Cotman House

Cotman House is a residential care home providing accommodation for person’s needing personal care support to up to 62 people. The service provides support to adults, some living with dementia. At the time of our inspection there were 51 people using the service.

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

Systems were in place designed to keep people safe from abuse and harm. Lessons were learned when incidents had happened to reduce future occurrence. There were systems to monitor the safety of the environment to reduce risks to people and staff.

Infection control processes and procedure reduced the risks of cross contamination. People were supported to have visitors from their family and friends, which was kept under review by the registered manager along with keeping updated on government guidance and to keep people safe.

There were staff vacancies, however, systems in place reduced the risks of people not having their needs met, including the use of agency staff and ongoing recruitment.

People received their medicines when they needed them and regular monitoring by the management team supported them to identify any shortfalls and address them.

The service had systems in place to monitor the service provided, this included audits and feedback from people using the service and relatives. Where improvements were identified as needed, actions were taken. There were systems to use learning to continuously drive improvement.

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 good (published 19 January 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to investigation. As a result, this inspection did not examine the circumstances of the incident. We received concerns in relation to staffing, visiting and the care provided. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report. We found the provider had taken action to reduce risks to people.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

You can read the report from our last comprehensive inspection and focused, by selecting the ‘all reports’ link for Cotman House on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cotman House is a residential care home providing personal care to up to 62 older people in one adapted building. At the time of our inspection there were 58 people using the service. Some were living with dementia.

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

People were being provided with a service which was well-led. The quality monitoring systems in place supported the registered manager and provider to identify and address shortfalls in a timely way. Where incidents had happened, lessons were learned to reduce the risks of them happening again. People’s views and concerns were listened to and used to drive improvement.

Systems designed to reduce the risk of avoidable harm to people using the service, including abuse, were in place. Medicines were managed safely and monitoring reduced risks to people. Staffing levels were determined by the monitoring of people’s dependency levels to reduce the risks of not having their needs met. Checks were made on new staff to reduce the risks of unsafe recruitment. Infection control processes and procedures reduced the risks to people, visitors and staff.

People were being provided with a service which was responsive to their needs. Care records guided staff in how people’s specific needs and preferences were to be met, these records included people’s end of life decisions. There was a programme of activities available to people to reduce isolation and boredom. There was a complaints procedure in place and complaints were addressed and used to drive improvement.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 10 January 2020) and there were two breaches of regulation relating to person centred care and safe care and treatment. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about medicines, care provided and staffing. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. We also undertook this focused inspection to check the provider 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, Responsive and Well-led which contain those requirements.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good. 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 Cotman House 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.

Cotman House is a residential care home providing personal care to up to 62 older people. At the time of our inspection there were 49 people using the service, some were living with dementia.

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

Improvements were needed in how the service ensured people’s care plans were reviewed and reflected people’s current needs and how they were met. Records reviewed did not include people’s end of life decisions, the registered manager was working on improving this. The risk assessments and associated care plans and documents were contradictory and did not demonstrate the risks to people in their daily living were robustly assessed and mitigated to reduce the risks of avoidable harm. We have made requirements to improve in these areas.

There had been several changes in the management team since our last inspection. A new registered manager was in place and staff and people told us they could see improvements were being made. The registered manager was aware of the improvements needed and was working to implement them. However, these were not yet implemented and improvements identified by the provider in May 2019 had not been addressed in a timely way.

Improvements had been made to reduce the risks of people falling from balconies in some bedrooms. The environment was safe and regular checks on equipment were undertaken. Improvements had been made in how the staff recorded when people had received support with their prescribed creams and lotions. Medicines management systems were safe. We had received concerns prior to our inspection relating to staffing levels, however at the time of our inspection the registered manager was taking action to improve in this area, including the recruitment of new staff. Recruitment processes were safe. Systems were in place which were designed to reduce the risks of abuse. Infection control processes were in place which reduced the risks of cross infection.

Staff were trained and supported to meet people’s needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service support this practice. People’s needs relating to their diet and hydration were being met. People had access to health care professionals where required and the service worked with other professionals involved in their care. The environment was well maintained, and the registered manager was in the process of making improvements to assist people to navigate independently around the service.

People told us the staff were caring and respectful, which was confirmed in our observations. People’s views were valued and acted on relating to how they wanted to be cared for. People’s rights to privacy, dignity and independence were promoted and respected.

People had the opportunity to participate in activities which interested them. There was a complaints procedure in place and complaints were investigated and addressed.

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 good (published 30 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the assessment and mitigation of risks and how people’s care was planned for and met at this inspection. For requirement actions of enforcement which we are able to publish at the time of the report being published:

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

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.

There were 55 people living in the service, six of these were living with dementia, when we inspected on 23 May 2017. This was an unannounced inspection.

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.

There were arrangements in place to ensure people’s medicines were stored and administered safely. However, the systems in place for the recording of the administration of creams were not robust. The service had identified this and were in the process of addressing it.

We identified that there was potential risk to people in relation to the French windows in some bedrooms. The registered manager assured us that this would be considered and addressed.

There were systems in place to guide staff to minimise the risks of people being abused. People’s care records included risk assessments provided guidance to staff on how risks to people were minimised, these included risk assessments related to people's mobility and pressure ulcers developing.

Staff were available when people needed assistance, care and support. The recruitment of staff was done to make sure that they were suitable to work in the service and people were safe. Staff were trained and supported to meet the needs of the people who used the service.

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. People’s nutritional needs were assessed and met. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

Staff had good relationships with people who used the service and were attentive to their needs. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner. People and/or their representatives were involved in making decisions about their care and support.

People were provided with personalised care and support which was planned to meet their needs. People were provided with the opportunity to participate in activities which interested them. A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

There was an open and empowering culture in the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system and shortfalls were addressed promptly. As a result the quality of the service continued to improve.