The Cottage Residential Home

The Cottage Residential Home is a residential care home providing personal care forup to 40 people. The service provides support to older people some of whom may be living with dementia or have a physical disability. At the time of our inspection there were 33 people using the service. The home is also registered to provide personal care to people in their own homes, but no one was using the service at the time of the inspection.

People’s experience of using this service and what we found

Risks to people were assessed and care was planned to keep people safe. Information was updated and shared with staff as people’s needs changed.

There were enough staff to provide safe care for people. Recruitment processes ensured staff were safe to work with the people living at the home.

Medicines were safely store and administered and people received their medicines as prescribed and in a timely manner.

The home was clean and hygienic, and systems were in place to keep people safe from the risk of infection.

People were supported to keep in contact with their relatives and visits were taking place in line with government guidance.

Systems were in place to monitor the quality of the care provided and to drive improvements.

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 home had a targeted inspection on 29 September 2020 but was not rated at that inspection. The last rating for this service was requires improvement (26 February 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to staffing levels and the management of the home. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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 has stayed the same.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Cottage Residential Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Cottage Residential Home is registered to provide nursing and personal care for up to 40 older people, some of which are living with Dementia. The service is also registered to support people living in their own homes. At the time of the inspection there were 32 people living in the service. The service was not currently supporting anyone in their own homes; therefore, we did not inspect this part of the service.

People’s experience of using this service and what we found

There were quality assurance processes in place. However, audits did not identify shortfalls in the service and audits were not robust. People received their prescribed medicines however, further improvements in practice were required. NICE best practice guidelines were not always followed.

There were measures in place to reduce the risk of infection. However, there were areas of the environment that required repair. These issues had been recognised but not actioned in a timely manner. There were enough staff deployed in the service to meet people’s needs. The registered provider had carried out sufficient pre- employment checks. Not all staff had received mandatory training

Falls were formally reviewed and monitored. Positive actions were taken to reduce further occurrences. People and their families told us they felt safe, and that staff were kind and caring. Complaints were managed well, and informal concerns were identified and addressed in a timely way. The service worked with other agencies and professionals.

People were supported to have maximum choice and control of their lives and staff supported not them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 25th February 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulations 12 and 17.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the relevant key question Safe and Well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We will continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We found the provider continued to be in breach of regulation 12 (Safe care and treatment) and regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We have identified breaches in relation to medicines, risk management and governance at this inspection. For each of these breaches you can see what action we have asked the provider to take at the end of the full version of this report.

Follow up

The overall rating for this service is requires improvement.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Cottage Residential Home is registered to provide nursing and personal care for up to 40 older people and for people living with Dementia. The service is also registered as a domiciliary care agency, providing personal care for people living in the community. At the time of inspection there was 32 people living in the service and two being supported in the community by the domiciliary care agency. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

There were enough staff deployed in the service to meet people’s needs. Staff received on- going training to enhance their knowledge. Safe recruitment practices were consistently followed.

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 26 February 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection, we inspected but did not rate the service. Should this say ‘at this inspection’

Why we inspected

We undertook this targeted inspection to follow up on a specific concern we had about the service, which was staffing levels. A decision was made for us to inspect and examine those risks.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We inspected the service on 16, 17 and 23 January 2019. The first day of our inspection was unannounced. On the first day of our inspection there were 36 people living in the care home and 6 people receiving personal care from the homecare service.

At our last inspection in June 2017 we rated the service as Requires Improvement reflecting shortfalls in the safety of the premises; medicines management; staff recruitment and quality monitoring. At this inspection we were disappointed to find the registered provider had failed to address all of these issues. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because of continuing shortfalls in organisational governance and a continuing failure to properly assess and mitigate risks to the safety of people living in the care home. We also found the registered provider was in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 due to a failure to notify us of allegations of abuse relating to people living in the care home. You can see what action we told the provider to take on these issues at the back of the full version of this report.

In other areas, the registered provider was also failing to provide people with the caring and responsive service they were entitled to expect. People in the care home did not receive sufficient physical and mental stimulation to meet their needs and people’s right to privacy was not consistently protected.

The overall rating for the service remains as Requires Improvement.

