Coxbench Hall

We undertook a focussed inspection of Coxbench Hall on 14 January 2017 to follow up a Warning Notice issued to the provider in November 2016. The focussed inspection only looked at two of the five questions we ask about services: is the service well led, and is the service safe.

We rated both Safe and Well-Led as Requires Improvement, and found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the management of medicines. The overall rating for Coxbench Hall was Requires Improvement. We asked the provider to complete an action plan to show what they would do and by when to improve the service to meet the requirements of the regulations. At this inspection, we found that improvements had been made. People's medicines were now managed safely and in accordance with professional guidance.

Coxbench Hall did not have a registered manager in post at the time of our inspection visit. A registered manager is a person who has registered with the Care Quality Commission 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 2008 and associated Regulations about how the service is run. The manager’s application to become the registered manager is now in progress.

People felt safe living at Coxbench Hall. There were processes and practices in place to ensure people were safeguarded from the risk of abuse. People received their medicines as prescribed. Staff worked with people, relatives and health professionals to identify risks and take steps to minimise harm. Risk assessments were tailored to each person’s needs, and staff knew what action to take to reduce risks associated with people’s health conditions. People felt supported to maintain their independence. People were kept safe from risks associated with the environment.

There were enough staff to provide the care and support people needed. Checks were carried out to ensure staff were of good character and were fit to carry out their work. The premises were kept clean, which minimised the risk of people acquiring an infection whilst using the service. Accidents and incidents were reviewed and monitored to identify potential trends and to prevent reoccurrences.

People felt staff had the training and skills to meet their needs. The provider ensured that staff maintained the level of skills and knowledge needed to support people in ways that worked for them. People told us that the food was good and that they were offered choices. People who needed assistance or encouragement to eat were provided with support in a discreet way. People were supported and encouraged to have a varied diet that gave them sufficient to eat and drink.

People were supported to access health services when needed to maintain their well-being. The provider had taken steps to ensure the environment was suitable for people's needs. The provider followed the requirements of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People felt supported by staff who provided care in a good-humoured, friendly, dignified and compassionate way. People and their relatives were involved in planning and reviewing their care and support. People were supported with their care needs in a dignified way and their privacy was respected. Staff understood how to keep information about people's care confidential, and knew why and when to share information appropriately. People’s right to private and family lives were respected.

People felt listened to, and that staff responded to their needs and wishes. Staff were knowledgeable about people's individual care needs and preferences. People and relatives felt able to raise concerns and knew how to make a complaint. People and relatives had regular opportunities to provide feedback on the quality of their care. The provider listened to people's views and suggestions to improve the quality of care and took action.

People were supported to express their views about their future care towards the end of their lives, and staff knew how to support people and their relatives in the way they wanted.

People and relatives felt the service was managed well. Staff understood their roles and responsibilities. During our inspection visit, staff were open and helpful, and demonstrated consistent knowledge of people’s needs. The manager understood their duties and responsibilities with respect to providing personal care, and felt supported by the provider in their role. They also took part in local health and social care networks in order to access ideas and support to improve the quality of care.

The provider sought peoples’ and relatives’ views about the service, responded to comments and complaints, and investigated where care had been below the standards expected. There was an open and inclusive culture within the service, and staff had clear guidance on the standards of care expected of them. There were systems in place to monitor and review the quality of the service, which enabled the provider to identify where action was needed and to ensure the quality of care was improved.

Coxbench Hall is registered to provide accommodation and personal care for up to 39 people. At the time of our inspection there were 35 people living there. The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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 2008 and associated Regulations about how the service is run.

Daily audits of medicines were not always recorded and the storage of medicines was not in line with the home’s policy. This meant staff could not be sure that medicines were given appropriately and remained safe and effective to use.

At this inspection we found improvements had been made and the concerns raised around the Warning Notice issued had been resolved. However, we identified other areas where improvements needed to be made in the management of medicines. You can see what action we told the provider to take at the back of this report.

Coxbench Hall is registered to provide accommodation and personal care for up to 35 people. At the time of our inspection, 35 people were living there. Coxbench Hall is a period building that has been adapted to the needs of people in residential care. The building has three floors, accessible by stairs and a lift. The gardens are spacious and well maintained, with several outside sheltered seating areas for people.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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 2008 and associated Regulations about how the service is run.

We found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Medicines were not consistently managed in a safe way and in accordance with current guidance and legislation. We saw on the second day of the inspection visit that action had been taken to address this.

