Coxwell Hall and Mews Nursing Home

Coxwell Hall and Mews Nursing Home is a residential care home providing accommodation with personal and nursing care to up to 66 people. The service provides care to people who require support with their physical needs but also people who live with mental health needs and dementia. At the time of our inspection there were 53 people using the service.

People were accommodated in two parts of a building which were linked together. One part, purpose built called Lavender Court and the other, in the older part of the building called, The Folly. People had access to gardens from each building.

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

Staff ensured people received support to take their medicines. Some additional information was required in relation to medicines administered covertly (hidden in food or drink).

We have made a recommendation in relation to the covert administration of medicines.

Risk management processes were in place to mitigate or reduce risks to people’s health and safety. This included falls from windows of height. A fire safety assessment had been completed by an external company and recommendations from this had been completed. People told us they felt safe and their relatives were reassured by the measures staff took to keep their relatives safe.

Safeguarding arrangements were in place to help protect people from abuse. Managers and senior staff worked with external health and adult social care professionals to safeguard people.

The service was staffed accordingly so people’s needs were met and the running of the service overall, maintained. There were arrangements in place to keep the environment clean and to reduce the risk of infection.

People’s care was delivered equally and without discrimination. The environment was adapted and decorated in a way which supported people who lived with dementia. Staff worked with a wide range of health and social care professionals to support people’s access to health assessments, specialist treatments and appointments.

Staff were supported and trained to deliver people’s care and treatment in line with best practice. People’s eating and drinking needs were well supported.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were treated with compassion, kindness and respect. Those who were important to people were made to feel welcome and their involvement encouraged and seen by staff as being integral to maintaining people’s wellbeing. People’s dignity and privacy was maintained, and their information treated confidentially.

People’s care and treatment was planned around their physical, emotional and spiritual needs. People’s individual preferences, choices, aspirations and wishes were explored and incorporated into the planning of their care. This included at the end of their life to support a pain free and dignified death.

People had opportunities to take part in social activities and staff remained aware of the risk of loneliness and self-isolation for others.

Concerns and complaints could be raised and there was a process in place to acknowledge and address these.

The registered manager was absent from the service so interim management arrangements were in place and working well. During the pandemic the provider’s quality monitoring of the service had been through virtual assessment and regular conference calls with managers, for information gathering and support purposes. The provider had subsequently commissioned an audit of the service, by an external company, to enable them to assess the service’s performance. This had resulted in an improvement plan, which the interim manager and team had made good progress against by the time of the inspection.

Audits had been completed by managers, which had identified areas for required improvement to the environment and premises. The provider explained that the refurbishment and repair work was due to commence in September 2022, having been delayed by the pandemic. At the time of the inspection general maintenance work was in progress.

The provider was making significant improvements to their IT systems which will make various management tasks easier and, for example, make record keeping easier.

Satisfaction surveys had been sent out to gather feedback from people and their relatives, on the services provided, but information had yet to be fully collated from these.

The service continued to work with commissioners including health and social care professionals to support people’s access to the service as needed. This close working had benefitted people with complex needs where other care placements had not been successful.

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 outstanding (published 3 January 2020).

Why we inspected

The inspection was prompted in part due to concerns received about people’s care and the condition of the environment. A decision was made for us to inspect and examine those risks.

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.

The overall rating for the service has changed from outstanding to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Coxwell Hall and Mews Nursing 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.

Coxwell Hall and Mews is residential care home providing personal and nursing care to 57 people with a range of conditions, including people living with mental health conditions and dementia at the time of the inspection. The service accommodates up to 66 people in one adapted building.

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

People received care and support that in many cases was life changing for them. The staff excelled in managing people’s complex needs, including distressed behaviours by using responsive techniques that had a positive impact on people’s well-being. We saw many examples where staff successfully contributed to people’s quality of life, this included people who in their previous settings were described as ‘complex’.

The service was led by a registered manager who was completely dedicated to providing high quality care that achieved the best possible outcomes for people. People benefitted from exceptional care delivered by a dedicated staff team who were committed to the vision and values of the service. Without exception feedback about the registered manager was exceedingly positive, both in relation to her exceptional leadership skills and her caring, empathetic approach to everyone. The registered manager constantly looked for ways to improve the service and had effective systems in place to monitor the quality of the service.

There was a warm, welcoming atmosphere that was promoted by caring, compassionate staff. People enjoyed worthwhile relationships with staff, who valued and respected them. There was a strong commitment to providing personalised care that appreciated people for who they were and recognised the value of their life experiences. Professionals were extremely impressed by the positive outcomes people had achieved through the support and encouragement provided at the service. We received exemplary feedback from several external professionals praising the significant impact living at Coxwell Hall and mews had for people.

The staff excelled in caring for people living with dementia. The service achieved an accreditation as a ‘Butterfly Care Home’. By fully embracing the Butterfly approach staff created a nurturing environment where people’s feelings mattered most. This culture was well embedded in the day to day care delivery and ensured people had support that recognised their personalities and individuality beyond their diagnosed conditions. People enjoyed a range of activities and staff took every opportunity to engage people in the activities of daily living. There was a collaborative approach to activities which meant all staff were involved in ensuring people participated in activities of their choice.

Staff received outstanding support from the registered manager both at a professional and personal level. Staff had completed high quality training that ensured they were confident and competent at delivering person centred care. Staff were encouraged and supported to develop their skills and follow a career progression within the service.

