Archived: Cottesmore House

At the inspection of 29 March 2017, we checked if the provider had put in place adequate systems to monitor, assess and make improvements. We found the provider had taken action and improved the way they managed medicines, assessed risks to people’s health and safety and worked within the principles of the Mental Capacity Act (2005). This meant that the provider had met the requirements of the warning notice.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Cottesmore House’ on our website at www.cqc.org.uk.

Cottesmore House is an extra care housing service that provides personal care for up to 47 people. Each person was living in their own flat and had their own tenancy with Paradigm Housing Association who also owned the building. There were eight flats on the fifth floor which were exclusively for people who were living with a learning disability.

There was a registered manager in post at the time of our inspection. 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.

There were effective systems in place for the management of prescribed medicines.

The provider had put in place robust health and safety checks and action was taken where issues were identified.

Where people lacked the capacity to manage their own medicines, the provider had carried out a mental capacity assessment and had acted in the person’s best interest.

While improvements has been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice.

We will review our rating at the next comprehensive inspection.

The service was last inspected on 5 July 2016 where we found one breach of Regulations in relation to leadership and governance. We also made a recommendation in relation to the management of medicines. At this inspection we found that the provider had not made sufficient improvements in these areas which meant there was a repeated breach of the Regulation concerning leadership and governance.

Cottesmore House is an extra care housing service that provides personal care for up to 47 people. There were 44 people living at the service at the time of our inspection, one of whom was in hospital, and five people were not receiving personal care. Each person was living in their own flat and had their own tenancy with Paradigm Housing Association who also owned the building. There were eight flats on the fifth floor which were exclusively for people who were living with a learning disability.

There was a registered manager in post at the time of our inspection. 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. There was also a branch manager at the service who managed the day to day running of the service.

Some people’s medicines were kept in the duty office in an unlocked drawer. We also found that some medicines did not have a date of opening, and one did not have a pharmacy label.

Medicines audits were undertaken, however these were mainly checking medicines administration record (MAR) charts audits. The current medicines management system was confusing and did not enable senior staff to conduct thorough audits of medicines.

A disabled toilet on the ground floor was dirty and the toilet seat was cracked. This meant that there was a risk of injury and cross infection.

The management and staff were aware of their responsibilities with regards to the Mental Capacity Act (MCA) 2005 and had received training in this. However, where people lacked the capacity to manage their own medicines, there were no evidence that the provider had carried out a mental capacity assessment or that a best interest decision was in place.

There were systems in place to monitor and assess the quality and effectiveness of the service, however, some of these were not always effective in identifying issues with medicines management, capacity and consent.

People told us they felt safe and we saw that there were systems and processes in place to protect people from the risk of harm. Most people thought there were enough staff on duty to meet people’s needs, although some people were concerned that this was not always the case at weekends.

The risks to people's wellbeing and safety had been assessed, and there were detailed plans in place for all the risks identified.

Staff had received training in safeguarding adults and this was refreshed regularly. There were procedures for safeguarding adults and the staff were aware of these. The manager worked with the local authority’s safeguarding team to investigate any safeguarding concerns raised. The staff knew how to respond to any medical emergencies or significant changes in a person's wellbeing.

Feedback from people and relatives was mainly positive. People said they had formed a good rapport and trusted their care workers.

Staff were caring and treated people with dignity and respect and in a way that took account of their diversity, values and human rights.

People's needs were assessed by the provider prior to receiving a service and support plans were developed from the assessments. People had taken part in the planning of their care and received regular visits from the senior staff.

Recruitment checks were in place to obtain information about new staff before they supported people unsupervised.

People's health and nutritional needs had been assessed, recorded and were being monitored.

Staff received regular training and were suitably supervised and appraised. The provider and management team sought guidance and support from healthcare professionals and kept themselves abreast of relevant development with the social care sector. They cascaded important information to staff, thus ensuring that the staff team were well informed and trained to deliver effective support to people.

There was a complaints procedure in place which the provider followed. People felt confident that if they raised a complaint, they would be listened to and their concerns addressed.

People and relatives told us that the staff were approachable and supportive. People were supported to raise concerns and make suggestions about where improvements could be made.

There were regular meetings for staff, managers and people using the service, which encouraged openness and the sharing of information.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to Safe Care and Treatment, Safeguarding service users from abuse and improper treatment and Good Governance. You can see what actions we told the provider to take at the back of the full version of this report.

Cottesmore House is an extra care housing service that provides personal care for up to 48 people. There were 45 people living at the service at the time of our inspection, 39 of whom were older people. Each person was living in their own flat and had their own tenancy with a housing association which also owned the building. There were eight flats on the fifth floor which were exclusively for people who were living with a learning disability. At the time of our inspection, six people were living there.

The service is required to have a registered manager and there was a registered manager in post at the time of our inspection. They had recently been promoted to area manager, and another manager working at the service had made an application to become the new registered manager.

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. There was also a branch manager at the service who managed the day to day running of the service.

Medicines audits were undertaken regularly, however these had not always been effective when issues were identified. This resulted in one person who used the service not receiving their medicine as prescribed. We have made a recommendation in the Safe section of this report.

Effective systems were in place to ensure safe administration of people’s prescribed medicines and staff had received training in the administration of medicines.

The provider had systems in place to monitor the quality of the service and ensured that areas for improvements were identified and addressed.

People had mixed views about the activities on offer at Cottesmore House. The provider told us they organised occasional outings and external entertainers visited the service several times a year. The housing department organised events and outings for people who used the service.

Staff had received training in safeguarding adults and this was updated regularly. There was a safeguarding policy and procedure in place. The registered manager worked with the local authority’s safeguarding team to investigate any safeguarding concerns raised.

Staff had undertaken basic awareness training in the Mental Capacity Act (MCA) 2005 and were aware of their responsibilities in relation to the Deprivation of Liberty (DoL). We were told and saw that people were given choices and the opportunities to make decisions, and records showed that consent was obtained.

People told us they felt safe and we saw that there were systems and processes in place to protect people from the risk of harm whilst giving them the chance to take positive risks. There were enough staff on duty to meet people’s needs and there were contingency plans in the event of staff absence to ensure people’s safety.

People’s nutritional needs were being met. Staff supported people to shop for their food and cook meals in their own flats if they wished to, and supported those who chose to come downstairs to use the canteen.

Staff received effective training, supervision and appraisal. The registered manager sought guidance and support from other healthcare professionals and kept themselves informed of important developments within the social care sector in order to cascade information to staff, thus ensuring that the staff team was well informed and trained to deliver effective support to people.

Staff were caring and treated people with dignity and respect and in a way that took account of their diversity, values and human rights. Care plans were in place and people had their needs assessed. Care records contained detailed information and reflected the needs and wishes of the individual so staff had the information they required to meet people’s needs.

People, relatives, staff and stakeholders told us the registered manager, management team and staff were supportive and professional. The management team said they encouraged an open and transparent culture within the service. The service supported people to raise concerns and used feedback to make improvements where needed.

There were regular meetings for staff, managers and people using the service which encouraged openness and the sharing of information.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to good governance. You can see what actions we told the provider to take at the back of the full version of this report.