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Inspection carried out on 7 February 2019

During a routine inspection

About the service:

Cote House is a care home providing personal and nursing care for up to 11 people. At the time of our inspection 10 people were living at the service permanently and one person was using the service for respite care. One room at Cote House is used for people to stay on respite care to enable their carer to have a break from their caring role.

People’s experience of using this service:

People received their medicines as prescribed. Improvement was required to make sure the service knew how many medicines were in stock. Also, staff administering medicines needed their competence assessed to make sure their practice was safe.

Checks were being completed to make sure the environment and equipment were safe however, there was conflicting information in the results. This meant action had not always been taken. The registered manager addressed this during our inspection.

People were supported to make their own decisions and were involved in planning their care. People had their own care plan which was reviewed when needed. People could have visitors without restrictions.

People were supported by staff who were trained and supported in their roles. Staff understood safeguarding responsibilities and told us they would report any concerns to their manager.

People told us they enjoyed living at Cote House and felt able to complain if they needed to. There was an open and inclusive culture at the service, the registered manager was approachable and a visible presence.

People told us and we observed that staff were kind and caring. Staff used different ways to communicate with people, there were sufficient staff to enable them to sit and talk to people. People were able to follow their own interests and join in with group activities if they wished.

People’s views had been sought and action taken to change the service or make improvements following their feedback. People had the opportunity to attend ‘house meetings’ to meet with other people and discuss views.

The service met the characteristics of Good overall; more information is available in the full report below.

Rating at last inspection:

At our last inspection in January 2018 we rated the service as Requires Improvement. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people did not receive care and treatment that was appropriate and that met their individual needs and preferences. There was a lack of managerial oversight which meant quality and safety was not monitored or improved where needed. In addition, staff did not receive training to ensure they had the skills to complete their role.

Why we inspected: This was a planned comprehensive inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

Inspection carried out on 11 January 2018

During a routine inspection

Cote House is a residential care home providing personal and nursing care for up to 11 people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The inspection took place on 11 January 2018 and was unannounced. The service did not have a registered manager; the previous registered manager had recently resigned and was overseeing the service two days per week until a new manager commenced employment. 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 had not received training in all aspects of their roles and had not had regular supervision sessions with their supervisor. This meant staff's performance in their role was not regularly monitored and training and development needs were not always being identified.

People were supported to contribute to decisions about their care and were involved wherever possible. Whilst we saw some positive interactions we observed that these were not consistent throughout the day. Staff did not always treat people with dignity and respect.

People and their relatives did not speak positively about the activities available. Staff we spoke with told us there wasn’t always time to support people with activities.

There were robust recruitment practices in place that protected people from being cared for by unsuitable staff. However, staff did not feel sufficient numbers of trained and experienced staff were deployed to ensure people’s needs were met.

The acting manager was working two days per week and there was no deputy manager in post. This meant that on the other five days of the week there was a lack of leadership and a lack of managerial oversight of the service. Three notifications had not been sent to the Commission as legally required to inform of significant events such as potential safeguarding alerts. Provider quality assurance audits had been completed, but issues arising from these had not been addressed despite the audits taking place seven months prior to our inspection.

Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents and concerns. Staff we spoke with said they felt confident to raise concerns and that action would be taken to address these.

People said they had access to external health care professionals when required and the GP would visit if needed.

Inspection carried out on 21 September 2015

During a routine inspection

Cote House is a residential care home providing personal and nursing care for up to 11 people. The inspection took place on 21 September 2015. The service had a registered manager who was responsible for the day to day operation of the home. 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 and associated Regulations about how the service is run. The registered manager was present on the day of the inspection.

People liked the staff who supported them and positive relationships had formed between people and staff. Staff treated people with dignity and respect.

The care records demonstrated that people’s care needs had been assessed and considered their emotional, health and social well being. People’s care needs were regularly reviewed to ensure they received appropriate and safe care, particularly if their care needs changed. Staff worked closely with health and social care professionals for guidance and support around people’s care needs.

Staff were knowledgeable about the rights of people to make their own choices, this was reflected in the way the care plans were written and the way in which staff supported and encouraged people to make decisions when delivering care and support. Staff had received training in how to recognise and report abuse. There was an open and transparent culture in the home and all staff were clear about how to report any concerns they had. Staff were confident that the registered manager would respond appropriately. People we spoke with knew how to make a complaint if they were not satisfied with the service they received.

There were systems in place to ensure that staff received appropriate support, guidance and training through supervision and an annual appraisal. Staff received training which was considered mandatory by the provider and in addition, more specific training based upon people’s needs.

The registered manager, the regional manager and the provider carried out audits on the quality of the service which people received. This included making sure that the accommodation and the environment was safe.

Inspection carried out on 5 October 2013

During a routine inspection

Some living people at Cote House had complex needs which meant they were not fully able to talk to us about their experiences. For those people that were unable to tell us what it was like living in the home, we observed staff interactions while supporting them in communal areas. We cross referenced this with their care plans to ensure care was being delivered in line with their assessed needs. We found this to be the case during our inspection.

Three people that were able to tell us of their experiences had positive comments to make about living in the home. Comments included; "staff are nice and I feel safe here, it�s ok". Another person told us "This is a good place to live�.

People were encouraged and made day to day decisions about their life. For more complex decisions and where people did not have the capacity to consent, the provider had acted in accordance with legal requirements.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We spoke with four members of staff during our visit. Staff were very motivated,caring and attentive of the people in their care. One member of staff told us "I like it, it can be busy but we have a really good team and it is a good place to work".

A visiting relative told us, "The staff are always very kind and helpful�.

The provider had an effective system in place to record and address any complaints that were made.

Inspection carried out on 2 March 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service because they had complex needs which meant that most of the people were not able to tell us about their experiences.

We spoke with two people about the support they received from staff. They told us that the staff were patient, respectful and supportive. One person told us; "The staff support me, I try and keep independent and they help me with things I cannot do". Another person said: "The staff treat me with dignity and respect. I am well looked after".

The manager, nursing and care staff understood the complex communication and mental capacity abilities of people they supported. We saw that where able people were encouraged to make day to day decisions about their life. For more complex decisions and where people did not have the capacity to consent, the provider had acted in accordance with legal requirements.

People�s healthcare was promoted, conditions were monitored and appropriate action was taken to respond to issues and concerns that arose.

Staff were supported and had received a range of appropriate training and quality assurance measures identified where improvements could be made.

Reports under our old system of regulation (including those from before CQC was created)