This inspection took place on 30 September and 1 October 2015. The first day was unannounced.
Coxbench Hall is a residential care home providing accommodation and personal care for up to 39 older people. There were 32 people living there at the time of our inspection. Coxbench Hall is a period building that has been adapted to the needs of people in residential care. The building has three floors, accessible by stairs and a lift. The gardens are spacious and well maintained, with several outside sheltered seating areas for people. All but two of the bedrooms have ensuite toilets, and there are bathrooms and shower rooms on each floor.
There was a registered manager at the service 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.
At our previous inspection on 4 July 2014 we found that there were two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 relating to the care and welfare of people who use services, and records. We asked the provider to send us an action plan to demonstrate how they would meet the legal requirements of the regulations. During this inspection we looked at whether improvements had been made.
At this inspection we found improvements had not been made in relation to care and treatment records. Staff were not consistently completing risk assessment and plans associated with people’s care. There was also evidence that one person was at risk from staff not making a timely referral to healthcare services.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
Staff were trained in how to protect people from the risk of abuse and avoidable harm. They knew how to recognise and report their concerns to the registered manager, provider, and local authority if required.
The provider had recruitment procedures and staff were subject to a probationary period. The provider had clear guidance and policies about what they expected from staff. Regular supervision and training was given to staff to ensure that they maintained the level of caring skills required by the provider. This showed that people were cared for by staff who were suitable and skilled to meet their needs.
Enough suitable skilled and experienced staff were available to meet people’s needs. People were supported to be as independent as possible, and had a call system that enabled them to alert staff quickly if they needed assistance. Staffing levels were adjusted according to people’s needs.
Medicines were stored, administered, recorded and disposed of in accordance with professional guidance and regulations. Staff were trained in safe administration of medicines.
Staff sought and obtained people’s consent before providing care. Where people declined support offered, staff respected their wishes and checked to make sure people had not changed their minds. Where people lacked capacity to consent to their care, staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). However, care plans did not always accurately record assessments of capacity.
Staff provided meals that were balanced and nutritious. They had a good understanding of people’s dietary requirements and supported people appropriately.
People were involved in planning and regularly reviewing their own care. They felt able to speak to staff about concerns or ideas for improving the service. The provider actively sought the views of people, relatives and staff about the service, and there was evidence of changes being made as a result of this.
The home supported people to take part in a range of activities during the week, and there were regular opportunities to maintain contact with family, friends and local communities.
The service had an open culture where people and staff felt supported to express their views about care. However, the provider’s monitoring system did not always identify issues or concerns about the quality of care.