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Archived: The Cottage Nursing Home Limited Requires improvement

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Reports


Inspection carried out on 13 August 2020

During an inspection looking at part of the service

The Cottage Nursing Home Limited is a nursing home which provides nursing and personal care for up to 53 older people. Thirty-one people were living at the service at the time of our visit.

People’s experience of using this service and what we found

Although the arrangements for assessing risk, safety monitoring and management within the service had improved since the last inspection, a number of fire safety risks had been identified in the environment and some works were required to be carried out.

Infection control measures had been increased since Covid-19 and the CQC had signposted the manager towards updated guidance for Personal Protective Equipment (PPE) in Care Homes for their staff.

Risk assessments were in place to support people to receive safe care.

People who used the service told us they felt safe. They told us staff treated them well and they knew who the manager was.

Safeguarding investigations were completed as required and appropriate action was taken when staff had not met expectations.

Relatives felt that communication could have been better during Covid-19. Professional agencies confirmed the management team had worked alongside them during Covid-19 and kept them informed.

The provider had quality monitoring systems in place which reviewed incidents and looked for patterns of behaviour. This was helpful to identify trends, or key times when people may need additional support.

The management team were striving to improve the culture within the service and took an open and transparent approach when incidents occurred. The management team were eager to learn and share good practice and this helped people remain safe. Systems were in place to audit the care provided and to seek feedback from people involved with the service.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 9 September 2019).

At this inspection we found improvements had been made and the provider was no longer in breach of regulation, however the overall rating remains the same.

Why we inspected

We carried out an announced comprehensive inspection of this service on 1 August 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe and Well-led, which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed.

This is based on the findings at this inspection.

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

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.

Inspection carried out on 1 August 2019

During a routine inspection

The Cottage Nursing Home Limited is a residential care home providing personal and nursing care to 20 people aged 65 and over at the time of the inspection. The service can support up to 53 people. The Cottage also provided personal care to people in their own homes. There was no one receiving this support at the time of our inspection.

People’s experience of using this service and what we found

At the time of the last inspection, 39 people were living at the home. Earlier in the year the provider made a business decision to stop providing nursing care for a period. This meant some people needed to move from the home. The change caused unrest with people living at the home and some people felt uncertain about the security of their placement there. The service had provided reassurance to people that nursing care would continue to be provided.

Changes in management since the previous inspection, had impacted on the leadership within the home and on the overall monitoring of the service. Quality assurance systems and processes to monitor performance required improvements. The provider had not always responded without delay to issues identified, to maintain a safe environment.

People told us they felt safe. Staff had been safely recruited and knew how to recognise abuse and keep people safe from harm. People received their medicines as prescribed. Staff had a good knowledge of infection control procedures.

People knew the current manager by name. The manager had identified improvements required and had a plan in place to action these. The service sought feedback from people about their care experience to ensure any issues were addressed.

People received care from staff that were kind, caring and compassionate. People and staff had built positive relationships together and enjoyed spending time together. People’s diversity was respected and embraced. Staff were respectful and open to people of all faiths and beliefs. People’s privacy and dignity was respected.

An activities programme was being developed. People told us activities had improved. Complaints had not always been managed to people’s satisfaction. However, the new manager was responsive to concerns raised and people felt confident they would be addressed. People were supported by staff that knew their hobbies and interests and their end of life preferences and wishes had been considered.

Staff had received training to meet people’s individual care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive ways possible; the policies and systems in the service supported this practice. People were supported to eat and drink enough and to attend healthcare appointments when needed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 02 August 2018). The service remains rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

At this inspection, we have identified a breach of regulation in relation to the systems and processes to monitor the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 17 July 2018

During a routine inspection

The Cottage Nursing home limited 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.

The Cottage Nursing home limited is located in a residential area in Northamptonshire and is registered to provide accommodation and personal care to people who may or may not have nursing care needs. They provide care for older people who may also be living with dementia and can accommodate up to 53 people at the service. When we visited there were 39 people living at the service.

At the last inspection in July 2017, the service was rated Good. At this inspection on 17 July 2018 we found the service had deteriorated to requires improvement.

There was not a registered manager in post. There was an acting manager in post, and the provider had recruited a new manager who would be going through the registration process once their employment commenced. 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.

