We carried out a review of the data available to us about The Cotswold on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Cotswold, you can give feedback on this service.
The Cotswold is a care home providing personal and nursing care for people predominantly aged 65 and over, either on permanent or short stay basis. The service is a purpose-built two storey building providing private rooms and a choice of communal spaces, such as a library as well as beautiful gardens. The Cotswold can accommodate up to 51 people and there were 49 people living at the service at the time of our inspection.
People’s experience of using this service and what we found
The entire team put people at the heart of the service delivery. Meeting people’s individual expectations, including any smallest and unique expectations as explored by gathering people’s life histories was the driving force for the staff. Staff fully appreciated the importance of ensuring people kept their own individuality and had the support that met their wishes and expectations, this included using innovative ideas.
The provider’s aim was to provide “Exceptional care delivered around the clock” and there was evidence the entire team shared this aim and delivered it successfully. The staff excelled at ensuring people experienced the benefits and the values of person-centred care. People described staff as “Marvellous”. Staff demonstrated they knew people’s needs in detail and formed a meaningful rapport with people and their relatives. People’s visitors were welcomed without restriction and encouraged to be actively involved in the life of the service.
Staff excelled in providing compassionate and dignified end of life care, with people’s lives celebrated and valued. We received exemplary feedback from people’s relatives around support they had with planning for the end of life care and the delivery of palliative care.
The registered manager promoted a positive approach to complaints management and they were able to demonstrate where improvements had been made as result of learning from concerns.
The service was run exceptionally well which ensured an excellent track record of their compliance with the regulations. The team was led by example by the extremely passionate registered manager who was fully committed to continuous improvement, she told us, “I always think we can do better”.
The registered manager proactively sourced any opportunities that ensured the staff were, in their words, “Ahead of the game” in relation to following the good practice guidance. They participated in local and national projects to ensure the quality of care delivered was constantly being enhanced.
The team worked closely with other agencies and promoted an open and transparent culture with a strong emphasis on staff development. We had exemplary feedback from the staff. One staff member reflecting on their personal development journey at the service commented, “It’s the role I want to do, the person I want to be”. There was a very high staff morale and the team demonstrated a real sense of pride working at the service. External professionals were very complimentary of the service and told us, “It is always a pleasure to visit the home”.
There was a very high level of confidence in the leadership of the service expressed by people, relatives, external health professionals and staff. There was a strong emphasis on involvement of people. This was not only in decisions relating to day to day running of the service but also in contributing to developing policies, recruitment of staff and decision at the provider’s level, such as marketing campaign. The registered manager ensured their systems to monitor the quality and safety of the service provided remained effective. There were additional checks at the provider’s level that ensured the team at The Cotswold was well supported.
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. People were supported to meet their nutritional needs and access health care services.
People remained safe and supported by sufficient numbers of skilled and motivated staff who provided caring and compassionate support. People’s dignity, privacy and confidentiality were respected.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
Good (report published 10 March 2017).
Why we inspected
This was a scheduled inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
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.
People and their relatives were very complimentary about the caring nature of the staff. People benefitted from staff that knew people’s needs well and used this information to take steps to enhance people’s quality of life. People had opportunities to contribute to the wider community and staff promoted people’s dignity and choices. People’s cultural and spiritual needs were considered and people had opportunities to celebrate different cultures and diversity via a themed events organised by staff.
People were supported to maintain good health and to access health professionals when required. Staff ensured people were supported with their meals and had their nutritional needs met. People were very complimentary about quality and choice of meals available at the service.
People were involved in decisions about the support they received and supported to remain as independent as possible. Staff had an excellent approach to their work. They were motivated and passionate about caring for people. Staff supported people and their relatives in a kind and compassionate way when people were approaching the end of their life. The team were in a process of working towards their Gold Standard accreditation in delivering end of life care.
Staff received sufficient training and told us they were confident to carry out their roles. Staff spoke positively about the support received from the management. Staff told us the registered manager was approachable and there was a good level of communication within the service. There were enough staff to meet people needs. The registered manager ensured provider’s recruitment procedures were followed. This included thorough background checks to ensure staff were suitable for their roles and safe to work with people.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. People were supported to have maximum choice and control of their lives. People benefitted from staff that understood the principles of MCA and ensured people’s right were respected.
