Cabot House

Updated 12 March 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 Care Act 2014.

This was a focused inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 12 Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There had been a continued failure to ensure robust infection prevention and control practices to ensure peoples safety and protect against infection. There had been a failure to assess risk in relation to preventing, detecting and controlling the spread of infection. Government guidance on care home visits, isolation and household mixing had not been followed. The inspection also checked whether the provider had met the requirements of the Warning Notice in relation to Regulation 17 Good governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured there were adequate systems to monitor and improve the quality and safety of services provided, including risks to the health, safety and welfare of people.

As part of this inspection we looked at the infection control and prevention measures in place. 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

Two Inspectors and an Expert by Experience carried out the inspection. 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

Cabot House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. 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 inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke/communicated with four people who live at Cabot house and seven relatives about their experience of the care provided. Some people who use the service were unable to talk with us so we used different ways of communication including Makaton, their body language and observation.

We are improving how we hear people’s experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves. In this report, we used this communication tool with one pe

Updated 12 March 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Cabot House is a residential care home providing accommodation and personal care to nine people. The service specialises in providing support to people with complex needs, learning disabilities and autistic people in one building. At the time of the inspection there were nine people living at Cabot house.

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

Right Support

Staff supported each person to have choice, control and independence. Nine people with differing needs and wishes living in one building did compromise individual choice which the staff did their best to manage. For example, we observed staff actively supporting people to do different things in different rooms. One person was looking at their tablet, another drawing and singing and a third being supported in the kitchen to bake cookies. Cabot is a large house and had a reasonable amount of space in shared areas. Each person had their own en suite rooms, which were personalised to meet their needs and preferences. For example, one person had a Disney themed room with all their favourite characters and Disney canvases on the walls, another person had decorative items that celebrated their family’s heritage. A person whose sensory needs meant they found it difficult to have things in their room, had a sparsely furnished room which still looked homely and comfortable. Staff focused on each person’s strengths and promoted what they could do, so they had a fulfilling and meaningful everyday life. This had improved since the easing of COVID -19 restrictions. Two people told us they were able to make decisions about their own lives and everyday life choices and we observed this in practice.

Right Care

We observed people receiving kind and compassionate care. People seemed at ease around staff and there were friendly conversations which involved a good deal of smiling and laughing. During the inspection we observed each person using individual and specific communication methods to communicate with staff. This included Makaton (a type of sign language), pictures, assistive technology, body language and written text. One staff told us. “Communication can be a challenge, but we are constantly learning.” People’s health needs were supported, one relative told us, “They had been very conscientious about the vaccinations and the dentist and are up-to-date.” The staff told us they prepared people for health appointments as they could be difficult for some people to understand and they worked with local health professionals to try to make it as easy as possible for each person.”

Right culture

The provider had a positive behavioural support (PBS) lead person who helped managers and staff understand the reasons people might behave in a certain way when distressed and discussed with staff ways to support them. Managers and staff knew how to analyse incidents and share the learning from them to reduce situations which cause people distress. People who had sensory perception and processing needs had health professional sensory assessments. Investment in learning for managers and staff was reflected in staff practice. People and most relatives told us they could talk to managers and staff freely. One person said, "I like (registered managers name), they are very good.” Staff told us they felt supported by the registered manager and the organisation. They said they were confidant to raise issues and knew they would be listened to.

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 (11 and 14 May 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 was a planned focused inspection based on the previous rating. We looked at infection prevention and control measures under the Safe and well-led key questions. 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 also looked at the caring key question on this inspection.

We carried out an unannounced focused inspection of this service on 11 and 14 May 2021. Breaches of legal requirements were found in the following regulations. Regulation 12 (safe care and treatment) and regulation 17 (good governance.) The provider completed an action plan after the last inspection to show what they would do and by when to improve. We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Follow up

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.