The Cottage Residential Care Home

The management team were working closely with the Clinical Commissioning Group, and the local commissioner’s safeguarding and quality improvement teams which mitigated the risk to people living at the service.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Cottage Residential Home on our website at www.cqc.org.uk

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

We undertook this comprehensive inspection to check that the registered provider had made the required improvements and to confirm they now met legal requirements. The management team had made significant progress to address the previous concerns and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The Cottage Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 10 people who have a learning disability or autistic spectrum disorder. People who use the service may also have mental health needs, a physical disability or dementia.

The Cottage is situated in a residential area, close to the seafront and the town centre. The premises are on two floors with each person having their own individual bedroom and communal areas are available throughout. At the time of our inspection, eight people were using the service.

There was a registered manager in post. 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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

Safe processes were in place for the administration of medicines and there were procedures in place to ensure the safety of the people who used the service. There were systems in place to safeguard people from abuse. There were adequate numbers of staff who had been recruited safely and were trained and supported to meet people’s needs. Staff were aware of their responsibilities and knew how to report any concerns.

Staff demonstrated an understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS.) People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service support this practice. People were supported to eat and drink enough and to ensure they maintained a balanced diet and referrals to other health professionals were made when required. The environment was well maintained and suitable for the needs of those living at the service.

People and their relatives were involved in the planning and review of their care. People were supported to follow their interests and participate in social activities. A complaints policy was in place.

Risk assessments and care plans provided detailed and relevant guidance for staff in the home. People were supported effectively with their nutritional needs and received personalised care from a staff team who were kind and caring, respected their privacy and dignity and promoted their independence.

Systems and quality assurance processes had been improved. The management team were more pro-active and committed to continuous development which had led to improvement in the managerial oversight of the service.

The Cottage accommodates up to 10 people who have a learning disability or autistic spectrum disorder. People who use the service may also have mental health needs, a physical disability or dementia. At the time of the inspection nine people were living in the service.

The Cottage is a ‘care home’. 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.

There was a registered manager, who also owned 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 service has been managed by the same provider with the support of a stable group of staff who know people well. Despite this we found shortfalls in protecting/promoting people’s best interests, risk management, health and safety, environment, infection control, medicines management, staff training, and effective care planning. The provider demonstrated a lack of awareness of national best practice guidelines and had not kept up to date to ensure the quality of care reflected this. This included the care Quality Commission’s; Registering the Right Support to ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen, as well as other best practice guidance linked to people’s needs.

Staff awareness of potential risks to people were not embedded in their day to day practice. Environmental risk assessments and checks in place were not comprehensive and were not based on nationally recognised health and safety requirements. The system in place to protect people from infection and promote good hygiene practice was not safe and effective. Improvements were needed to ensure people were consistently supported in a clean and hygienic environment. This extended to ensuring their own privacy and dignity was being respected at all times.

Improvements were needed in the management of people’s medicines to ensure they were effectively administered and supported people’s individual needs. Insufficient information and guidance for staff meant that opportunities to limit risk were not understood or recognised.

Risks were being mitigated by the support of other health and social care professionals. However we were concerned that the opportunity to take effective action and embed it in staff practice had not been taken after our previous inspection in March 2016.

We identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following this inspection we took immediate enforcement action to restrict admissions and force improvement. The Commission is further considering its enforcement powers.

The overall rating for this service continues to be 'Inadequate' and the service is therefore in 'Special Measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Cottage Residential Care Home provides accommodation and personal care to up to ten people who have a learning disability or autistic spectrum disorder. People who use the service may also have mental health needs, a physical disability or dementia. On the day of our inspection there were nine people living in 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.

The service was not consistently well-led. The management team did not keep up to date with current guidance and good practice particularly with regard to the people they supported. This was reflected in a number of areas of the service, for example the implementation of the Deprivation of Liberty Safeguards. Some systems were not robust enough to ensure that the service provided a consistent, safe and good quality service.

Whilst staff displayed an in-depth knowledge of the people they supported some care plans contained duplicated and contradictory information about the care people required and how it should be delivered.

People were encouraged to take part in activities that they enjoyed and were supported to maintain relationships with family. Where appropriate people were supported to gain employment and attend college.

The majority of people and staff had been with the service for a long time. This was reflected in the knowledge staff displayed of the people they supported and the homely atmosphere in the service.

We have made a recommendation that the service explore current good practice guidance on supporting people with autism and learning difficulties.

Below is a summary of what we found. We used the evidence we collected during our inspection to answer five questions.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People commented, 'The staff are good.' One person said, 'Staff help me to look after myself.'

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service safe?

Records contained detailed assessments of people's needs that had been carried out prior to them moving to the home. Any training needed for staff to support people safely was identified and provided prior to the person moving to the service and if their needs changed. This ensured that the staff had the relevant skills and knowledge required to meet the individual's identified needs.

Where people did not have the mental capacity to provide consent the provider complied with the requirements of the Mental Capacity Act 2005. Staff had received training in this area. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Whilst no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

Where people were able they told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew the people well.

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary needs had been identified in care plans where required. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

The training that staff had received equipped them to meet the needs of the people who used the service.

Is the service responsive?

There was information on how to make a complaint if people were unhappy. This was in a variety of formats that met people's individual communication needs. Monthly service user meetings took place where people had an opportunity to provide feedback on the service. Where shortfalls or concerns were raised these were addressed.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. As a result, the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities and that they received excellent support and supervision from the manager. Staff had a good understanding of the ethos of the service. We saw that all staff had accessed National vocational qualifications ranging from level two to level four. This helped to ensure that people received a good quality service from trained and competent staff at all times.

We saw that staff treated people with respect and encouraged them to make choices and express their views. It was evident that staff knew people well and were caring in the way they supported people.

Relatives were complimentary about the service and happy with the quality of care. A relative who completed a survey as part of the home's quality assurance process said: 'We are very happy with the care that X is receiving.' Another relative said: 'This is X's family. They are very happy at The Cottage. The care is really great.' We saw that the service responded to people's needs effectively.

There were systems in place to support people to take their medication appropriately and safely.

The environment at The Cottage Residential Care Home was homely and people's bedrooms were decorated according to their preferences.

The provider had processes in place to seek the opinions of people who lived at The Cottage Residential Care Home and their relatives. They also carried out checks to monitor the quality and safety of the service.

We saw that The Cottage provided a relaxed and homely environment to people. Staff were friendly and respectful in their approach and interacted with people using the service in a confident and considerate manner. During the course of our visit we saw that people were supported to express their views and choices, taking part in activities such as cooking and going out into the community.

The staff team were well trained but not always regularly supervised and supported through the management supervision process.

Some records were not sufficiently maintained and the provider did not have an effective quality monitoring and assurance system in place.