East Cosham House

East Cosham House is a residential care home providing accommodation and personal care for up to 24 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 15 people using the service, although 13 of them were moved to alternative accommodation by the local authority on the day of the inspection. The remaining two people were found alternative accommodation the day following the inspection.

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

The service was not safe, people had experienced avoidable harm and the provider had failed to take action to manage the risks people faced. Plans to keep people safe from the risk of falls and skin damage were inconsistent and did not give staff the information they needed to provide safe care. Some care plans had been reviewed by the provider and transferred to an electronic system, but staff did not have access to them. Staff did not demonstrate a good understanding of people’s needs or the support they needed to stay safe.

The home was dirty and infection prevention and control systems placed people at increased risk of avoidable harm. Clinical waste was not securely stored. The kitchen was dirty and contained out of date and mouldy food. The temperature of the kitchen fridge was too high for the safe storage of food. A fire exit had been blocked by a vacuum cleaner and fire extinguishers had not been serviced within the correct timescale.

Medicines were not managed safely. People were not supported to take their medicines as they had been prescribed. Medicines were not securely stored in the home, with large quantities of medicines stored in a hallway.

Staff were not provided with the right training and induction to ensure they knew how to provide safe care for people.

The failings in the service placed people at increased risk of avoidable harm.

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 inadequate (published 30 September 2022). At this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about management of risks, medicines, infection control and staffing. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

We have identified breaches in relation to safe care and treatment, staffing and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

The overall rating for this service is ‘Inadequate’ and the service remains 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.

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.

East Cosham House is a residential care home providing personal care to 23 people aged 65 and over at the time of the inspection. The care home can accommodate 24 people in one adapted building.

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

Care plans and risk assessments did not always contain the detail they required. In some instances, some people’s individual risks had not been assessed placing them at risk of harm.

Infection, prevention and control practices were not always carried out safely. The provider had a policy in place however, this had not been updated. The COVID-19 policy did not follow government guidance.

There was no systematic approach to determine the number of staff required and to effectively deploy staff with the range of skills required in order to meet the needs of people using the service and to keep them safe.

Quality assurance systems had not been effective in identifying the concerns we found at this inspection and bringing about improvement.

The duty of candour had not always been followed and the registered manager did not have a full understanding of what duty of candour meant. The duty of candour is a statutory (legal) duty to be open and honest with ‘service users’ and their families, when something goes wrong that appears to have caused or could lead to significant harm in the future. CQC was not always notified about significant events that occurred at East Cosham House. The local authority safeguarding team was not always told when a safeguarding incident occurred.

Medicines management was not always carried out safely, improvement was required with medicines records. We have made a recommendation about this.

Lessons were not always learnt when mistakes had happened. We made a recommendation about this.

Safe recruitment practices were followed; the required checks were carried out to protect people from the employment of unsuitable staff. IPC training was out of date for some staff.

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 supported this practice.

Staff were positive about the management of the service and told us the registered manager was supportive and approachable.

People were supported to access other healthcare services in a timely way.

The registered manager had considered the environment for people living with dementia.

The registered manager demonstrated a willingness to make improvements and during the inspection began reviewing some of their systems and process to initiate the changes we had identified as being required.

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 the service under the previous provider was Requires Improvement, published on 16 April 2020.

Why we inspected

We received concerns in relation to the safeguarding, staffing and non-notification to CQC of incidents. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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. This is the first inspection of this service since they have had a new provider.

We are unable to give an overall rating for this service because the effective, caring and responsive domains were not inspected.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding, infection control, assessing risk, safe staffing, duty of candour and good governance at this inspection.

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.