We carried out an unannounced comprehensive inspection of this service on 6 and 13 October 2014. At which breaches of legal requirements were found. This was because care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare. Also the provider did not have effective systems to regularly assess and monitor the quality of service that people receive. The provider did not have effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. Also people were not protected against the risks associated with the management of medicines. People did not receive care or treatment in accordance with their wishes. People were not always asked for their consent before treatment was given. Comments and complaints people made were not responded to appropriately.
After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a comprehensive inspection on the 14 and 22 April 2015 to check that they had followed their plan and to confirm that they now met all of the legal requirements.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘China Cottage Nursing Home’ on our website at www.cqc.org.uk’
China Cottage Nursing Home is a care home situated in Carcroft, Doncaster which is registered to care for 33 people. The service is provided by Doncaster Property Investment Fund Limited. At the time of the inspection the home was providing nursing and residential care for 27 people.
The service did not have a registered manager in post. However the Commission had received an application to register the manager who has been in post since January 2015. 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.
At our inspection on the 14 and 22 April 2015, we found that the provider had followed their plan which they had told us would be completed by the 31 March 2015 and legal requirements had been met.
People were kept safe at the home. However we found that some staff did not have a good understanding of the legal requirements as required under the Mental Capacity Act (2005) Code of Practice. The Mental Capacity Act 2005 sets out how to act to support people who do not have the capacity to make a specific decision.
People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms, so appropriate referrals to health professionals could be made. The home involved dietician and tissue viability nurses to support people’s health and wellbeing.
We found the home had a friendly relaxed atmosphere which felt homely. Staff approached people in a kind and caring way which encouraged people to express how and when they needed support. People we spoke with told us that they were encouraged to make decisions about their care and how staff were to support them to meet their needs.
Medication systems had improved so that the administration of medicine was safer. However, the incorrect stock count for some medicines meant we could not confirm that people are getting their medication as prescribed. There was still a lack of PRN protocols. We found the systems still needed to be embedded into practice.
There were robust recruitment procedures in place; most staff had received formal supervision since the new manager had been in post. Qualified nursing staff had also received a monthly clinical supervision. Annual appraisals had been scheduled. These ensured development and training to support staff to fulfil their roles and responsibilities was identified.
Staff told us they felt supported and they could raise any concerns with the registered manager and felt that they were listened to. People told us they were aware of the complaints procedure and said staff would assist them if they needed to use it
The provider had introduced new systems to monitor the quality of the service provided. We saw these were more effective. Although improvements were now taking place the provider needs time to ensure the systems are embedded and sustainable.