Risk assessments were in place to manage potential risks within people’s lives, but they were not always implemented or followed by staff.

People did not always receive the support they needed to go to the toilet. There was a lack of moving and handling equipment including hoists, which meant that people had to wait long periods of time before getting the support they required.

People were not always engaged with and spent long periods of time un-occupied.

Quality audits in place were not always effective, and issues found were not always followed up on promptly.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Adequate staffing levels were in place. Staffing support matched the level of assessed needs within the service during our inspection.

Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles. Specialist training was provided to make sure that people’s needs were met and they were supported effectively.

Staff were well supported by the acting manager and senior team, and had one to one supervisions. The staff we spoke with were all positive about the senior staff and management in place, and were happy with the support they received.

People's consent was gained before any care was provided. 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 supported this practice

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Care plans reflected people’s likes and dislikes, and staff spoke with people in a friendly manner.

People were involved in their own care planning and could contribute to the way in which they were supported. People and their family were involved in reviewing their care and making any necessary changes.

A process was in place which ensured people could raise any complaints or concerns. Concerns were acted upon promptly and lessons were learned through positive communication.

Inspection carried out on 25 July 2017

During a routine inspection

This inspection took place on 25 July 2017 and was unannounced.

The Cottage Nursing Home Limited is registered to provide accommodation and care for up to 53 older people, ranging from frail elderly to people living with dementia. On the day of our visit, there were 35 people using this service.

There was no registered manager in post during our inspection; however the service had a new manager who was in the process of registering with the Care Quality Commission (CQC). 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.

Quality monitoring systems and processes were in place but required time to become embedded in staff practice to demonstrate how effective they were at identifying and improving the care and welfare of people using the service.

People felt safe. Staff had been provided with training to enable them to recognise signs and symptoms of abuse and they knew how to report any concerns. People had risk assessments in place to enable them to maintain their independence and keep them safe. Adequate staff with the appropriate skill mix were available to support people with their needs. Effective recruitment procedures were in place to ensure suitable staff were employed to work with people using the service.

Systems were in place to ensure that medicines were managed safely. This ensured that people received their medicines at the prescribed times.

Staff received appropriate training, supervision and support to enable them to carry out their roles and responsibilities effectively. People’s consent to care and treatment was sought in line with the principles of the Mental Capacity Act (MCA) 2005 legislation.

People were able to make choices about the food and drink they had and to maintain a healthy and balanced diet. If required, staff supported people to access a variety of health professionals including the dentist, optician, chiropodist, dietician and the speech and language therapist.

Staff provided care and support in a meaningful manner; and knew about people’s preferences and personal histories. People’s views were listened to and they were actively encouraged to be involved in their care and support whenever possible. Staff ensured that people’s privacy and dignity was upheld. Any information about people was respected and treated confidentially.

People’s needs were assessed before coming to live at the service and the care plans reflected how their needs were to be met. Records showed that people and their relatives were involved in the assessment process and review of their care. There was a complaints procedure in place to enable people to raise complaints.

The service was led by a manager who was new in post, and received additional support from the clinical lead. Although the manager was new to the service we found that there was an open and transparent culture, which was used to good effect in supporting people and staff to express their views about the delivery of care.

Inspection carried out on 29 September 2016

During a routine inspection

This inspection took place on 29 September 2016 was unannounced.

This was the fourth comprehensive inspection carried out at The Cottage Nursing Home.

Following our previous comprehensive inspection, on 17 and 18 May 2016 we gave this location an overall rating of 'inadequate', and placed them into special measures.

During our previous inspection we found there were no clear systems in place to log safeguarding referrals, or to ensure follow up action was carried out. We also found that people using the service were at risk of harm from some people who displayed behaviours that could challenge the service.

This was a breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also found that risk assessments in place to protect and promote people's safety needed to be strengthened to ensure risks were managed effectively to keep people safe. There were inconsistencies with the recording and administration of medicines. Records were not always fully completed and we found that people did not always receive their medicines as prescribed.

This was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In addition we found that people were not always protected against the risks associated with unsafe or unsuitable premises. Some areas of the service had not been maintained to a safe standard and repairs had not been carried out in a timely manner. This meant that areas of risk that may be hazardous to people's safety and health had not always been identified and rectified as soon as possible.

