Cosham Court Nursing Home

Cosham Court Nursing Home provides care and accommodation for up to 47 people. The home specialises in providing care to older people, who have nursing needs. At the time of our inspection there were 32 people living at the home.

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

We could not be fully assured the provider had effective management of infection control risks to keep people safe.

Some areas of the home were poorly maintained, so could not be effectively cleaned and staff failed to wear personal protective equipment, such as masks appropriately.

The provider’s quality assurance systems had not always been used effectively to either identify areas for improvement and/or to bring about effective improvement.

Care records including care plans and risk assessments did not provide clear and consistent information in relation to people’s needs and abilities and some information was conflicting. This placed people at risk of receiving inappropriate and ineffective care and treatment which could result in harm.

On day one of the inspection we could not be assured people’s prescribed topical medicines were consistently applied as required. When this was discussed with the staff this was immediately addressed. All other medicines were managed safely.

Appropriate recruitment procedures were in place and there were enough staff to support people's needs. Staff had received training and support to enable them to carry out their role safely.

There were appropriate policies and systems in place to protect people from the risk of abuse. 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.

Relatives had mixed views about communication with the staff at the home and the opportunity to speak to their loved ones. However, people and relatives were also complimentary about many aspects of the service and described staff as kind and responsive.

CQC were notified of all significant events that occurred in the service and the previous performance rating was prominently displayed on the premises as per requirements.

The service worked in collaboration with all relevant agencies, including health and social care professionals. This helped to ensure there was joined-up care provision.

The provider was responsive to our feedback and discussed how they planned to make changes to improve the service.

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 10 April 2019).

Why we inspected

The inspection was prompted in part due to concerns received about; staffing levels, the management of people’s nursing and personal care needs and good governance. As a result, we undertook a focused inspection to review the key questions of safe and well-led only to 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. This included checking the provider was meeting COVID-19 vaccination requirements.

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. Please see the safe and well led sections of this full report.

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 Cosham Court Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the infection control, risk management and the governance of the service.

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

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rating at last inspection: Good (published 17 September 2016).

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

People’s experience of using this service:

People were happy with the care and support they received at Cosham Court Nursing Home. Feedback from visitors and involved professionals was positive and we observed kind, compassionate interactions between staff and people during our inspection.

People received a safe service because the provider had systems and processes which helped to minimise risks. This included safe recruitment procedures and training for staff about how to recognise and report suspicions of abuse.

Staff were well trained and knew people and their individual needs. This meant that care was planned and delivered effectively.

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 care records showed that their support was reviewed at least monthly and was therefore responsive to changing needs. People were supported by staff to engage in a range of social opportunities which included some group activities, one to one time with staff and a range of visits from external providers.

Leadership was visible and promoted good teamwork. People, professionals and staff spoke positively about the management and staff had a clear understanding of their roles and responsibilities.

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

A registered manager was 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 was on holiday at the time of this inspection.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Robust processes to check the suitability of staff to work with people were in place. There were sufficient staff available to meet the needs of people and they received appropriate training and support to ensure people were cared for in line with their needs and preferences.

Medicines were administered, stored and ordered in a safe and effective way. We have made a recommendation about how records are kept for medicines which are given as required or in a varied dose.

Risk assessments in place informed plans of care for people to ensure their safety and welfare, and staff had a good awareness of these. Incidents and accidents were clearly documented and investigated. Actions and learning were identified from these and shared with all staff.

People were encouraged and supported to make decisions about their care and welfare. Where people were unable to consent to their care the provider was guided by the Mental Capacity Act 2005. Where people were legally deprived of their liberty to ensure their safety, appropriate guidance had been followed.

People received a wide variety of nutritious meals in line with their needs and preferences. People had access to fresh fruit and snacks throughout the day and were encouraged to take fluids especially in the hot weather. Those who required specific dietary requirements for a health need were supported to manage these.

People’s privacy and dignity was maintained and staff were caring and considerate as they supported people. Staff involved people and their relatives in the planning of their care.

Care plans in place for people reflected their identified needs and the associated risks. Staff were caring and compassionate and knew people in the home very well. External health and social care professionals were involved in the care of people and care plans reflected this.

Effective systems were in place to monitor and evaluate any concerns or complaints received and to ensure learning outcomes or improvements were identified from these. Staff encouraged people and their relatives to share their concerns and experiences with them.

The service had a good staffing structure which provided support, guidance and stability for people, staff and their relatives. Relatives spoke highly of all staff.

During this inspection we spoke with twelve people, including those with dementia and one relative and five staff members including the manager. Comment cards were received from five people. One professional wrote, 'I have never had any concerns about the home looking after individuals with dementia. They show compassion, a caring manner and treat people with respect and dignity'

People's needs were assessed and care was planned accordingly. All people spoken with told us they were happy with the care they received. They told us they felt able to exercise choices about their care and how they spent their days.

People were supported and had access to a range of services to ensure their overall needs were met. The manager had built good relationships with other professionals to ensure people received access to a range of health and social services.

The manager had an effective way of monitoring and assessing the service provided to people with dementia.

On the day of the inspection many people were suffering a gastroenteritis type illness and we saw that this was being managed to ensure that people received care, treatment and support that met their needs. Through observation we had concerns that one person did not have their care needs met and we spoke to the manager to ensure this was addressed.

People we spoke with said that they felt safe in the home and that they would "have no problem" to speak to a member of staff if they felt concerned. Staff were knowledgeable on safeguarding matters and recognised that many of the people they cared for were vulnerable and relied on them to protect them.

Care was delivered by sufficient numbers of staff. The records of staff training were incomplete however staff told us that they had received training relevant to peoples care needs.

Systems and procedures were in place to monitor the quality of the care. People's views were sought through a number of systems.