Background to this inspection
Updated
11 December 2019
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.
Inspection team
Our inspection was completed by two inspectors and a nurse specialist
Service and service type
Old Wall Cottage 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.
The service did not have a manager registered with the Care Quality Commission at the time of the inspection. A manager was in post and had begun the registration process. Once registered this would mean that they and the provider were 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 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 also checked for feedback we received from members of the public, local authorities and commissioning groups. We checked records held by Companies House. We used all of this information to plan our inspection.
During the inspection
We spoke with three people who used the service and one relative about their experience of the care provided. We spoke with six staff and the manager. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
The manager supplied additional information to demonstrate action taken as a result of our findings on the day. We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
11 December 2019
About the service
Old Wall Cottage is a nursing home which accommodates up to 33 people in one adapted building. The building is divided into two units. There were 26 people living at Old Wall Cottage at the time of our inspection.
People’s experience of using this service and what we found
People and relatives were positive about the care and support given by staff, and the changes being made by the new manager. While we noted that a number of improvements had been made to address the concerns we raised at our last inspection, we have identified several ongoing issues around management of risk and how the service was led.
Risks to people’s health and safety were still not well managed. The home environment and equipment were not kept consistently clean, which put people at risk of infections. Staff were also observed to carry out unsafe moving and handling practices which put people at risk of injury.
The home had not had consistent day to day leadership since our last inspection, and the provider had not ensured that improvements were made in response to the concerns raised at our last inspection.
Some aspects had improved, for example deployment of staff had improved to ensure that there were enough to meet people’s needs. The management of people’s medicines had also improved, so that they had them when they needed them, and the systems that were being used minimised the risk of errors. We have recommended that the provider updates their policies with regards to the use of covert medicines.
Where accidents and incidents had taken place, these had been reviewed to see if anything could be learnt, and to prevent reoccurrence. The new manager had not yet completed a review of this information for August or September 2019, so we have recommended that this is completed.
New staff were recruited in a safe way to ensure they were suitable to support the people that live here. Staff understood their roles and responsibilities in keeping people safe from abuse.
Staff now received training and supervision to ensure they had the skills needed to meet people’s needs. 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.
People were supported to access health care professionals such as the GP, dentist and chiropodist when needed. We have recommended that the staff review the level of detail in oral healthcare plans, so they are clearer on how staff should support people.
The home was all on one level, so people did not have to negotiate stairs. They also had access to the gardens, which had several points of interest for them. We have made a recommendation around the internal environment and how it should be reviewed as part of the planned refurbishment to better meet the needs of those people living with dementia.
The choice and variety of food had improved since our last inspection, and people were supported to have enough to eat and drink.
People were supported by kind and caring staff; however, we have made a recommendation because they could have been more attentive to people and their needs.
People had more access to activities than at our previous inspection; and their care records were in the process of being updated to ensure they better reflected the care and support people needed. As both these processes were just being introduced at the time of the inspection, we have recommended that the provider continues to make improvements in these areas.
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 25 September 2018) and there were six breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection although some improvement had been made, not enough had been done, and the provider was still in breach of two regulations. This is the second consecutive inspection where the service has been rated requires improvement.
Why we inspected
This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. 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 Old Wall Cottage on our website at www.cqc.org.uk.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.