed or requested it. We observed lots of smiles, laughter and banter between people and the support workers on duty at the time of our inspection. It was evident that the staff clearly knew people well and we frequently heard them use information about people's hobbies and families to engage and prompt conversations and positive reactions. Our observations also demonstrated that staff were able to interpret the verbal and non-verbal ways people communicated in order to assess mood, behaviours and general wellbeing.

- Is the service responsive?

Observations on the day of our inspection showed us that Cottam Road appropriately responded and met people's individual care needs and requests. We saw that staff responded promptly to people's needs.

Our conversations with staff and our review of records demonstrated that there was an effective system to record, analyse and learn from incidents which had resulted in harm or had the potential to result in harm. Staff were clear and confident about the incident reporting process in place. The registered manager told us that incidents and accidents were analysed on a monthly basis to enable responsive action to be taken to address and reduce the likelihood of future risk.

-Is the service well led?

We found that there was a system in place to monitor and assess the quality of care provided at Cottam Road. We saw that the provider, South Yorkshire Housing Association, carried out monthly audit visits. The audit document incorporated key aspects of the service in addition to focussing upon a different area of the service each month. The template also had an 'action plan' section to detail any shortfalls identified and to check that shortfalls identified in previous audits had been addressed.

Each member of staff was complementary about the registered manager and felt that the service was well led. The registered manager had been in post for approximately one year. One supported worker stated, 'Cottam Road is a lot better run that it used to be, [the registered manager] has high standards. She makes it clear what these are and what we need to do'. Staff felt that the registered manager responded to, and dealt with any issues they raised. One member of staff said that the registered manager was, 'receptive to suggestions and listens to you'.

One person said, 'I love living here [Cottam Road],' and described the staff as, 'great.' Our observations confirmed people's opinions of staff. Throughout our inspection we saw staff interact positively and speak with people in a kind, patient way. We saw that staff were attentive and focussed on the needs of people living at Cottam Road and worked well together in order to ensure that people's needs were met.

We identified issues relating to staff training and the care records at Cottam Road. A number of staff had not received key training within the provider's specified timescales. There were gaps in a number of records and variable practice in relation to how often care plans and risk assessments were reviewed. A number of records were not dated. This made it difficult to establish if these plans were current and accurately met people's needs. We were concerned that the issues identified during our inspection could result in people not receiving appropriate care and treatment.

One person described living at Cottam Road as, 'perfect' and stated, 'I like everything about living here.' We saw that care plans were up-to date, person centred and contained detailed information about people's support needs. Our observations demonstrated that staff knew the individual needs of people living at Cottam Road. Throughout our inspection we noted that staff spoke with people in a warm and respectful way.

People told us that they felt, 'safe' living at Cottam Road and we found appropriate arrangements were in place to safeguard people.

We found that staff were supervised and received training. A number of supervisions, appraisals and training courses had not taken place within the provider's identified timescales.

We saw that a system was in place to gather, record and evaluate information about the quality and safety of care provided. We noted that up-to date records of people's health and social care needs were maintained and stored securely.

One visitor we spoke to said 'Everybody is friendly here, and the staff are really lovely with people who live here'.

Care plans were personalised for each person who lived in the home and had information on people's preferences. The plans contained good information about the person's biography and their healthcare needs. There was documented information of healthcare professionals being involved with peoples care and treatment.

Staff said that they all had a key worker role and in that role they were responsible for ensuring that people had everything they needed such as toiletries, etc.

Medication prescriptions were up to date and medicines were safely stored in a locked cupboard in each of the houses. Medication records were accurate and there was a clear process for the management of 'as and when required'(PRN) medication which was monitored by team leaders.

There were clear procedures to follow when someone made a complaint and the process that staff were to follow. Where people did not have family to support them there was information on support being provided by independent advocates particularly where people lacked capacity.

Surveys where sent to people to get their views on the service and any complaints they had.