Cotteridge House

Cotteridge House is a residential care home providing personal care and accommodation to up 10 people. The service provides support to older people and people with dementia. At the time of our inspection there were 8 people using the service.

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

Some people, whose personal budgets were managed by the home did not have a written agreement in place giving the provider authorisation to manage their personal budgets. The entrance to a fire door on the ground floor was blocked due to items being placed in front of the door, such as a wheelchair and cleaning equipment.

Some staff members had a temporary Disclosure and Barring Service (DBS) certificate and did not have the required risk assessment in place or evidence they were being supervised when administering care tasks.

We were not assured that the provider was supporting people living at the service to minimise the spread of infection.

Some people had mental capacity assessments records however the mental capacity assessments were not signed, no name details of the person undertaking the assessment and no date. In addition, the mental capacity assessments were not decision specific. The lack of information recorded did not assure us people were being supported to make their own decisions. Some people’s Deprivation of Liberty Safeguards (DoLS) authorisation renewals were not sent in a timely manner.

The provider had safeguarding systems and processes in place to keep people safe. Staff knew about the risks to people and followed the assessments to ensure they met people's needs.

People felt safe and were supported by staff who knew how to protect them from avoidable harm.

Audits undertaken by the provider were not effective at monitoring the quality of the service, some risk assessments lacked detail to clearly identify what mitigation was in place. In addition, some care plans did not contain enough detail.

Staff spoke positively about working for the provider. They felt well supported and that they could talk to the management team at any time, feeling confident any concerns would be acted on promptly. They felt valued and happy in their role.

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

Rating at last inspection and update

The last rating for the service under the previous provider was requires improvement, (published on 11 July 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about care delivery. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well Led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective 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.

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.

Enforcement

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 safe care and treatment, the need for consent and governance.

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 changes will be implemented. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cotteridge House is a residential care home providing personal care and accommodation to 11 people aged 65 and over at the time of the inspection. The care home accommodates 11 people in one adapted building.

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

People's care plans were limited in the information they provided. Risk assessments were in place but did not contain enough information to mitigate risk. Medicine processes were not always safe. People told us they felt safe and staff knew people well.

Staff received training and had been provided with an induction and felt able to approach the registered manager with any concerns. People were supported to maintain their health.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff treated people with dignity and respect. We observed positive interactions between staff and people. People told us staff were kind and caring.

The provider had a complaints procedure but there was not an easy read version available. People felt able to go to staff who would listen to them. People participated in activities and community involvement was encouraged.

Quality monitoring systems included audits on medicine, care plans and risk assessments. These systems and processes did not demonstrate safety was effectively managed. Professional advice was not always sought in relation to health needs. Information was not always shared with external agencies in relation to safeguarding.

Rating at last inspection

The last rating for this service was good. (report published 5 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to consent to care and treatment and good governance at this inspection.

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 work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

There was a registered manager in post who was present throughout the 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.

People and their relatives told us that they felt safe with the staff who supported them. Staff were aware of the need to keep people safe and understood their responsibilities to report allegations or suspicions of poor practice. Assessments had been undertaken to identify any potential risks to people and guidance was available for staff to follow to minimise those risks. Moving and handling transfers were carried out in a safe manner. Medicines were being given as prescribed and stored safely.

Staff were provided with training to keep their knowledge and skills current. Staff told us that they had received an induction when they commenced working at the home, and safe recruitment practices were in place. People were provided with a good choice of food and were supported to access relevant healthcare professionals when needed.

People were cared for by staff who knew them well and who they described as kind and compassionate. People expressed how they wanted their care to be delivered. Staff did not have sufficient information to apply the principles of the Mental Capacity Act in all instances. People told us that they were treated with dignity and respect, but we could not be sure that people had their privacy fully respected.

People and their relatives had been involved in the development of their care plans. People were supported to participate in some social activities. People told us that they felt enabled to raise concerns and complaints and were confident that these would be investigated and acted upon.

People, their relatives and staff described the home as well-led and felt confident in the registered manager. People told us that they were asked their views about the care and support they received. There were systems in place to monitor and improve the quality and safety of the service provided.

People told us and we saw that staff were polite, respected people's dignity and spoke to them as adults.

People experienced care, treatment and support that met their needs and protected their rights. There was a range of activities however several people said they would like to go out more. A person who used the service told us, 'The staff are very good but I wish I went out more'.

People received sufficient quantities of food and drink to meet their needs and were supported to make choices about what they ate and drank from the menu.

The provider had robust recruitment procedures in place to ensure that people employed at the service were of good character and had the necessary skills, qualifications and knowledge to meet the needs of the people who used the service.

There were good arrangements for making sure that standards of care and support were monitored and improved, where necessary. We saw that the manager supported the people who used the service and their relatives to comment on the quality of care people received.

People told us that they were happy with how their care and support needs were being met. They told us that staff were available at the times they needed them and that they supported them in a respectful manner. People told us that staff offered them choices of how and where they wanted to spend their time. A person using the service told us 'I am looked after really well here. Staff can't do enough for me.'

People told us about the quality and choice of food and drink available. They told us that they were satisfied about the choice and quality of meals and that food and drink was readily available to them. A person using the service told us 'Staff always let us know what it is for lunch. There are always alternatives if we don't like the meals they have prepared.'

People told us that they felt safe living at the home and that they would speak to the staff if they had any concerns. A person using the service told us 'If I had any complaints I would be happy to talk to the manager or staff.'

During our inspection, we asked local authority staff involved in monitoring the home about the quality of service provided. They told us that they did not have any concerns about the service provided.