More positively, in both elements of the service, there were sufficient staff to meet people’s care and support needs. People using the homecare service were particularly appreciative of the timeliness of their care calls. Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively. Staff at all levels worked well together in a mutually supportive way. Senior staff were committed to strengthening the links between the care home and homecare service, to provide people with increasingly personalised support.

Staff were kind and attentive in their approach. People were provided with food and drink that met their individual needs and preferences. Staff provided end of life care in a sensitive and person-centred way.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm.

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.

There was evidence of organisational learning from significant incidents and events. People were invited to give feedback on the quality of the service. There were very few formal complaints and any informal concerns were handled effectively. There was an ongoing programme of improvement to the physical environment and facilities in the care home.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers (‘the provider’) 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 registered manager demonstrated strong, supportive leadership which was appreciated by her team.

The Cottage Residential Home can provide accommodation and personal care for 40 older people, people who live dementia and people who have a physical disability. There were 38 people living the service at the time of our inspection. The service can also provide care for people in their own homes in Nocton, Billinghay and surrounding villages. At the time of our inspection eight people were receiving care in this way.

In this report we refer to the two services as being the ‘residential service’ and the ‘care at home service’. In addition, when we speak about issues that affect the staff working in both services we refer to them as being, ‘care staff’.

The service was run by a company who was the registered provider. There was a registered manager in post. 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. In this report when we speak both about the company and the registered manager we refer to them as being, ‘the registered persons’.

People had not always been assisted to avoid preventable accidents and medicines were not consistently being managed safely. In addition, full background checks had not always been completed before new staff were employed. However, there were enough care staff on duty in both services and they knew how to safeguard people from situations in which they might experience abuse.

Although some care staff had not received all of the training the registered persons considered to be necessary, in practice they had the knowledge and skills they needed. People were supported to eat and drink enough and care staff ensured that people received all of the healthcare they needed.

The registered persons had ensured that whenever possible people were helped to make decisions for themselves. When people lacked mental capacity the registered persons had ensured that decisions were taken in people’s best interests.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had ensured that most people only received lawful care. However, an improvement needed to be sustained to ensure that people living in the residential service only received lawful care.

Care staff were kind and compassionate. People’s right to privacy was promoted and confidential information was kept private.

People who used both services had been consulted about the care they wanted to receive and were given all of the practical assistance they needed. Care staff promoted positive outcomes for people who lived with dementia and people were supported to pursue their hobbies and interests. There were arrangements to quickly resolve complaints.

Although quality checks had not always effectively resolved problems in the running of the residential service, people had been consulted about the development of the services. Care staff considered that the services were run in an open and inclusive way so that they were able to speak out if they had any concerns.

Due to the complex needs of some of the people who lived at the home we also used a number of different ways to help us understand their experiences. For example, we spent time observing the care people received and we looked at a range of records kept in the home. The records we looked at included people's care files and information about how the home operated.

We saw people were asked for their consent before staff carried out any care task with them. Where people were unable to give clear consent to their care we saw meetings had been held to make decisions in their best interest.

We saw staff provided care for people in a way that maintained their dignity and privacy. Staff spoke with people in a friendly and respectful way. One person told us, 'Four star care here ducky.' We know there was an effective system in place for people to raise concerns or complaints.

People told us they had a good range of food and drink. One person said, 'Top quality food here.' Records showed us that people were involved in planning their menus.

The home was clean and hygienic during our visit and we saw the provider had systems in place to reduce the risks of infections spreading through the home.

Staff received a range of training which was based on the needs of people living in the home.

At this inspection we observed members of staff treating people with respect and courtesy. We saw staff knocking on doors before entering; staff also called people by the preferred name.

We saw assessments of people's needs and plans set out the care and support people needed. The assessments included information about people's likes and dislikes and things that were important to them; for example, the specific way they wanted the support they received to be provided.

We observed staff provided support and engaged with people who lived at the home positively. People appeared relaxed and comfortable in the presence of their support staff. In discussion, it was evident staff understood the needs of people they supported.

We observed members of staff lifting people using hoists. We noted two people operated the hoist at all times and people were told what was happening at every stage of the process.

We spoke with four members of staff, all of whom were able to demonstrate thorough knowledge of the moving and handling procedures in place at the home. Staff confirmed no member of staff was ever permitted to operate the hoist on their own.