People’s care needs were assessed and recorded and risks identified. However, risk assessments and care plans did not consistently identify steps staff should take to reduce the risk of avoidable harm. We spoke with the provider about this, and saw that improvements had been made on the second day of the inspection visit.

There were systems to monitor and review all aspects of the service, and these were undertaken regularly. However, the systems did not always identify where areas of care needed to be improved. This meant the provider was not always able to identify areas for improvement, and to make changes to improve the quality of the service for people. We saw on the second day of the inspection visit that action had been taken to improve the systems to monitor and review the quality of care.

People had their care reviewed on a regular basis, and they and their relatives were involved in this. There were enough staff to ensure that people’s needs were met in a timely manner.

People felt the care provided kept them safe, and relatives also felt this was the case. Staff understood how to keep people safe from the risk of potential abuse.

People and relatives spoke positively about staff, saying they were cared for by staff who treated them with kindness, dignity and respect. They were encouraged to continue with hobbies and interests, and to maintain relationships that were important to them. People were also cared for by staff who were knowledgeable, skilled and trained to provide personal care to the standards set by the provider.

Staff understood the principles of the Mental Capacity Act 2005 (MCA), including how to support people to make their own decisions. The provider was working in accordance with the MCA, and people had their rights upheld in this respect.

People and their relatives were positive about the quality and choice of food and drinks. We also found that people were supported to maintain their health and to access healthcare services when required.

The provider had a clear complaints policy, and people and relatives felt able to make a complaint or raise concerns. The provider investigated complaints according to their policy, and created opportunities for people to provide regular feedback about the service, which was acted on.

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

We considered all the evidence we gathered under the outcomes we inspected. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards.

People using the service were supported to be independent with the appropriate use of equipment. Equipment was maintained to ensure it remained safe to use.

People's needs were not always clearly assessed. Staff did not always have clear and sufficient detail on how to provide support to meet people's assessed needs.

Accurate records were not always being kept to ensure people received safe and appropriate care.

Is the service effective?

Staff meetings and staff supervision provided opportunities for staff to discuss issues important to them and identify improvements to the service.

Plans had been made to deal with foreseeable emergencies and staff we spoke with told us they felt confident in dealing with any emergency, such as a fire.

Is the service caring?

One person told us, 'The carers got the GP to check my cough this week. Staff are very attentive and very cheerful.'

During our inspection visit we observed staff asking people if they felt ok in a friendly and caring manner. One person told us, 'The staff are lovely.'

The manager had used the views of people using the service, their relatives and staff to plan improvements to the service.

Is the service responsive?

Staff's knowledge of the care people required varied. This was because people's assessed needs had not always been clearly recorded in a care plan.

Is the service well led?

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service. Staff completed accident report forms appropriately. These were checked by managers for identification of any improvements that could be made to reduce or minimise further risks to people.

People told us the food was good and they had a say in what was provided. One person said, 'We had a talk about menus last week and I asked for smoked haddock. The next thing I knew it was on the menu.'

People said they felt safe in the home and trusted the staff. One person told us, 'If I was not happy about anything I would tell Olive (the registered manager). You can tell her anything and she will sort it out.'

Records showed people received their medication on time and when they needed it. One person said, 'The staff look after my tablets and bring them to me three times a day. There's never been a problem and my medication has never been late or ran out as far as I know.'

The people who used the service, relatives, and staff members all said the home was well-staffed. One person said, 'There's always someone around to help when you need them, we have lots of staff here.' A relative commented, 'There is no shortage of staff at this home.' And a staff member said, 'The staffing levels are very good for the needs of the residents.'

We found that people were fully involved in discussions about their needs and care. One person said that they were 'looked after well, the home is clean, the staff are friendly and the food is good.' Another person using the service for eight weeks told us that 'the place is marvellous, with nice spacious grounds. The staff are marvellous.'

One relative said that the service is 'great, good value for what you get and a lovely place.' Another relative said their family member had 'a lovely room which has been recently refurbished and has a nice view. The staff are so nice and helpful and I would recommend Coxbench Hall.' We saw that staff were aware of people's individual needs and knew how best to support people make choices for themselves.

We found that staff were well supported in their work. One member of staff talked of the 'warmth of the team'. Another member of staff told us 'if I win the lottery, I would not give up my job here'. A visiting health professional told us 'staff are helpful and the residents seem happy.'

We found that the care home is well managed, and that clear lines of responsibility were in place. The effect on people living in the home was that people were receiving consistent standards of care and service.