We carried out a review of the data available to us about Old Wall Cottage Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Old Wall Cottage Care Home, you can give feedback on this service.
Old Wall Cottage is a residential care home providing personal and nursing care to up to 36 people aged 65 and over, many of whom live with dementia. At the time of our inspection there were 34 people using the service, living in two units (Topaz and Sapphire).
People’s experience of using this service and what we found
Improvements had been made and the home was well-led. The registered manager had a robust governance and auditing system in place. Audits were up to date and identified any lessons learnt following incidents and accidents so that they could take action to keep people safe. Notifications were submitted to CQC in a timely manner.
The planning and provision of meaningful activities for people had improved. They considered people’s individual needs and preferences, including those cared for in their rooms. The environment was enhanced so that people who lived with dementia were able to locate themselves around the building. Adjustments were made so that people could spend time in quite spaces as they chose.
People told us they were safe at Old Wall Cottage. Staff understood their responsibilities in safeguarding people from abuse and knew how to report any concerns they had. Assessments were carried out to identify any potential risks to people and measures put in place to mitigate these. Medicines were managed safely. The home was clean and hygienic, and staff maintained effective systems of infection prevention and control. The provider exercised safe recruitment practices.
There were enough staff on each shift to keep people safe and meet their needs. People told us they did not have to wait when they needed support and did not feel rushed when staff provided their care. Staff received an induction when they started work and had access to the training they needed for their roles. Staff were expected to meet regularly with their managers for supervision and appraisal.
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 were supported to maintain good health and to access healthcare services when they needed them. They received person centred care, planned and reviewed to meet their individual needs. People and relatives told us staff knew them well. Staff supported people in a kind and compassionate way, considering their dignity and respect.
People, relatives and staff spoke positively of the culture within the home. Communication amongst the staff team was effective, which helped ensure people received safe and effective care. Staff were well-supported by their managers and colleagues and felt valued for the work they did. Staff and managers had developed effective working relationships with other professionals involved in people's care and implemented any professional guidance effectively.
The home was following up to date government guidance relating to COVID-19 for care homes. Cleaning and infection control procedures followed the relevant COVID-19 guidance to help protect people, visitors and staff from the risk of infection.
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 20 September 2021). 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
This inspection was carried out to follow up on action we told the provider to take at the last 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 COVID-19 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 Old Wall Cottage 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.
Old Wall Cottage is a residential care home providing personal and nursing care to people aged 65 and over, many of whom live with dementia. The service can support up to 36 people and there were 31 people at the time of the inspection living in two units (Topaz and Sapphire).
People’s experience of using this service and what we found
We found that the environment did not meet the needs of people who lived with dementia. Whilst staff understood their roles, some told us that more in-depth training specific to the needs of people who lived with dementia would enable them to do their job more effectively. We have made recommendations that the provider ensures that the environment, activities and staff training were tailored to meet these needs.
We found people were not always treated with dignity and respect and improvements could be made to make people’s dining experience more pleasurable.
We found that care plans were not always personalised in recognition of people’s individual needs and people’s end of life care choices were not always clearly documented. Some people told us activities were not varied enough and the activities we observed did not engage those with more profound dementia. Family members told us they were supported to maintain contact in a variety of ways during the COVID-19 pandemic. People knew how to make a complaint and told us they were confident this would be addressed in a timely manner.
There were quality assurance processes in place, but these did not always identify areas for improvement including environmental issues. Not all significant events were notified to CQC. People who lived in Old Wall Cottage, their relatives and visiting professionals spoke positively of the manager, as well as the owners of the service. Staff felt valued and believed they made a positive difference to people’s lives.
People told us they were well cared for and felt safe in the home. They received their medicines as prescribed, and staff had been safely recruited.
Staff were using Personal Protective Equipment correctly and there were appropriate systems in place for the testing of staff, visitors and people living at the service for the Covid-19 infection.
Capacity assessments were completed, and decisions were taken in people’s best interest where they were unable to consent to decisions.
People told us that staff were kind and always asked for their permission before they completed a task. Family members said that staff were very encouraging towards their relative. There was a relaxed atmosphere around the home, and we observed friendly interactions throughout the day.
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 monitor the service.
We have identified breaches in relation to risks associated with people’s care not always managed in a safe way and insufficient staffing levels at night-time. People did not always receive person centred care. We found there was lack of robust effective oversight of the service, and notifiable incidents were not always being submitted to the CQC.
Please see the action we have told the provider to take at the end of this report.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This was the first inspection of Old Wall Cottage since there was a change in provider in November 2019. Under the previous registered provider, the last rating for the service was Requires Improvement, published on 23 September 2019.
Why we inspected
We undertook a five domain inspection to review the key questions of safe, effective, caring, responsive and well-led. This was because the location had not been inspected since there was a change to the provider ownership.
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.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.
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.