Archived: Onny Cottage Rest Home

Onny Cottage is a care home providing support with personal care needs to a maximum of seven older people. Accommodation is provided in one adapted building. At the time of the inspection, four people were using the service.

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

Risks to people’s safety and well-being were not always considered and plans to mitigate risks were either not in place or had not been reviewed.

People were not protected by the provider’s staff recruitment procedures. The provider failed to ensure staff received the required training and support to meet people’s needs safely. People were not protected by the procedures for the safe storage, management and administration of medicines. The management of medicines were unsafe and did not ensure people received their medicines as prescribed.

Infection, prevention and control procedures did not protect people from the risk of infection or contracting avoidable infections.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The provider had failed to follow the principles of the Mental Capacity Act 2005 which meant people were not safeguarded from receiving care and treatment which was not lawful. Staff had not received up to date training about how to safeguard people from the risk of abuse.

The service was not effectively managed and there were no systems in place to monitor the quality and safety of the service provided. The provider had failed to act on the breaches of regulations identified at our last inspection. The provider did not always work effectively with other professionals to achieve good outcomes for people.

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. (Report published December 2019) and there were multiple breaches 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

We received concerns in relation to the lack of effective management and communication, infection, prevention and control procedures, staff recruitment and training and care planning. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. 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 coronavirus and other infection outbreaks effectively.

Ratings from the previous comprehensive inspection for those key questions we did not look at were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Onny Cottage Rest Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Onny Cottage is a care home providing support with personal care needs to a maximum of seven older people. Accommodation is provided in one adapted building. At the time of the inspection, six people were using the service. This included one person who was in hospital and one person who was receiving short term respite care.

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

Risks to people’s safety and well-being were not always considered and plans to mitigate risks were not in place or had not been reviewed. These included environmental and risks posed by equipment, fire safety, the management of medicines and risks associated with individual health needs. People felt safe and staff had been trained to recognise and report concerns. Staff followed effective infection control procedures. There were enough safely recruited staff to meet people’s needs.

There was no registered manager in post however the provider told us a manager had been appointed and was due to start imminently. They also said they would submit an application to register the manager with the Commission. Systems to monitor standards of care and safety and plan on-going improvements were ineffective. Staff were well supported and motivated by the provider.

Care plans did not always reflect people’s current needs and there was not always sufficient information for staff about how needs should be met. 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 said staff always asked for their consent before helping them.

Staff received the training required to meet people’s needs. People’s health was monitored, and people saw health care professionals when they needed. People’s nutritional needs were met and everyone we spoke with was happy with the food and drinks provided.

People were treated with kindness and they told us they could make decisions about their day to day lives. People were treated with respect and their right to privacy was understood and respected by staff. People were supported to remain as independent as possible.

People were supported by staff who knew them well and who understood what was important to them. There were opportunities for social stimulation and people could see their friends and family whenever they wanted. People were treated as individuals and chose how they spent their time. People felt confident and comfortable to discuss any concerns with staff. People could be confident that their wishes for end of life care would be respected by staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good. (Report published June 2017).

Why we inspected

This was a planned inspection based on the previous rating. However, the inspection was prompted in part due to concerns received about staff’s ability to meet people’s needs, staff recruitment, the management of medicines and meeting people’s nutritional needs. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Following our inspection, we wrote to the provider to request information about the immediate action they would take to mitigate risks to people’s safety. The provider’s response detailed satisfactory actions and timescales to mitigate these risks.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Onny Cottage on our website at www.cqc.org.uk.

Follow up

We will request an action plan from 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.

At the last inspection on 14 December 2016 we identified that improvements were needed regarding four out of the five key questions. We identified breaches of Regulations 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider sent us an action plan telling us what they would do to make improvements and meet legal requirements in relation to the law. We found at this inspection the provider had taken the necessary measures to ensure the quality of care people experienced had improved.

The provider had addressed advice from the Fire and Rescue Service. The premises and equipment were appropriate to meet people’s individual needs. However, people were not enabled to have easy access to the outdoor spaces due to large loose chippings.

