Archived: The Cottage Residential Home

Updated 30 September 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 27, 28, 29 July and 7 August 2015 and was unannounced. The inspection was completed by one adult social care inspector, an inspection manager and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

The local authority safeguarding and quality teams and the local NHS were contacted as part of the inspection, to ask them for their views on the service and whether they had any ongoing concerns. We also looked at the information we hold about the registered provider.

We used the Short Observational Framework for Inspection [SOFI]. SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with five people who used the service and three of their relatives who were visiting during the inspection. We observed how staff interacted with people who used the service and monitored how staff supported people throughout the day, including meal times.

We spoke with the registered manager, two representatives of the company, the administrator, the assistant manager and four care staff.

We looked at six care files which belonged to people who used the service. We also looked at other important documentation relating to people who used the service such as incident and accident records and six medication administration records [MARs]. We looked at how the service used the Mental Capacity Act 2005 and Deprivation of Liberty code of practice to ensure that when people were deprived of their liberty or assessed as lacking capacity to make their own decisions, actions were taken in line with the legislation.

We looked at a selection of documentation relating to the management and running of the service. These included three staff recruitment files, training record, staff rotas, supervision records for staff, minutes of meetings with staff and people who used the service, safeguarding records, quality assurance audits, maintenance of equipment records, cleaning schedules and menus. We also made a tour of the building.

Updated 30 September 2015

We undertook this unannounced inspection on 27, 28, 29 July and 7 August 2015. The last inspection was undertaken in December 2014 when the service was found to be non-compliant with two of the regulations looked at.

Part of this inspection was to see if the registered provider had complied with the actions we asked them to take following the last inspection. We also received information from the local authority safeguarding team which raised concerns about the standard of care and attention the people who used the service received.

The Cottage is registered with the Care Quality Commission [CQC] to provide care and accommodation for 30 older people who may be living with dementia. Accommodation is provided in a mixture of shared and single rooms, with some having en-suite facilities. There is a large dining room and two lounges.

The Cottage is on the outskirts of Hull and has good access to public transport routes.

At the time of the inspection there was a registered manager in post. A registered manager is a person who has registered with the 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 found the registered provider was in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 following the last comprehensive inspection in December 2014. The breaches included safe care, the environment, how people were supported to make informed choices and decisions, gaining people’s consent to care and treatment, staff training, people’s privacy and dignity, person centred care and monitoring and governance. You can see what actions we have told the provider to take at the end of this report.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by the CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

People were not consulted with regard to the care and treatment they received and decisions were made which were not in the best interest of the person or the least restrictive option available. For example, the registered manager had been using a covert camera in two people’s bedrooms and had not gained their permission or consulted with any other stake holders. People were receiving medicines covertly and no assessment had been undertaken as to their capacity or if this was the least restrictive practise.

The environment was dirty and at the time of the inspection smelt of urine. Bedrooms were dirty and bedding was stained as were the beds. The bathroom was dirty and in need of redecoration, the bath sides had mould growing on them. Since the inspection in July we have revisited and found the registered provider has cleaned the service and addressed some of the infection control issues and has made us aware of plans to re-site the bathroom and make it fit for purpose.

Staff knew how to identify and report abuse they may become aware of but their training needed updating and renewing in line with current good practise guidelines.

Staff had been provided in enough numbers to meet the needs of the people who used the service and had been recruited safely. However, as a result of the findings of this inspection with regard to the environment the registered provider is increasing the domestic staff.

The City Health Care Partnership [CHCP] pharmacist had recently undertaken an audit of the medicines systems due to concerns raised and had recommended areas for improvement. When we looked at the medicines we found the registered provider had complied with what the CHCP had recommended. Discussions with the CHCP pharmacist confirmed they were working closely with the staff at the service to implement changes and improvements. We found the registered provider had improved the way the medicines were stored and administered and how the staff recorded this. The registered provider had developed protocols for the use of medicines which were administered as and when the person required [PRN]. This meant people received their medicines as prescribed by their GP. The main outstanding recommendation made by the CHCP pharmacist was with regard to the temperature of the room the medicines was stored in, however the registered provider told us they had plans to relocate this to another room so the temperature could be better regulated.

We found staff training had not been updated and some staff had not completed training identified as mandatory by the registered provider and part of their development. Staff supervision had not been carried out for over 12 months and staff had not had the opportunity to undertake any further qualifications and development. We found the staff induction was basic and did not follow current good practise guidelines with regard to staff skills and development. This meant people may have been cared for by staff who did not have the training, support and experience to meet their needs.

People were not protected by legislation or assessment to make informed decisions about their care and treatment practises were not always the least restrictive or in the person’s best interest. The principles of the MCA 2005 were not being followed and deprivation of liberty safeguards [DoLS] were not being used to protect people.

At the time of the inspection we found the environment to be in need of refurbishment and redecoration. Double glazed window seals had ‘blown’ and this made it difficult for people to see through the windows and they appeared murky. Windows frames were rotten and need of replacement. The bathroom was not fit for purpose and was dirty and need of upgrading, the bath sides had mould growing on them. We have revisited the service since the inspection in July and found the registered provider had replaced the double glazing and was systemically replacing the rotten windows. They told us they had plans to relocate the bathroom making it fit for purpose and meet the needs of the people who used the service better; this was to commence week commencing 24 August 2015. We will check this has been done.

At the time of the inspection there were no locks fitted to the doors of either the bathrooms or the toilets. Some of the door handles on people’s bedrooms and toilets did not work properly therefore making it difficult to keep the door closed. This meant people’s privacy and dignity was compromised. We have revisited the service since the inspection in July and found the registered provider had fitted locks to the bathroom and toilet doors and replaced the defective door handles on the bedrooms.

People were provided with food which was wholesome and nutritious and of their choosing. Staff monitored people’s daily food and fluid intake and involved health care professionals when required.

People had good relationships with the staff and staff respected their privacy and dignity, however, people did not receive person centred care and their needs were not always met by the staff. People’s care plans were not followed and staff did not always understand people’s needs, especially with regard to behaviours which could challenge the service and put the person and others at risk.

There was a lack of meaningful activities provided at the service and there were no specific activities to support those people who were living with dementia. This meant people could go for long times unstimulated and became bored and restless.

There were no management systems in place to ensure the service was safe, effective, caring, responsive and well led. There were on monitoring systems which audited the service and made sure it was safe for people to live in. There were no systems in place which audited the environment to ensure it was clean and free from the risk of cross contamination. There were no systems in place which systematically gathered the views of the people who use the service and other stakeholders about the running of the service. There were no systems in place which ensured the staff had the right skill to meet the needs of the people who used the service. The management style was not inclusive and did not motivate staff to achieve excellence and ensure the service moved forward.

You can what actions we have told the registered provider to take at the end of this report.