This was in breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also found that there was no formal staff induction programme in place and there were gaps in staff training that failed to support them to develop their skills and knowledge.

This was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During our previous inspection we also found that people were not always treated with compassion, kindness, dignity and respect. People did not always receive care that was responsive to their needs or focused on them as individuals. In addition we found that people were not enabled to participate in sufficient, meaningful activities that met their needs and reflected their preferences.

This was in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In addition we found that people were not always treated with dignity and respect and some staff were not always respectful of people's right to confidentiality.

This was in breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also found that the culture at the service was not person centred, but task focused. Quality assurance, health and safety checks and feedback from people had not been undertaken consistently and had not therefore effectively checked the care and welfare of people using the service.

This was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations2014.

The provider submitted an action plan to tell us how they would meet these regulations and the timescale they intended to have met them by. We carried out this inspection on 29 September 2016 to see if the provider had made the necessary improvements to meet the breaches of regulation, and to review whether the service should remain in special measures. We found that the provider had implemented systems which had improved the provision of service. The regulations were met and, as such, the service is no longer in special measures.

The Cottage Nursing Home Limited is registered to provide accommodation and care for up to 53 older people, ranging from physical disabilities to people living with dementia. On the day of our visit, there were 33 people using this servic

Inspection carried out on 17 May 2016

During a routine inspection

This inspection took place on 17 and 18 May 2016 and was unannounced.

This was the third comprehensive inspection carried out at The Cottage Nursing Home.

The Cottage Nursing Home Limited is registered to provide accommodation and care for up to 53 older people, ranging from frail elderly to people living with dementia. On the day of our visit, there were 36 people using this service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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 service did not have a registered manager. At the time of our inspection there was an operations manager in post who visited the service four days a week. They had been in post for eight weeks. In addition, the clinical lead for the service was acting as manager until one was recruited. 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.

We found that people were not always supported to remain safe in the service. A small number of people displayed behaviours that could challenge the service and this had an impact on other people living there. We found there was no clear system in place to log referrals, or to ensure follow up action was carried out. Risk assessments in place to protect and promote people’s safety needed to be strengthened to ensure risks were managed effectively to keep people safe. We found that not all the risk assessments we looked at detailed the control measures or actions to be taken to address the identified risk. This meant that risks were not always managed in such a way as to keep people safe.

People had not been protected against the risks associated with unsafe or unsuitable premises. Some areas of the service had not been maintained to a safe standard and repairs had not been carried out in a timely manner. People had Personal Emergency Evacuation Plans (PEEP) in place but they did not provide staff with sufficient and appropriate guidance to follow, to safely support people to move to a place of safety if there was a fire. The fire risk assessment had an action plan to make it more robust; however we were unable to find any evidence that the actions had been addressed. This meant that areas of risk that may

Inspection carried out on 28 July 2015

During a routine inspection

This inspection took place on 28 July 2015 and was unannounced.

At our previous inspection on 22 January 2015, we found that people were not protected against the risk of unsafe management of medicines. There were inadequate systems in place to protect people against the risk of, preventing, detecting and controlling the spread of infections. We also found that the training and development systems in place were failing to ensure that staff received the training they needed, to care safely and appropriately for people using the service.

This was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

We found that people were not provided with choices of food and drink and meal times were rushed. Staff support for people in relation to their nutritional needs was not carried out with sensitivity and staff showed little respect towards maintaining people’s dignity.

This was in breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

In addition, we found that people were not always treated with respect and dignity. Staff did not have an understanding of how to promote respectful and compassionate behaviour towards people using the service. We saw that care records did not always promote individualised care. There was little information in files about people’s personal history, interests and hobbies. We also found that people were not supported to follow their interests and there was a lack of social activities.

This was in breach of Regulation 9(3) (a)(g) and 10 of the Health and Social Care Act 2008 (Regulated Activities)

We asked the provider to provide us with an action plan to address the areas that required improvement, and to inform us when this would be completed. After the comprehensive inspection, we undertook this focused inspection to check that the provider had made improvements and to confirm that they now met legal requirements.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting 'all reports' link for ‘The Cottage Nursing Home’ on our website at www.cqc.org.uk’

The service had a manager in post. They were not registered with the Care Quality Commission at the time of our visit. However, they had submitted an application to register as a manager for 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 Cottage Nursing Home Limited provides care and support for up to 53 older people with a wide range of needs, including dementia care. There were 32 people using the service when we visited.

