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Archived: The Cottage Care Home Requires improvement

Reports


Inspection carried out on 21 and 23 July 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 20 and 22 January 2015 at which three breaches of legal requirements were found. Accurate records relating to medicines, risk assessments and evacuation plans were not available in some instances. People had decisions made on their behalf that were not fully documented to make sure their changing needs and circumstances were addressed. We had not received some relevant notifications from the service. Services tell us about important events relating to the service they provide using a notification.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this focused inspection on 21 and 23 July 2015 to check they had followed their plan and to confirm they now met legal requirements. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘The Cottage Care Home’ on our website at www.cqc.org.uk.

The Cottage Care Home provides accommodation and personal care for four adults with a learning disability or an autistic spectrum condition. Both younger and older adults use the service. The four people living at the home had a range of support needs including help with communication, personal care, moving about and support if they became confused or anxious. Staff support was provided at the home at all times and people required the support of one or more staff when away from the home.

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 and associated Regulations about how the service is run.

At our focused inspection on 21 and 23 July 2015 we found the provider had followed the action plan which they had told us would be completed by 31 May 2015 and legal requirements had been met. The safety of the service had been improved as risk assessments, evacuation plans and medicines records now reflected the help people needed. People’s ability to make decisions was being routinely assessed and decisions made in their best interests as a result were being recorded. Staff understood the limitations of their decision making for others. Notifications of significant events were being shared with us in line with the requirements of the law.

Inspection carried out on 20 and 22 January 2015

During a routine inspection

This inspection took place on 20 and 22 January 2015 and was unannounced. The Cottage Care Home provides accommodation and personal care for four adults with a learning disability or an autistic spectrum condition. Both younger and older adults use the service. The four people living at the home had a range of support needs including help with communication, personal care, moving about and support if they became confused or anxious. Staff support was provided at the home at all times and people required the support of one or more staff when away from the home.

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 and associated Regulations about how the service is run.

At the last inspection on 6 August 2014, we asked the provider to take action to make improvements to the way medicines were stored and recorded. This action has been completed.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The evidence was gathered prior to 1 April 2015 when the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 were in force.

Accurate records relating to medicines, risk assessments and evacuation plans were not available in some instances. People had decisions made on their behalf that were not fully documented to make sure their changing needs and circumstances were addressed. We had not received some relevant notifications from the service. Services tell us about important events relating to the service they provide using a notification. You can see what action we told the provider to take at the back of the full version of this report.

People were supported by a caring staff team who knew them well and treated them as individuals. For example, staff understood the ways each person communicated their needs and preferences. One relative said “Brandon Trust have given him a wonderful life. They support him and help him emotionally.” People were supported to stay active at home and in the community. Staff supported people to take part in activities they knew matched the person’s individual preferences and interests.

People were encouraged to make choices and to do things for themselves as far as possible. In order to achieve this, a balance was struck between keeping people safe and supporting them to take risks and develop their independence. One relative said “staff have worked hard to help [name] reach their potential.”

Staff felt well supported and had the training they needed to provide personalised support to each person. Staff met with their line manager to discuss their development needs and action was taken when concerns were raised. Learning took place following any incidents to prevent them happening again. Staff understood what they needed to do if they had concerns about the way a person was being treated. Staff were prepared to challenge and address poor care to keep people safe and happy.

Inspection carried out on 6 August 2014

During a routine inspection

At the time of our inspection the provider had a new manager in post. The manager was applying for registration with the Care Quality Commission. In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

Four people lived at the home but we were unable to speak to them as they had complex needs and had difficulty communicating. We gathered evidence of people's experiences by reviewing records, observing care practices and talking with staff.

A single adult social care inspector carried out the inspection. The focus of the inspection was to answer five questions: Is the service safe, effective, caring, responsive and well-led?

We found the service was safe.

Overall we found the service was safe but we found the management of medicines to be unsafe. We found inappropriate arrangements for the recording, handling, dispensing and disposal of medicines.

Staff told us they had received training about safeguarding vulnerable people. They told us they would report concerns immediately to a senior staff member. Policies, procedures and local guidelines were available for staff to follow. The provider might find it useful to note that the policies read were dated 2010 and we found no evidence of policies being reviewed.

We saw that staff had a good rapport and interacted well with the people living in the home. We saw that people freely approached members of staff when they wanted support.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act (MCA) and people had DoLS authorisations in place. This was in line with the provider's policies and procedures, and the CQC had been notified as required by law. This meant that people would be safeguarded as required. We saw systems in place to ensure that managers and staff learnt from accidents and incidents as well as comments received from professionals and relatives of people who use the service.

Is the service effective?

People's health and care needs were assessed comprehensively and found they had been supported to be involved with their health action plans and care plans. We saw involvement from external health professionals such as the community learning disability team (CDLT).

We spoke with staff who told us the had received regular supervision and an annual appraisal.

We found the service was caring.

We spoke with staff, and observed the interactions they had with people. We found, without exception, that staff spoke kindly and demonstrated a good understanding of people's needs. Staff said they enjoyed working at the home as each day was different. During our visit we observed there was a relaxed atmosphere with people choosing where they wished to spend their time. We observed staff treating people with kindness and patience. Staff demonstrated they knew people's needs and ensured people were treated with privacy and dignity.

We found the service was responsive.

People had their needs assessed on a regular basis. They met with their key workers regularly to review their plans and to discuss what was important to them. Staff told us that people understood what they said and were able to respond through the use of symbols, signs and gestures. We saw care plans which showed us that that the care, treatment and support was reviewed in line with people's changing needs. Records confirmed people's likes and dislikes and preferred routines.

We found the service was well-led.

The service had a good quality monitoring system which ensured that the manager was aware of any changes in the service and was able to respond proactively.

Other agencies had written positive comments about the way the service provided good information and worked in a way that improved people's health and well-being.

We observed good relationship between staff and management on the day of our visit. Staff were clear about their roles and responsibilities and told us that they were supported by their manager.

Inspection carried out on 19 August 2013

During a routine inspection

We were unable to ask people about their views of living in the home because of their complex communication needs. However, we observed that staff understood people's communication needs and were able to support people to make choices about their daily living. Staff we spoke with showed that they had a clear understanding of involving people in day-to-day decisions about their care.

Care plans were personalised to each individual's needs and detailed how staff should work with people to meet those needs. Risk assessments had been completed where necessary and all care records were regularly reviewed.

There were enough qualified, skilled and experienced staff to meet people�s needs. Care was provided in an environment that was safe, well maintained and met people�s needs. The provider sought the views of people�s families and visiting professionals and used these comments to improve and develop the service.

Inspection carried out on 19 June 2012

During a routine inspection

We were not able to speak to people to ask them directly about living in the home because the people using the service had complex needs which meant they were not able to tell us their experiences.

We gathered evidence of people�s experiences of the service by reviewing feedback that families and professionals had given the service. It was clear from the comments made by families and professionals that they were confident in the home�s ability to provide a good standard of care to the people living at The Cottage. Comments were made referring to the staff's attention to detail regarding people�s needs and how well staff alleviated any problems.

Staff were observed interacting with people in a respectful manner that showed that they understood each individual�s needs and how to communicate with them.

There was a calm and relaxed atmosphere in the home and we observed people moving freely around their home accessing communal areas, their bedrooms and the garden.