The Cottage Christian Nursing and Residential Home

The Cottage Christian is a care home registered to provide nursing and personal care and accommodates up to 40 people. At the time of this inspection the service was providing personal and nursing care to 36 older people.

People’s experience of using this service:

People were positive about the care and support they received.

Governance of the service was robust with effective checks and audits carried out to determine the quality of the care. The registered manager had acted promptly to address areas identified for improvement.

Risks to people were monitored and plans were in place to help keep people safe.

The provider had safe systems for the management and administration of people's medicines.

People were supported by adequate numbers of staff who were safe and competent to work with them.

People were protected from the risks associated with the control and spread of infection.

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's health care and nutritional needs were monitored and understood by staff.

People told us staff understood their needs and were kind, caring and friendly.

People had opportunities for social stimulation and were supported to maintain links with the local community where able.

Rating at last inspection:

The service was rated Good at the last inspection in 19 September 2016.

Why we inspected:

This was a scheduled inspection based on the previous rating.

Follow up:

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

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

The Cottage Christian Nursing Home provides accommodation, personal and nursing care for up to 40 older people. The service also caters for respite and end of life care. At the time of our inspection there were 40 people living at the home.

People told us they felt safe. People were supported by a staff team who knew how to keep people safe from harm and abuse. People’s care records contained risk assessments and there were plans in pace to manage these risks. Staff had a good understanding of people’s risks and how to manage them to ensure people’s safety.

People were supported by sufficient numbers of staff to ensure their needs were met and they were safe. People received their medicines as prescribed and were given medicines by staff that were suitably trained. People’s medicines were stored safely.

People received care and support from a suitably trained staff team who had been recruited safely. The registered manager had systems and processes in place to ensure that staff were kept up to date with their core training.

People were asked for their consent to care and support and the principles of the Mental Capacity Act 2005 were being followed. Staff had a good understanding of the MCA and how to apply this in practice. People’s capacity was being assessed where appropriate and where required decisions were being made in the best interests of people. The registered manager had submitted DoL’s applications to a supervisory body as appropriate.

People were supported to have sufficient to eat and drink. People were offered a choice of what they ate and drank. People’s specific dietary needs were catered for and specialist professional advice was being followed.

People were supported to access healthcare services when they needed to. People were supported by a staff team who were able to recognise changes in people’s health and well-being and knew how to report and respond to any changes.

People were supported by a staff team who were kind and showed compassion. People were supported to make decisions about how their care and support was provided. People were also supported to make decisions about how they spent their leisure time.

People were treated with dignity and respect. People were encouraged to maintain their independence and were supported to maintain relationships that were important to them.

People were involved in the planning and review of their care where possible and relatives were invited to attend care reviews.

The provider employed a dedicated activities co-ordinator. People were supported to follow their interests and take part in a range of activities which they enjoyed. Activities were person centred and were tailored to meet individual needs.

People were supported by a staff team who knew peoples care and support needs well and had an understanding of people’s likes and dislikes.

People and their relatives knew who the registered manager was and felt confident to approach them with any concerns or queries. People and their relatives knew how to make a complaint and felt confident that complaints would be effectively managed. We looked at complaint records and saw complaints were logged, responses recorded and actions taken to improve practices had been documented. We also saw there were learning objectives recorded for each complaint received.

People, relatives and staff were provided with opportunities to give feedback on the service. The registered manager had systems and processes in place to monitor and analyse the quality of the service, and they used information from quality checks to drive improvement.

We saw that staff responded promptly to any requests for assistance. People told us that the staff were, "Kind, just so nice, nothing's too much trouble" and, "Always willing to help". Staff made sure that people were given choice and were encouraged to be as independent as possible. People considered staff were well trained to do their job and one person said, 'They have good personalities which counts for a lot'. People considered the service would be responsive to their changing needs and that staff cared.

The provider recruited new staff well and made sure that all checks were in place before they started in the home.

The provider made sure that people were able to express their views of the service. People told us that they would feel comfortable raising any concerns. The provider regularly audited the service provision and took action to remedy any shortfalls. This meant that the service was effective and well led.

People said they felt safe living at the home. One person commented, 'The staff treat me well'. Staff told us they had received training in keeping people safe. They demonstrated an understanding of the different forms of abuse and knew the procedure to follow if they suspected abuse.

Staff told us they had attended a range of training courses to equip them with the knowledge and skills to effectively carry out their duties.

Some changes had been put in place since our last visit to improve the quality of life of some residents. There was evidence that residents' concerns and the concerns of their relatives were now being listened to.

The provider monitored the service more robustly. The systems in place enabled them to identify problems swiftly and act upon them to keep people safe.

Staff told us they had received training in keeping people safe. We found that safeguarding concerns that had been raised with the manager had not been acted on to ensure the safety of people.

People had mixed views about the staff. One person said, 'The staff are very nice and I get on well with them.' Another said, 'It depends who is on the shift, they are not all good.' One person said they were kept waiting for a long time in the mornings for staff to attend to them. They said, 'Sometimes I worry as you just can't get them when you want them.'

Staff told us they had received training to meet people's needs. We were shown training and supervision records that were incomplete. Compliance visits by senior management had identified failings in this area since March 2012.

The majority of people told us they were asked how they were but were unsure of how to complain formally. One visiting relative told us they were happy to report concerns but considered the management would not take action.