Improvements had been made to the management of medicines. Medicines were stored, administered and recorded safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

We found that the home was clean, hygienic and improvements had been made to reduce the risk and spread of infection.

Improvements had been made to core training and supervision for staff. Staff were continually being provided with training to ensure they were able to care for people safely and to perform their roles and responsibilities. However, some staff still needed to complete areas of core training.

We found that improvements had been made to the menus and choices of meals available for people. People were supported to eat and drink sufficient amounts to ensure their dietary needs were met. However, we observed that some people had to wait lengthy periods before they received their meal.

People were looked after by staff that were kind, patient and caring. However, improvements were required to ensure people’s privacy and dignity were maintained.

People were not always supported to be actively involved in making decisions about their care, treatment and support.

There was information available to people about the organisation, its facilities and how to access advocacy services.

People were not well supported to take part in meaningful activities and pursue hobbies and interests.

We found that the manager had introduced a system of audits, surveys, meetings and reviews for obtaining feedback, monitor performance, managing risks and keeping people safe. These were still in the early stages of development and had not yet been embedded to ensure good governance.

Inspection carried out on 16 April 2015

During an inspection looking at part of the service

This inspection took place on the 16 April 2015 and was unannounced.

We carried out an unannounced comprehensive inspection of this service on 22 January 2015. Breaches of legal requirements were found. This was because fire doors had continued to be wedged open with wooden blocks. We found that people, relatives and staff were not consulted regularly about the delivery of service and there were no systems in place to monitor performance and manage the service.

After the comprehensive inspection, we undertook this focused inspection to check that the provider had made improvements and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Cottage Nursing Home Limited on our website at www.cqc.org.uk

The Cottage Nursing Home Limited is registered to provide accommodation and care for up to 53 older people, ranging from frail elderly to people living with dementia. At the time of this inspection there were 44 people living at the service.

At this inspection the service had a manager who was new in post and had not yet registered with the Care Quality Commission. 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.

During this inspection we found that fire doors that had previously been wedged open had been fitted with automatic door guards which closed when the fire alarm sounded.

We found that the manager had introduced a system of audits, surveys, meetings and reviews to obtaining feedback, monitor performance, managing risks and keep people safe. These were still in the early stages of development and had not yet been embedded to ensure good governance.

Inspection carried out on 22 January 2015

During a routine inspection

This inspection took place on the 22 January 20215 and was unannounced.

We carried out an unannounced comprehensive inspection of this service on 10 November 2014. A breach of legal requirements was found. As a result we undertook another comprehensive inspection on 22 January 2015 to establish what improvements had been made to the service.

The Cottage Nursing Home Limited is registered to provide accommodation and care for up to 53 older people, ranging from frail elderly to people living with dementia. At the time of this inspection there were 44 people living at the service.

At this inspection the service did not have a registered manager; however they did have an interim 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.

During our inspection in November 2014 we found that people’s safety had been compromised in a number of areas; not all staff were able to demonstrate that they knew how to identify or respond to abuse appropriately; parts of the home had not been adequately cleaned or maintained and there were poor arrangements for the management of medicines that put people at risk of harm. Bedroom doors had been wedged open and this put people at risk if there was a fire in the home.

We had concerns about the arrangements in place for obtaining and acting in accordance with the consent of people.

Records did not demonstrate that people had access to health care professionals to meet their specific needs. Care records and risk assessments did not accurately reflect people’s current care needs or offer guidance for staff as to how people should be cared for and supported.

People were not provided with choices of food and drink and meal times were rushed. Staff support for people in relation to their nutritional needs was not carried out with sensitivity and staff showed little respect towards maintaining people’s dignity.

Staff were not always patient and many did not take time to listen and observe people’s verbal and non- verbal communication.

We found a deeply embedded culture which included a lack of respect, dignity and compassion for people. Care was not based around the involvement of the individual, but was task focused, and we observed people’s safety was compromised by poor practice.

