Cottingley Hall Care Home

Cottingley Hall Care Home is a residential care home, providing personal and nursing care to a maximum of 40 people, accommodated in 1 adapted building. At the time of the inspection there were 35 people using the service.

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

Shortfalls were identified which impacted on the safety and quality of care people received. There had been some changes to the management team which led to a lack of effective leadership at provider level. As a result governance arrangements had failed to identify all of the shortfalls we found on inspection. Feedback from people and relatives was overwhelmingly positive about the care people received. Staff were also positive and complimentary of the new manager who had recently transferred and was overseeing the service.

Systems were not always robust enough to demonstrate safety was effectively managed. Staff were inconsistent with the recording of required repositioning and food and fluid monitoring. Medicines were not always managed safely. Some of these shortfalls had not been identified through the providers own governance arrangements. Prompt action was taken once we brought this to the attention of the management team. The provider had safe recruitment process and adequate staffing levels in the service. The environment was well maintained, personalised, welcoming and adapted to suit people’s needs.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

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 12 December 2018).

Why we inspected

The inspection was prompted in part by 2 notifications of an accident and incident following which a person using the service died, and another person sustained a serious pressure area wound. These incidents are subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incidents indicated potential concerns about the management of risk of pressure area care, falls management and record keeping. This inspection examined those risks.

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

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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. The provider was responsive to inspection findings and action has already been taken to mitigate the risks identified.

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

Enforcement and Recommendations

We have identified a breach in relation to good governance at this inspection. We also made recommendations in relation to medicine management. 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

Cottingley Hall 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.

This inspection took place on 31 October 2018 and was unannounced. Our last inspection took place on 25 February 2016 and at that time the service was rated ‘Good’ overall with no breaches or regulations.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff told us they had regular safeguarding training and were confident they knew how to recognise and report potential abuse. Where concerns had been brought to the registered manager’s attention, they had worked in partnership with the relevant authorities to make sure issues were fully investigated and appropriate action taken to make sure people were protected.

The registered manager and staff were observed to have positive relationships with people living in the home. People were relaxed in the company of staff and there were no restrictions placed on visiting times for friends and relatives.

We found staff were respectful to people, attentive to their needs and treated people with kindness and respect. The atmosphere in the home was calm and relaxed and from our observations it was clear staff knew individual people well and were knowledgeable about their needs, preferences and personalities.

Appropriate Deprivation of Liberty Safeguard (DOLS) applications had been made to the local authority and people's mental capacity to make their own decisions had been assessed and recorded in line the requirements of the Mental Capacity Act 2005. People were supported to have 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.

Each person had a care plan that was person centred and sufficiently detailed to ensure staff provided appropriate care and treatment. People’s care and support was kept under review and, where possible they were involved in decisions about their care. Risks to people’s health and safety had been identified, assessed and managed safely. Relevant health and social care professionals provided advice and support when people’s needs changed.

There were enough staff to support people when they needed assistance and people received support in a timely and calm manner. There was a robust recruitment procedure to ensure new staff were suitable to care for vulnerable people and arrangements were in place to make sure staff were trained and supervised.

Medicines were managed safely and people had their medicines when they needed them. Staff administering medicines had been trained and supervised to do this safely.

Appropriate aids and adaptations had been provided to help maintain people’s safety, independence and comfort. People had arranged their bedrooms as they wished and had brought personal possessions with them to maintain the homeliness.

There were a range of leisure activities for people to participate in, including both activities and events in the home and in the local community and it was apparent people enjoyed a full and active social life. People told us they enjoyed the food and there was a good choice at every mealtime.

There was a complaints policy available which detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

There was a quality assurance monitoring system in place that was designed to continually monitor and identified shortfalls in service provision. Audit results were analysed for themes and trends and there was evidence that learning from incidents took place and appropriate changes were made to procedures or work practices if required.

Further information is in the detailed findings in the full version of the report.

We inspected Cottingley Hall on the 25 February 2016 and the visit was unannounced. Our last inspection took place in January 2014 and at that time the service was meeting the regulations we looked at.

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.

The home had a safeguarding policy in place which made staff aware of their roles and responsibilities. We found staff knew and understood how to protect people from abuse and harm and kept them as safe as possible. People told us they felt safe because the staff were caring and because the registered manager listened to them and acted quickly if they raised concerns.

There were enough staff on duty to meet people’s needs and staff had undertaken training relevant to their roles. Staff told us communication within the home was good and staff meetings were held to keep them up to date with any changes in policies and procedures or anything that might affect people’s care and treatment.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act 2005 (MCA).

The activities plan for the home showed that daily activities took place and people were encouraged to participate in local community events.

People told us they enjoyed the food and we saw a wide range of food and drinks were available. We saw people’s weight was monitored to ensure they had sufficient to eat and drink.

We saw the complaints policy had been available to everyone who used the service. The policy detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

The care plans in place were person centred and contained individual risk assessments which identified specific risks to people health and general well-being, such as falls, mobility, nutrition and skin integrity.

We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services. This included GPs, hospital consultants, community health nurses, opticians, chiropodists and dentists. We found medication policies and procedures were in place and staff responsible for administering medicines received appropriate training.

There was a quality assurance monitoring system in place that was designed to continually monitor and identified shortfalls in service provision. Audit results were analysed for themes and trends and there was evidence that learning from incidents took place and appropriate changes were made to procedures or work practices if required.

The staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered. We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

We found people were able to make decisions in relation to their daily lives. Where people did not have capacity to make decisions for themselves, systems were in place to ensure any decisions made were in their best interests. In addition, we found care was planned and people's needs assessed so appropriate care could be delivered.

We also found the service had quality assurance systems in place which monitored the quality of the service provided and ensured compliance with the essential standards of quality and safety.

At lunchtime we heard people being offered choices and people said the food was good, two people told us it 'tasted good'. There were three communal areas for people to use, and a range of activities were available for people throughout the day. We saw people were able to stay in their rooms if they preferred.

People told us the staff were 'caring' and were always available to provide whatever help was needed. They said the staff were respectful, listened to them and took notice of what they said People said they had nothing to complain about but said they felt confident any concerns they had would be addressed by the staff.