Archived: Carewatch (Cottesmore House)

Updated 9 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 29 and 30 August 2018 and was unannounced.

The inspection was carried out by one inspector and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection we reviewed notifications the provider sent us. Notifications are for certain changes, events and incidents affecting the service or the people who use it that providers are required to notify us about.

During the inspection, we observed support being delivered to people to help us understand people’s experiences of using the service.

We looked at records, including 15 people’s care plans, five staff records, medicines administration records and records relating to the management of the service. We spoke with 19 people who used the service, five relatives, one volunteer, the provider’s head of extra care services for London, the quality improvement service manager, two quality officers also working for the provider, two senior care staff, one housing support staff and a range of care and outreach workers. The registered manager was on annual leave at the time of our inspection so we were assisted by the quality officers and the quality improvement manager. We spoke with two healthcare professionals who were visiting on the day of our inspection.

Updated 9 October 2018

This comprehensive inspection took place on 29 and 30 August 2018 and was unannounced.

Carewatch (Cottesmore House) has been re-registered under the provider, Carewatch Care Services Limited since March 2018. The company was established in 1993, and runs a range of care services in the whole of the UK. This was the first inspection of Carewatch (Cottesmore House) under their ownership. Carewatch (Cottesmore House) is also registered to provide care and support to people living in Triscott House.

Carewatch (Cottesmore House) is an extra care housing service. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

At the time of the inspection the service provided personal care to people living in two extra care settings, Cottesmore House and Triscott House. There were 42 people living at Cottesmore House, four of whom were not receiving personal care. There were 38 people living at Triscott House. Each person was living in their own flat and had their own tenancy with Paradigm Housing Association who also owned the buildings. There were eight flats on the fifth floor of Cottesmore House which were exclusively for people with a learning disability.

The part of the service for people with a learning disability 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.

There was a registered manager in post at the time of our inspection. 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 was quality officer at each of the two schemes who managed the day to day running of the service.

Staff did not always follow the procedures to manage medicines which meant that people were at risk of not receiving their medicines safely.

Not all the risks to people's wellbeing and safety had been assessed, and where risks had been identified, the provider had not always taken appropriate action to mitigate these.

The provider had systems in place to monitor the quality of the service and put action plans in place where concerns were identified. However, although an audit in May 2018 had identified some of the issues we found in relation to risk assessments and medicines audits, the provider had not taken prompt action to address the shortfalls they had identified.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.

The provider was not always acting in accordance with the Mental Capacity Act 2005 (MCA). There were no records to show that any attempts had been made to appropriately assess a person’s mental capacity in line with the MCA principles.

People did not always receive person centred care and there was little stimulation for those who were unable to go out even if this was part of their care plan. Some staff practices were not always person-centred and did not take into account people’s choices.

We have made recommendations to the provider with regards to person-centred care, people’s social and recreational needs and consent to care and mental capacity.

People had access to healthcare professionals where necessary and the outcomes of their visits were recorded in people’s care plans for follow-up and review.

People were protected by the provider’s arrangements in relation to the prevention and control of infection.

The provider had processes for the recording and investigation of incidents and accidents. These were investigated and where necessary measures put in place to prevent reoccurrence. The provider acted appropriately when things went wrong.

Care plans and risk assessments were reviewed and updated whenever people's needs changed. People told us they were involved in the planning and reviewing of their care and support and we saw evidence of this. However, we saw that one person had not signed their care plan.

Recruitment checks were carried out before staff started working for the service and included checks to ensure staff had the relevant previous experience and qualifications to work with people using the service.

Staff assessed, recorded and monitored people’s health and nutritional needs and took action where necessary to make sure these were being met.

Staff liaised with the relevant healthcare professionals to provide appropriate care and support when people reached the end of their life.

People were supported by staff who were sufficiently trained and supervised. The registered manager liaised with other services to share ideas and good practice.

People's care plans were comprehensive and detailed how their individual needs were to be met. They were personalised to reflect people’s wishes and what was important to them.