Records we looked at demonstrated people’s concerns and complaints had not been dealt with appropriately. We were unable to find any information in a format that was suitable for people who were using the service to use in relation to making a complaint.

There were no systems in place to adequately monitor the quality of the service.

During this inspection we found that staff were able to demonstrate how to respond to allegations or incidents of abuse.

We found that overall, improvements had been made to the management of medicines. However, we found some gaps in the recording of medicines.

People’s safety continued to be compromised by the on-going practice of wedging open fire doors.

We found that improvements had been made to reduce the risk and spread of infection. However, there were still some areas that needed to be addressed.

We found there were sufficient staff available to meet people’s individual care and support needs. Safe and effective recruitment practices were followed.  

Improvements had been made to training and supervision for staff. However, staff had not been provided with sufficient training to ensure they were able to care for people safely and to perform their roles and responsibilities.

People’s consent to care and treatment was sought in line with current legislation. Where people’s liberty was deprived, Deprivation of Liberty Safeguards [DoLS] applications had been approved by the statutory body.

People were provided with a balanced diet and adequate amounts of food. However, people were not always offered a choice of food and drink; people who needed assistance to eat their meals were  not always provided with support in a sensitive and unrushed manner and drinks were not readily available.  

Improvements had been made to the environment. However, there remained a lack of signage for toilets and bathrooms to make them recognisable for people using the service. We have made a recommendation about providing a supportive environment for people with dementia care needs.

People told us their healthcare needs were met and care records confirmed that people had been visited by healthcare professionals such as the dietician, district nurse and GP.

People were not always looked after by staff that were caring, compassionate and promoted their privacy and dignity.

Complaints had been dealt with in a timely manner and were well recorded.

No improvements had been made to the Quality Assurance systems to assess and monitor the quality of service.

We identified that the provider was not meeting regulatory requirements and was in breach of a number 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.

Inspection carried out on 10 November 2014

During an inspection looking at part of the service

The Cottage Nursing Home Limited is registered to provide accommodation and care for up to 53 older people, ranging from frail elderly to people living with dementia. On the day of our visit, there were 44 people living in the home.

The inspection was unannounced and took place on 10 November 2014.

The service has not had a registered manager for three weeks. 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.

People’s safety had been compromised in a number of areas; not all staff were able to demonstrate that they knew how to identify or respond to abuse appropriately; parts of the home had not been adequately cleaned or maintained and there were poor arrangements for the management of medicines that put people at risk of harm. Bedroom doors that had been wedged open and this put people at risk if there was a fire in the home.

We had concerns about the arrangements in place for obtaining and acting in accordance with the consent of people. Steps had not been taken to ensure each person was protected against the risks of receiving care that was inappropriate and unsafe.

Records did not demonstrate that people had access to health care professionals to meet their specific needs. Care records and risk assessments did not accurately reflect people’s current care needs or offer guidance for staff as to how people should be cared for and supported.

People were not provided with choices of food and drink and meals were rushed. Staff support for people in relation to their nutritional needs was not carried out with sensitivity and they showed little respect towards maintaining people’s dignity.

We observed that some staff were not always patient and many did not take time to listen and observe people’s verbal and non- verbal communication. Throughout the day of our inspection we observed some poor interactions between some staff and people using the service.

Through our observations and by talking to staff we found there was a deeply embedded culture which included a lack of respect, dignity and compassion for people. We found that care was not based around the involvement of the individual, but was task focused, and we observed people’s safety was compromised by poor practice.

Records we looked at demonstrated that people’s concerns and complaints had not been dealt with appropriately. We were unable to find any information in a format that was suitable for people who were using the service to use in relation to making a complaint.

The provider was not adequately monitoring the quality of the service and therefore not effectively checking the care and welfare of people using the service.

We identified that the provider was not meeting regulatory requirements and was in breach of a number 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.

Inspection carried out on 5 June 2014

During a routine inspection

The inspection of The Cottage Nursing Home was carried out by an inspector who gathered evidence to help us answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive to people's needs? Is the service well-led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We saw that people were cared for in an environment that was clean and hygienic. We found that the equipment in place for staff to use was appropriately serviced. This meant that people were cared for in a safe, well maintained environment.