The manager had started to do more regular quality checks of the service. They engaged more with people and their families and encouraged feedback from people in order to improve the service. People felt confident they were listened to and their views were valued. The manager had sustained improvement of the record keeping and embedded management practice consistently.

A registered manager is not required for this provider as Mrs Elizabeth Owen is registered as an individual. There is a new manager in post for day to day management of the service. The provider and manager were not present at this inspection.

People received support with their medicines from staff who were trained to safely administer them. Medicines were locked away safely and in accordance with their individual risk assessments.

People were safe as staff had been trained and understood how to support people in a way that protected them from harm and abuse. People's records had individual assessments of risk associated with their care. Staff knew what to do in order to minimise the potential for harm.

People were supported by enough staff to safely meet their needs. The provider followed safe recruitment practices and completed checks on staff before they were allowed to start work. The provider had systems in place to address any unsafe staff practice including retraining and disciplinary processes if needed.

People received care from staff that had the skills and knowledge to meet their needs. New staff received an introduction to their role and were equipped with the skills they needed to work with people. Staff attended training that was relevant to the people they supported and any additional training needed to meet people's requirements was provided.

People's rights were protected by staff who were aware of current guidance and legislation directing their work. People were involved in decisions about their care and had information they needed in a way they understood.

Staff received support and guidance from a manager who they found approachable. People and staff felt able to express their views and felt their opinions mattered. People had good relationships with the staff who supported them. People's likes and dislikes were known by staff who assisted them in a way which was personal to them.

People had their privacy and dignity respected by those supporting them. People had access to healthcare when needed and staff responded to any changes in need promptly. People were supported to eat and drink sufficient amounts to maintain optimum health.

This was an unannounced inspection that took place on 14 December 2016. The home has a registered manager who was present during the inspection but had recently applied to cancel their registration. 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 and associated Regulations about how the service is run.

The provider delivered care and support in a grade 2 listed domestic building. As such permission to carry out certain works to meet the fundamental standards had been difficult to achieve. We identified hazards with the premises and appliances that could be a risk to people’s safety. We contacted other regulators to ascertain their views on safety in the home.

The provider had policies and procedures to ensure that people who could not make decisions for themselves were protected. People’s human rights were protected because staff understood the policies and legislation and how to apply them. Staff were aware of their responsibilities to report any incidents of abuse or suspected abuse immediately

People felt the staff had the right skills and experience to look after them. The provider had omitted to provide staff with the mandatory updates of some training. Regular supervision and appraisals had not taken place. Not all staff had received certificated training in keeping people safe.

People believed staff would do everything necessary to keep them safe. One person shared a concern about how they would get out if there was a fire. Accidents and incidents were monitored on an individual basis to identify any trends or concerns. People were assessed against a range of potential risks such as poor nutrition, falls, skin damage and mobility according to their current need.

The registered manager assessed people’s needs and this information was used to determine the minimum staff number needed to run the home. In addition to this system they monitored people’s changing needs and staff feedback on the number of staff needed.

Suitable recruitment procedures and checks were in place to ensure staff had the right skills to support people at the home.

Medicines were stored securely but not always handled safely.

People were happy with the standard and range of food and drink provided at the home. People did not know what they were having in advance of their meal.

Staff were able to tell us about people’s particular needs and how best to support them. People’s health and wellbeing was monitored and staff regularly referred

people to GPs and district nurses as required.

People and their families were encouraged to express their views through surveys and day to day contact. The registered manager made time to speak with people directly.

People could speak to the registered manager or staff if they were concerned about anything. A complaint procedure was in place but not sufficient enough in its detail.

The registered manager had organised external activities in the community and visiting entertainers in the home. There was little opportunity for social stimulation in the home on a daily basis. People had, through provider surveys, expressed a wish for this to be improved but the provider had not acted on it.

The provider had quality monitoring processes which included audits and checks on medicines management, care records and staff practices. However, these were not always carried out and so were not effective in identifying where improvements were required to ensure the regulations were met. Feedback from people and their relatives was sought but comments not always acted upon. This meant opportunities to identify where improvement was needed were missed.

You can see what action we have asked the provider to take at the back of this report.