Cosin Lodge

Cosin Lodge is a residential care home providing accommodation and personal care to up to 4 people. The service provides support to people with learning disabilities and autistic people. At the time of our inspection there were 4 people using the service.

Not everyone who used the service received personal care. The Care Quality Commission (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. At the time of our inspection, 3 people using the service received personal care.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Systems and processes were not always robust enough to ensure people were safeguarded from the risk of improper treatment. People were generally supported to have maximum choice and control of their lives, but documentation was not in place to assure us that staff always supported people in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. We found the use of 1 restrictive practice where documentation and procedures around its use were not robust. The registered manager took steps to address this immediately.

The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. People had a choice about their living environment and were able to personalise their rooms. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right Care: The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. People were supported to attend medical appointments.

Right Culture: Quality assurance systems and processes were in place. However, they were not robust enough around the use of a restrictive practice and this had not been identified.

There was a culture of learning within the service. Lessons learnt were shared with staff in meetings, supervisions and appraisals. There was a positive culture within the service. Staff felt supported and valued. Feedback was sought from staff, people, relatives and professionals. Actions were implemented in response to the feedback received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 2 October 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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 changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified a breach in relation to having appropriate systems, processes and documentation in place to ensure people are receiving appropriate treatment and safeguarded from potential improper treatment.

Please see the action we have told the provider to take at the end of this report.

We have made a recommendation about the effectiveness of oversight of restrictive practices.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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

We last inspected the service in November 2014 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Staffing was provided at safe levels and any staff absences were covered by the provider’s own permanent and bank staff.

Accidents and incidents had been appropriately recorded and risk assessments were in place for people who used the service and staff.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show the service verified the conduct of prospective staff members.

People and relatives we spoke with told us they felt safe at Cosin Lodge. Staff were aware of procedures to follow if they observed any concerns.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner.

Staff were suitably trained and training was arranged for any due refresher training. Staff received regular supervisions and appraisals and told us they felt supported.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA). People are 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 were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external healthcare specialists.

Care records showed that people’s needs were assessed before they started using the service, they were supported to transition to the service at their own pace and support plans were written in a person centred way. Person centred means the individual needs of the person, their wishes and preferences were central to the support plan.

Staff supported people who used the service with their social needs. We observed that all staff were very caring in their interactions with people at the service. People clearly felt very comfortable with staff members and there was a warm and positive atmosphere in the service and people were very relaxed. We saw people being treated with dignity and respect and relatives and people told us that staff were kind and professional.

People who used the service and family members were aware of how to make a complaint. Information had been provided in an easy to read format.

Staff told us they felt supported by the registered manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service.

The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment at Cosin Lodge and actions plans and lessons learnt were part of their on-going quality review of the service.

Some people who used the service understood the care, treatment and support choices available to them. For those people who lacked capacity. We saw their relatives had been fully consulted and were involved in making decisions about their care, treatment and support needs.

The arrangements for supporting people to make decisions about their daily lives and preferences were recorded in their care plans. Each person was supported to take appropriate risks to promote as much independence as possible.

The relationships between staff the people who they supported were good. We saw lots of evidence about how the provider co-operated with others involved in the care, treatment and support of the people who used the service. For example, when people were admitted to hospital, each person had a hospital passport. This document informed the hospital staff all about the persons heath and personal care needs and how they preferred to be supported.

We saw detailed practices were in place to prevent the spread of infection. The cleanliness and hygiene of the premises were maintained to a high standard.

There was a competent staff team who had been appropriately recruited and had the training, skills and experience to meet the specific conditions of the people who they supported.

Suitable arrangements were in place for people to take part in appropriate activities in line with their needs and preferences.

The relationships between staff and the people who lived there were good and personal support was provided in a way that promoted and protected their privacy and dignity.

Suitable arrangements were in place for handling complaints and for protecting people from abuse. One person told us they could share any concerns with the staff and felt their views were listened to.

There was a stable and competent staff team who had the training, skills and experience to meet the specific conditions of the people who lived there.