Suitable arrangements were in place for staff to respond to emergencies, deal with incidents, or seek guidance from their manager. This meant that staff received the advice and support they needed to manage problematic situations safely, effectively, and in a timely way.

There were sufficient numbers of experienced and competent staff on duty to safely meet people's personal and healthcare needs. We saw that staff had been appropriately trained to provide safe care. One person said, �I feel safe here because they do a good job and look after me.�

Staff said they had received training in the safeguarding of vulnerable adults (SoVA) and the staff that we spoke with knew how to report concerns. We saw documentary evidence that incidents or accidents had been appropriately reported to the Local Authority and the Care Quality Commission (CQC). This meant that people were protected from the risk of neglect or unsafe care.

We found that people's needs had been appropriately assessed before they were admitted to The Cottage Nursing Home. After admission to the home we saw that their needs were regularly reassessed to ensure they continued to receive safe care when their needs changed. This meant that staff had the up-to-date information they needed to minimise identified risks to people's safety and welfare.

Is the service effective?

Staff had received the information, training and managerial support they needed to do their job effectively. We saw there were arrangements in place that ensured staff had the most up-to-date information about people's personal care and nursing needs. These arrangements included verbal 'handovers' of pertinent information to staff that had arrived for duty. We saw that care records had also been updated so that staff were able to access recorded information that confirmed what had been said at the shift �handover�. This meant that the staff were able to do their job effectively because they had received the information about people they needed.

We spoke with three staff and during our inspection we had observed them going about their duties without rushing. They were able to tell us about people's individual needs and how they delivered their care. This meant that because staff had a good knowledge of each person's care needs and preferences they were able to provide effective care.

Is the service caring?

The staff presented as friendly and helpful. We heard staff encourage people to do things for themselves but they made sure people were safe and provided them with timely assistance whenever that was appropriate. People were offered support at a level which encouraged independence and ensured their individual needs were met.

We saw that people nearing the end of their life were treated with compassion and sensitivity so that their final days were as comfortable and pain free as possible.

Is the service responsive to people's needs?

We saw that there was enough staff on duty to meet people's nursing and personal care needs. This was also confirmed by the three staff, two visitors, and three people in residence we spoke with.

We heard that call bells were always answered in a timely way, with people rarely kept waiting. One person said, �I never have to wait if I need help.�

Is the service well-led?

There was a registered manager in post when we inspected. The three care staff we spoke with individually were aware of their roles and responsibilities and they confirmed they were well supported by their manager, deputy manager, and other senior staff, including the nurses. They all said that the manager maintained an 'open door' approach so that staff could readily express any concerns or ask for guidance whenever they needed to.

Inspection carried out on 13 November 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us about their experiences. We spoke to the relatives of two people, who told us that their relative received a good standard of care. One person told us �The care is alright, the fact that (our relative) is eating and drinking is a good sign�. Another person told us �I am very happy with the care, (our relative) is well cared for, the staff make sure they has a soft diet and thickened fluids on a spoon�.

We found that the provider ensured that there were appropriate staff recruitment procedures in place and that staff were suitably trained to meet people�s needs.

We found that there had been an improvement in the record keeping. However we found concerns with the management of medicines and the storage of people�s valuable belongings.

Inspection carried out on 4 October 2012

During a routine inspection

We spoke with people who use the service and they told us they liked living at the home. One person told us that the staff were good and they had no complaints. We spoke to relatives of people who use the service and they told us that staff were extremely kind. One relative told us that they had looked at numerous homes before deciding on the home and didn't think there was a better option. We found concerns in relation to record keeping at the home.

Inspection carried out on 8 September 2011

During a routine inspection

As most of the people in the home have dementia, with associated communication problems, we only spoke with three people. We also spoke with four relatives about their views of the care provided.

The people we spoke with were satisfied with the home�s care. Staff were seen as friendly and welcoming. Suggestions for improving the service were to have more outside activities with transport that can accommodate wheelchair users, and for more care staff time to be available to help people to eat at mealtimes.

People and their relatives largely praised the service: 'Staff are always friendly to me �. �I have no problems with any of the staff. They are always helpful�. �There are no rules here. I get up and go to bed when I like�. �There are no set visiting times. I come and go as I please�. �The home always looks clean and tidy �. �I never have complained but I went to the manager once and it was quickly sorted out.�

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