Archived: East Cosham House

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

The provider lacked effective governance systems to identify concerns in the service and drive the necessary improvement. At times there was a lack of clear and accurate records regarding people’s medicines, support and any potential risks to them. Accidents and incidents were not analysed sufficiently to ensure risks were reduced for people. Insufficient mental and physical stimulation was provided due to a lack of activities staff.

We found concerns in relation to cleanliness of the home and a failure to report safeguarding incidents to the local authority and CQC, We also observed that there were some health and safety concerns in relation to an uncovered floor level radiator and windows that needed to be propped open.

The provider had not followed legislation that required them to act in an open and transparent way when people came to harm.

Best practice guidance was not utilised in providing an environment that promoted the well-being of people who lived with dementia. Some parts of the home were not well maintained and were a risk to people.

People were happy living at East Cosham House and people told us they felt safe. People were supported by staff who were kind, caring and who mostly understood their likes, dislikes and preferences. People’s religious needs were met. People were cared for by staff who were well supported and received regular supervision to meet people's needs effectively.

People and their relatives knew the management team and felt able to speak to them if they had any concerns. The registered manager and provider demonstrated a willingness to make improvements.

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.

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 17 January 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. At the last inspection there was one breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement, had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment of people, safeguarding people from improper treatment, maintaining suitable premises, failure to notify CQC of reportable incidents 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 identified five breaches of regulation and because this is the second consecutive time the service has been rated as requires improvement we will request a clear action plan from the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider following receipt of this plan. 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.

East Cosham House 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.

East Cosham House provides accommodation for up to 24 people, some of whom live with dementia and mental health conditions. At the time of our inspection, there were 24 people living in the home.

There was a registered manager at the home. 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.

Medicines were not always managed safely. Procedures in place were not robust and did not evidence that people were receiving their medicines as prescribed.

There were quality assurance systems in place based on a range of audits. However, we found these were not always effective and had not identified the concerns raised during the inspection, around medicines management.

People felt safe living at East Cosham House. Staff knew how to keep people safe and how to identify, prevent and report abuse. They engaged appropriately with the local safeguarding authority.

Individual and environmental risks were managed effectively. Risk assessments identified risks to people and provided clear guidance to staff on how risks should be managed and mitigated.

Thorough staff recruitment checks were carried out when a new staff member started working for the service. There were enough staff available to keep people safe at all times and staffing levels were monitored by the registered manager.

Staff received a variety of training and demonstrated knowledge, skill and competence to support people effectively. Staff were supported appropriately by the registered manager and deputy manager.

People had access to health and social care professionals where required and staff worked co-operatively and efficiently.

People were supported by staff with their nutritional and hydration needs. People were offered choice at mealtimes and menus contained a variety of nutrition and healthy foods. Where people had specific dietary requirements, these were well documented and staff were aware of how to meet these needs.

Staff were knowledgeable of the Mental Capacity Act 2005 and people’s rights were protected in line with the Act at all times. Where people were required to be deprived of their liberty, this was completed and recorded in an appropriate and timely manner.

People were cared for with kindness and compassion. Staff had developed positive relationships with people and their relatives and knew what mattered most to them.

Staff took action to protect people’s dignity and privacy at all times and encouraged people to be independent with all aspects of their daily routines where possible.

People had a clear, detailed and person-centred care plans in place, which guided staff on the most appropriate way to support them. People’s families were invited to be involved in the planning and delivery of their relatives care where appropriate.

People had access to a variety of activities to ensure they received appropriate mental and physical stimulation, and were encouraged to follow their own interests.

The service had a clear process in place to deal with complaints and we saw that concerns were dealt with in a timely and effective manner.

The provider was engaged with the running of the service and was approachable to people and staff.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the end of the full version of this report.

The home provides accommodation and personal care for up to 24 older people, some of whom live with dementia and mental health conditions. Accommodation is arranged over two floors with stair lift access to the second floor. At the time of our inspection 21 people lived at the home.

A registered manager was 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.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Robust processes to check the suitability of staff to work with people were in place. There were sufficient staff available to meet the needs of people and they received appropriate training and support to ensure people were cared for in line with their needs and preferences.

Medicines were administered and ordered in a safe and effective way.

Risk assessments in place informed plans of care for people to ensure their safety and welfare, and staff had a good awareness of these. External health and social care professionals were involved in the care of people and care plans reflected this.

People were encouraged and supported to make decisions about their care and welfare. Where people were unable to consent to their care the provider was guided by the Mental Capacity Act 2005. Where people were legally deprived of their liberty to ensure their safety, appropriate guidance had been followed.

People received nutritious meals in line with their needs and preferences. Those who required specific dietary requirements for a health need were supported to manage these.

People’s privacy and dignity was maintained and staff were caring and considerate as they supported people. Staff involved people and their relatives in the planning of their care.

Care plans in place for people reflected their identified needs and the associated risks. Staff were caring and compassionate and knew people in the home very well.

Effective systems were in place to monitor and evaluate any concerns or complaints received and to ensure learning outcomes or improvements were identified from these. Staff encouraged people and their relatives to share their concerns and experiences with them.

The service had effective leadership which provided good support, guidance and stability for people, staff and their relatives. People spoke highly of the registered manager and their team of staff.

Care was provided over two floors with chair lift facilities for those people who could not manage the stairway. People were able to personalise their rooms with their own possessions and could access their rooms whenever they chose. We saw that most people chose to move around on the ground floor of the home interacting with others during the day. Two communal lounges and a dining area were available for people to utilise with staff present in these areas.

During our visit we used our SOFI (Short Observational Framework for Inspection) tool to help us see people's experiences of the care and support they received. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences.

We saw that clear care plans were in place to support people who lived in this home. Staff treated people in a kind and gentle manner respecting their dignity at all times. Staff we spoke with knew people living at this home very well. People had their care discussed and agreed with them or their representative.

People told us they were happy living at this home and that, 'The staff are wonderful.'

We spoke to four people living at the home who told us they received the care and support they needed. People also said care was provided in they manner they preferred. People said they were bale to make choices in how they spent their time, in the food they ate, the times they went to bed and got up in the morning. We saw that care records reflected people's individual preferences.

We looked at care records and the arrangements for ensuring people received an adequate diet. These showed people's weight was monitored and the home liaised with specialist services so that people's nutritional needs were addressed.

During the lunchtime we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We spent 40 minutes observing at lunchtime and found that people had positive experiences. Staff were observed assisting people in a calm, friendly and polite manner. We observed staff to be tactful when supporting people to eat who had behaviour needs.