The provider ensured their practices were in line with the current good practice, guidance and legislation. There was a focus on continuous development, for example the environment was being developed in line with standards set out in research around environments that improved the impact on people living with dementia

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People felt safe living at the service and for some this had a significant impact on their well-being. There were always sufficient staff available to meet people’s needs. Risks were assessed and there were plans in place to ensure risks were managed. Staff were confident in conflict resolution and in supporting people who could experience distressed behaviours. Medicines were managed safely.

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 19 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

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. The registered manager worked closely with the operations manager.

At the last inspection on 14 March 2016, we asked the provider to take action to make improvements and make sure people were protected from the risks of pressure sores, choking and infection. Also to ensure people’s capacity assessments were completed in line with the principles of the mental capacity act 2005 (MCA) and that the registered manager had a good understanding of the MCA. At this inspection on 20 and 24 April 2017 we found the actions had been completed.

Risks to people relating to development of pressure sores were assessed and risk management plans were in place. People were protected from risk of choking as well as risk of infection.

The registered manager and staff had a good understanding of the MCA. Where people were thought to lack capacity, assessments in relation to their capacity had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

People who were supported by the service felt safe. Staff had a clear understanding of how to safeguard the people and protect their health and well-being. People’s medicines were stored and administered safely.

There were enough suitably qualified and experienced staff to meet people's needs. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where required, staff involved a range of other professionals in people’s care.

People received care from staff who understood their needs. Staff received adequate training and support to carry out their roles effectively. People felt supported by competent staff who benefitted from regular supervision (one to one meetings with their line manager) and team meetings to help them meet the needs of the people they cared for.

People’s nutritional needs were met and people had a good dining experience. People were given choices and received their meals in timely manner. People were supported with meals in line with their care plans.

There was a calm, warm and friendly atmosphere at the service. Every member of staff we spoke with was motivated and inspired to give kind and compassionate care. Staff knew the people they cared for and what was important to them. Staff appreciated people’s unique life histories and understood how these could influence the way people wanted to be cared for. People's choices and wishes were respected and recorded in their care records.

People had access to activities and stimulation from staff in the home. Activities were structured to people's interests. Staff knew how to best support people and what activities and changes to the home would suit the needs of people.

Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. End of life care was provided in a compassionate way.

Leadership within the service was open and transparent at all levels. The provider had quality assurance systems in place. The provider had systems to enable people to provide feedback on the support they received.

The registered manager informed us of all notifiable incidents. The registered manager had a clear plan to develop and improve the home. Staff spoke positively about the management and direction they had from the manager.

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. The registered manager worked closely with the area manager.

People who were supported by the service felt safe. The staff had a clear understanding on how to safeguard the people and protect their health and well-being. There were systems in place to manage safe administration and storage of medicines. However, there was no clear guidance for people using thickener where choking was a risk.

People at risk of developing pressure sores were not always protected from these risks. People’s pressure mattresses were not always set to correct pressures.

The provider had an infection control policy in place. However, people were not always protected from the potential risk of infection. Staff wore long sleeved clothes whilst delivering care as well as handling food.

There were enough suitably qualified and experienced staff to meet people needs. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where required, staff involved a range of other professionals in people’s care.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005. However, the registered manager did not have a clear understanding of their responsibilities in relation to completing mental capacity assessments. Where people were thought to lack capacity, assessments in relation to their capacity had not been completed in line with the principles of MCA. The registered manager relied on capacity assessments carried out by other health professionals.

People received care from staff who understood their needs. Staff received adequate training and support to carry out their roles effectively. Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

People’s nutritional needs were met and people had a good dining experience. People were given choices and received their meals in timely manner. We observed people during lunch time and saw people being supported with meals in line with their care plans.

People felt supported by competent staff. Staff benefitted from regular supervision (one to one meetings with their line manager) and team meetings to help them meet the needs of the people they cared for.

There was a calm, warm and friendly atmosphere at the service. Every member of staff we spoke with was motivated and inspired to give kind and compassionate care. Staff knew the people they cared for and what was important to them. Staff appreciated people’s unique life histories and understood how these could influence the way people wanted to be cared for. People's choices and wishes were respected and recorded in their care records.

People had access to activities and stimulation from staff in the home. Activities were structured to people's interests. We observed people engaged in arts and crafts, ball games and cake baking.

The registered manager used best practice guidance in dementia care. For example, the butterfly scheme was used in the home and all staff had an awareness of it. This is a scheme used to improve the wellbeing of people with dementia. Staff discussed how to best support people and what activities and changes to the home would suit the needs of people.

Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. End of life care was provided in a compassionate way.

The registered manager informed us of all notifiable incidents. The service had quality assurances in place. However, these quality assurance systems were not always effective. The registered manager had a clear plan to develop and improve the home. Staff spoke positively about the management and direction they had from the manager. The service had systems to enable people to provide feedback on the support they received.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014. You can see what action we have required the provider to take at the end of this report.

Two people told us that they were 'happy and well looked after '. Other people were able to indicate by nodding and smiling that they were happy. Two professionals and a family member who were visiting the home told us that they felt the home offered a very good standard of care.

We saw that staff respected people's individuality and diversity.

We found that staff members knew the individual's current needs and were observed meeting the person's needs effectively.

People who used the service told us that staff were 'always patient and kind'. Other people nodded and smiled in agreement.

We found that the home was keeping all the management records necessary to show that people who used the service were being looked after in the safest possible way.