People told us they were safe at the service. Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risks to people’s health and well-being were assessed and recorded. People received their medicines as prescribed and when needed. However, the provider’s system to manage stock control and safe storage of medicines needed improving. The registered manager took immediate action to address this issue.
People's needs were thoroughly assessed before people were admitted to the service. This ensured the care plans drawn were detailed, personalised and contained detailed information about people’s preferences. People told us they received the care they wanted and needed. The dedicated team of activity coordinators ensure there was a varied activity programme available to people.
People knew how to make a complaint and the complaints received were managed in accordance with the provider’s complaints policy. The provider had quality assurance systems in place and a clear plan to develop and further improve the service. The registered manager promoted open and transparent culture and was very receptive to any feedback.
We visited The Cotswold on 27 November 2014. The Cotswold provides nursing care for people over the age of 65. A few people living at the home had a diagnosis of dementia. The home offers a service for up to 51 people. At the time of our visit 50 people were using the service.
We last inspected in August 2013. We looked at how people were respected and involved in their care, and also how the provider managed the quality of service they provided, managed safeguarding concerns and recruited workers. We found no concerns at that inspection.
There was a registered manager in post at the service. 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, staff and people were all aware of the aims of The Cotswold. This included ensuring people, as much as possible, continued to live an active and social life. People we spoke with were incredibly happy with the social life at the home and how they were involved in making changes and improvements to their home. There were always plenty of activities and events for people to enjoy, and people were encouraged and supported by staff to organise their own events
People were safe and were cared for by trained and knowledgeable staff. There were enough staff to meet the needs of people living at the home. The registered manager ensured where people’s needs changed, the level of staff changed to meet those needs.
Staff knew the people they cared for, and ensured people were respected and treated as individuals. People spoke positively about staff and how caring and compassionate the staff were. Staff kept people comfortable and reassured people when they were in pain or distress. People told us how staff took the time to know them, and ensured they were happy with their surroundings.
People were involved in planning their care. People were supported to make decisions about their care and these decisions were respected. Where people did not have the mental capacity to make certain decisions, they were supported by relatives, staff and local healthcare professionals to make decisions in their “best interest.”
There was a “residents committee” which met with the registered manager regularly. This committee discussed changes to the home, and allowed people to raise ideas and concerns. We saw the manager, where appropriate, acted on people’s ideas.
Where people had specific dietary needs, staff ensured these needs were met. People had access to plenty of food and drink, with a variety of meals on offer.
People and staff felt the registered manager and clinical lead were approachable and available. Everyone spoke positively about the management team, and felt their concerns would be listened to. The registered manager and clinical lead had effective systems in place to manage the home and ensure people’s needs were met.
The registered manager supported staff and people to be involved in changes to the home. Staff were involved in discussions around concerns and people were involved in refurbishment choices.
The provider supported the registered manager and regularly monitored the home to ensure people were safe and cared for. When concerns were identified, clear action was taken by the registered manager and their staff.
We observed that care workers cared for people in a caring and respectful way. For example, we observed one care worker assist a person to walk to the toilet. We saw the care worker worked at the persons pace and reassured them. The care worker supervised and only supported when the person requested.
One person told us "I feel safe, if I didn't, I'd let someone know". Another person told us, 'Oh I feel very safe and I've got no concerns'. This showed us that people felt safe living within the home.
Care workers, nurses and domestic workers received appropriate professional development. Care workers we spoke with felt that they were supported by the provider and had access to appropriate training and a structured supervision and appraisal programme.
People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. We saw a copy of the last two quality assurance surveys completed by the home. People's views were brought together and the provider documented any actions. We saw that appropriate action was taken.
People were provided with information about the service provided and involved in discussions about how to improve this. People were treated with dignity and respect.
People's needs were assessed and their care and support plans were person centred and kept up to date. We observed staff supporting people sensitively and patiently. Those spoken with had a good understanding of people's needs.
Systems were in place for the safe handling and administration of medication. People were supported to manage their own medication if they wished.
Robust recruitment and selection processes were in place to make sure that all information and records were obtained about new staff before they started work.
People said they had no concerns about the quality of care provided. A visitor told us, "we couldn't find fault with anything". People told us they could talk to any member of staff if they had concerns. Residents' and relatives' meetings provided the opportunity to discuss any issues with other people.