Cosham Court Nursing Home

Updated 29 April 2022

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.

As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by three inspectors who visited the service and an Expert by Experience who contacted people’s relatives by telephone. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Cosham Court Nursing Home 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. Cosham Court Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information, we had received about the service, including concerns raised by professionals and relatives and previous inspection reports and notifications. Notifications are information about specific important events the service is legally required to send to us. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all of this information to plan our inspection.

During the inspection

We spoke with five people who used the service about their experience of the care provided and two relatives. We spoke with 10 members of staff including the provider, the deputy manager, registered nurses employed by the provider, care staff, the maintenance person and a housekeeper. We spoke with an additional four relatives via telephone and received feedback from three health and social care professionals.

We reviewed the safety of the environment, medicine processes, looked at records relating to staff recruitment, reviewed infection control processes and observed interactions between staff and people.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, quality assurance records and six people’s care records in detail.

Updated 29 April 2022

About the service

Cosham Court Nursing Home provides care and accommodation for up to 47 people. The home specialises in providing care to older people, who have nursing needs. At the time of our inspection there were 32 people living at the home.

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

We could not be fully assured the provider had effective management of infection control risks to keep people safe.

Some areas of the home were poorly maintained, so could not be effectively cleaned and staff failed to wear personal protective equipment, such as masks appropriately.

The provider’s quality assurance systems had not always been used effectively to either identify areas for improvement and/or to bring about effective improvement.

Care records including care plans and risk assessments did not provide clear and consistent information in relation to people’s needs and abilities and some information was conflicting. This placed people at risk of receiving inappropriate and ineffective care and treatment which could result in harm.

On day one of the inspection we could not be assured people’s prescribed topical medicines were consistently applied as required. When this was discussed with the staff this was immediately addressed. All other medicines were managed safely.

Appropriate recruitment procedures were in place and there were enough staff to support people's needs. Staff had received training and support to enable them to carry out their role safely.

There were appropriate policies and systems in place to protect people from the risk of abuse. 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.

Relatives had mixed views about communication with the staff at the home and the opportunity to speak to their loved ones. However, people and relatives were also complimentary about many aspects of the service and described staff as kind and responsive.

CQC were notified of all significant events that occurred in the service and the previous performance rating was prominently displayed on the premises as per requirements.

The service worked in collaboration with all relevant agencies, including health and social care professionals. This helped to ensure there was joined-up care provision.

The provider was responsive to our feedback and discussed how they planned to make changes to improve the service.

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 10 April 2019).

Why we inspected

The inspection was prompted in part due to concerns received about; staffing levels, the management of people’s nursing and personal care needs and good governance. As a result, we undertook a focused inspection to review the key questions of safe and well-led only to examine those risks.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cosham Court Nursing Home 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 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 the infection control, risk management and the governance of the service.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will continue to monitor information we receive about the service, which will help inform when we next inspect.