East Cosham House

Updated 19 January 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

This was a targeted inspection to check on concerns we had about the safety and welfare of people using the service.

Inspection team

The inspection was completed by two inspectors and an assistant inspector.

Service and service type

East Cosham House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. East Cosham House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We inspected all areas of the home, the care records for three people using the service, accident records, fire safety records and medicines management records. We spoke with a director and operations manager for the provider by phone, as they were not present in the service. We spoke with three care staff, the chef, two staff from the local authority who were based at the service due to safeguarding concerns and a safeguarding specialist nurse.

Updated 19 January 2023

About the service

East Cosham House is a residential care home providing personal care and accommodation in one adapted building for up to 24 people. At the time of our inspection there were 23 people using the service, all of who were over the age of 65 and some of which were living with dementia.

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

Although people told us they felt safe, we identified some care plans and risk assessments had not been completed where required. However, most staff demonstrated they understood people’s needs and how these should be managed.

Risks associated with infection, prevention and control were not managed safely. Concerns found, included, but were not limited to; areas of the home which could not be effectively cleaned due to wear and tear and poor maintenance, poor cleanliness and lack of systems in place to ensure people had access to safe and effective handwashing facilities.

Effective systems and processes were not in place to ensure people were cared for in a safe environment. Environmental safety checks had not been regularly completed to identify risks.

There were not sufficient numbers of staff available to meet people’s needs in a person centred, timely or effective way. People were not supported to partake in activities meaningful to them that considered their individual interests.

Records to demonstrate 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, needed improving.

People were supported to access healthcare services when needed and received enough to eat and drink. However, further work was needed to help ensure people were involved in food choices and had access to food they enjoyed.

People were not provided with enough meaningful activities to ensure they were mentally and physically stimulated. People we spoke with felt there wasn’t enough for them to do.

Mixed feedback was received from people, relatives and staff about the management of the service and the level of care received. We did observe some positive interactions by staff that were caring, and kind, however interactions were limited.

Quality and safety monitoring systems were not adequate, and we found there was a lack of governance processes and systems in place to help ensure the safe running of the service. Without these systems, the provider and registered manager could not be proactive in identifying issues and concerns in a timely way and acting on these.

Processes were in place to ensure safe recruitment of staff and people were supported to take their medicines safely.

Systems were in place to help ensure staff had received adequate training in a timely way to equip them to do their roles, safely and effectively.

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 22 April 2021) and there were breaches of regulation. 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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about environmental issues, lack of person-centred care, staffing levels and poor management and leadership. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

Please see the all key questions sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified five breaches of regulation including, person-centred care, safe care and treatment, staffing, premises and equipment and good governance.

We have also made two recommendations in respect of mealtime arrangements and consent.

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

We served warning notices in relation to safe care and treatment and good governance and required the registered manager to be compliant by 17 October 2022.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.