Cottingham Manor Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People felt able to raise concerns with staff. Staff described how they reported safety concerns via an electronic system, which managers reviewed. A staff member said, “[These] are thoroughly investigated, CCTV is utilised a lot for unwitnessed falls. Most of the time we have debriefs.” The provider explained a new system was being implemented which would provide managers with a greater ability to track and monitor themes and trends across the service.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Systems were in place to ensure people’s needs were shared with partners when people were admitted to the home. A relative told us, “The whole admissions process was very thorough.” A staff member described the process, “[We] go through an admission checklist and risk assessments. Care plans are pre-written, printed off and staff read before people come in.” Hospital passports were used to provide information about people when they were admitted to hospital.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe. Staff said they felt people were safe living at the service. Staff were trained in how to spot signs of abuse and were able to describe these. A staff member told us, “I would document concerns and go to the [registered] manager. I would go above the [registered] manager if needed.” Staff told us they felt concerns would be dealt with. One staff member said, “I’m definitely able to raise concerns for [people]. I would escalate any concerns. I would absolutely feel confident raising concerns.”

The provider did not always work well with people to understand and manage risks. Staff were not always provided with the direction to ensure the care they provided met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

Risks to people were not always consistently recorded or understood across the service. For example, clinical risk sheets, developed by the home to ensure staff were aware of risks to people’s health, described health conditions not contained in people’s medical diagnosis on their care plans. This meant staff were not adequately directed to provide support appropriate to their needs. There was a lack of consistency about whether people required fluid monitoring based on their health risks and whether that monitoring took place. People who were using catheters did not always have care plans in place, nor in, one case, was this recorded on the clinical risk sheet. A staff member told us, when asked about information in care plans, “It depends who writes them, some go into more detail than others. There needs to be consistency.”

Although mechanisms were in place to review people’s care with them, most people and their relatives told us they had not taken part in regular reviews about their care. A person said, “No, they (staff) don’t talk to me about my care plan.” However, another person told us, “They come once every so often to talk about the care plan, the manager or assistant manager.”

The service had a positive approach to risk taking. A staff member said, “It’s their choice we can advise and present the risk and give them informed choices.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Appropriate regular checks were undertaken for all aspects of the service’s environment. Records of completion of required actions taken following a fire service visit were noted. Records showed fire drills and simulated evacuations were undertaken regularly.

The provider did not always make sure there were enough qualified, skilled and experienced staff. The provider used a tool based on people’s dependency to establish staffing levels. Observations showed care was generally unhurried. However, audits showed people waiting long times for a response to their call bells. Comments from people included, “They (staff) don’t have time to talk to you, they are too busy, they don't have time to spend with you” and “I don’t feel rushed, but they are short of staff.”

During mealtimes people who required support to eat were, in some instances, supported by relatives. A relative said, “If they didn’t have the three of us regularly at lunchtime they would be pushed.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. However, management checks and observations had not identified areas of poor practice.

Appropriate procedures were in place to ensure the environment was clean and people were kept free from infection. Domestic staff had a good understanding of infection prevention and control (IPC) processes and appropriate checks were in place. Staff wore personal protective equipment (PPE) and told us they had been trained on how to use this. However, observations of staff serving food in the dining area found staff were not following best practices. Feedback from the residents’ meeting also described poor practice and areas where cleanliness was not effectively monitored. The registered manager had committed to ensuring the concerns about these areas were addressed.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. However, it was not always clear whether medicines were used for the appropriate reasons or were available at the appropriate times.

Systems were in place to ensure the effective storage and administration of medicines. Staff were trained and had their competencies assessed to administer medicines regularly checked. The electronic medicine administration records (eMAR) system was not fully utilised to ensure staff recorded the reason why they administered people’s prescribed ‘as and when’ medicines. This meant we could not be assured medicines were administered appropriately in accordance with the prescribers’ directions. The provider had started to review these areas to ensure these took place as required.