Archived: Cottisbraine House

Cottisbraine House is registered as a partnership and provides accommodation, care and support to up to nine older people with learning disabilities, some of whom also have dementia and other mental health needs. At the time of the inspection six people were using the service.

The service had a 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.

Staff were aware of people’s needs and the level of support they required with their personal care and activities of daily living. However, we found that accurate and detailed care records were not maintained about people’s needs, and the support they required in regards to individual health needs. There was a risk that people would not receive the support they required if supported by staff that were unfamiliar with their needs.

The registered manager did not adhere to all the requirements of the Mental Capacity Act 2005. People required one to one support from staff in the community and due to this did not have many opportunities to access the community. The registered manager was aware that this may amount to depriving a person of their liberty but had not made applications for authorisation to do this. There was a risk that people may be unlawfully deprived of their liberty.

Staff received training to ensure they had the knowledge and skills to support people. However, sufficient processes were not in place to ensure staff were adequately supported to undertake their role, and to review their competency and performance. Staff did not receive regular supervision or appraisals.

The registered manager undertook checks on the quality of the service. However, we saw that these checks were not robust enough and did not sufficiently address areas that might require improvement. We also identified that accurate records were not kept in regards to incidents that occurred at the service so these could be analysed to identify trends and patterns to prevent similar incidents from reoccurring. There was a risk that people were not adequately supported after an incident to ensure their safety and welfare.

Staff had built relationships with people and were aware of people’s individual personalities. They were aware of people preferences as to how they wished to be supported, and were aware of people’s interests and hobbies. Staff had arranged for professionals to visit the service to provide activities for people, including a music session and a ‘keep fit’ session. However, there were limited opportunities for people to access the community. We recommended that the registered manager reviews national guidance to support social inclusion for people, in the community.

Staff supported people to have their health needs met. Staff liaised with healthcare professionals if they had concerns about a person’s health and supported people to attend healthcare appointments. People received their medicines as prescribed. Staff were aware of people’s dietary requirements and supported them to have regular meals and fluids to protect them from the risk of malnutrition or dehydration.

Staff respected people’s privacy and supported people to maintain their dignity. There were sufficient staff to provide people with timely and responsive care.

The registered manager had assessed risks to people’s safety upon their admission to the service, and plans were in place to support people to minimise and manage those risks. Staff were aware of their responsibilities to safeguard people from harm and reported any concerns a person was potentially being harmed to the registered manager so appropriate action could be taken to protect the person.

There was open communication amongst the staff team and good information sharing to ensure staff were aware of any changes in people’s support needs. Staff felt listened to by the registered manager and felt able to express their views and opinions.

We identified three breaches of legal requirements in relation to safeguarding people who use services, staffing and good governance. You can see what action we have asked the provider to take at the back of the main body of the report.

We looked at the care records of four people, spoke with seven people and three members of staff, including the manager and owner.

Below is a summary of what we found.

Is the service safe?

Care plans had details of people's needs and how these were to be met. These plans were regularly reviewed with the person using the service. Risk assessments relating to the care and support being provided were regularly reviewed to ensure people's individual needs were being met safely.

Staff understood the policies and procedures that were in place, to assess and monitor the service to prioritise people's safety. We reviewed maintenance contracts for the building and various pieces of equipment including Legionella water testing, the fire alarm system, and portable appliance testing (PAT). We found that these were all valid and within date. The provider regularly risk assessed several areas of the home. These included the hot water temperatures, the maintenance of the stair lift and wheelchairs, spills of chemicals or bodily fluids and moving and handling procedures.

Staff had not undertaken recent training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards but did understand how this could impact on the people they cared for.

Is the service effective?

People received effective care from staff that were trained and supported by the manager.

We saw that people were happy, well cared for and treated with respect. People were involved in assessments of their health and care needs and in writing their plan of care.

Is the service caring?

The service was caring. This was confirmed by our observations of staff and people using the service. Staff respected peoples' privacy, dignity and their right to be involved in decisions and make choices about their care and treatment. Where people were non-verbal, pictures were used to help staff get to know a person and communicate. Staff we spoke with told us 'each person has a gift' and 'there's an awful lot in all of them, we just help to bring it out'.

Is the service responsive?

People's needs were reassessed on a regular basis and we saw the service responded to any changing needs. We saw from the daily notes that people enjoyed the activities on offer and the home catered for their individual preferences.

Is the service well-led?

The home employed a manager who knew their staff and people well. The manager told us about the audits that they conducted and showed us the recorded evidence to support them.

The regular audits of medicines helped to reduce the associated risks with the storage and handling of medicines. Monthly checks were made by management and any mistakes noted and action taken. The supplying Pharmacy also conducted annual checks of storage and handling of medicines. The first aid boxes were checked monthly to ensure that products were within their use by date and sufficient supplies of first aid equipment were available. This meant that people using the service were kept safe from errors in storage and handling of medicines. We saw that regular checks were made of any mobility aids; this also included cleaning the equipment. Hot and cold water taps and outlets were descaled and flushed monthly.

The provider told us that when there were only three people using the service they had not carried out any formal surveys. They said that now there numbers had increased they would start again.

Due to their needs, some people we met were unable to share direct views about their care. We therefore used a number of different methods to gather evidence of people's experiences. These included observing care practices; interactions with staff and reviewing records.

On the day of our inspection we met with three people who used the service and observed how staff supported and cared for individuals. We saw that the registered manager and staff respected people's privacy and dignity, and took account of what people expressed and said in relation to the way their care and support was provided.

People who were able to communicate with us said they were happy with the service. One person told us, 'I like living here. The staff are very nice. Another person told us that they had a range of activities they enjoyed doing and they were attending an art class on the day of our inspection. We saw that people were supported to undertake a range of activities in the community and had varied and individual routines.

We spoke with representatives of people who use the service. One person told us 'I am very happy with the care and support that is provided. The staff are very nice and helpful. I have never needed to complain but if I had a problem I would just speak with the manager and I know it would be resolved'.

People had consented to their care and treatment. Where people did not have the capacity to consent, decisions would be made in their best interest and with people's representatives fully involved. People we spoke with said they had choice and control over the support they received. We observed they were involved in making decisions about their daily lives.

Due to their needs, some people we met were unable to share direct views about their care. We therefore used a number of different methods to gather evidence of people's experiences. These included observing care practices; interactions with staff and reviewing records.

During our visit people were offered choices, spoken to respectfully and showed signs of well being when interacting with the staff. People who were able to communicate with us said they were happy with the service. Comments included, 'the staff are very nice and helpful' and 'I enjoy the food and choices I am given'.

Since our last inspection, care plans had been updated to reflect people's agreed care and support needs and people were being supported to make decisions about their lives. We found that the registered manager and staff had attended relevant training to keep their knowledge and skills refreshed. Quality monitoring systems had been strengthened. This meant that the manager knew what was working well and what needed improving in the home.