The Cottage

The Cottage is a residential care home providing personal care for a maximum of 10 people in one purpose-built house. The service provides support for people who live with autism and a learning disability. There were 9 people living at The Cottage at the time of the inspection.

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 assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of the service and what we found:

Right culture:

Systems were in place to monitor the quality of the support and services provided for people. However, the provider had not resolved identified shortfalls within the environment in a timely manner.

Support was person-centred and promoted people's individuality, well-being and dignity.

There was a culture of openness, inclusivity and partnership working which enabled people to live meaningful lifestyles.

Right Support:

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.

Risks to people’s health, safety and welfare were assessed and mitigated. Lessons were learned from accidents and incidents and used to improve the support people received.

Staff supported people with their medicines in a safe way.

Right care:

People were protected from abuse and poor care by staff who understood how to recognise and report incidents of this nature.

There were enough safely recruited and well-trained staff available to meet people's needs.

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 (published 23 August 2023).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘All inspection reports and timeline’ link for The Cottage on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to the governance at this service.

Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

At the time of our inspection there was a registered manager in post. 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. In this report when we speak about both the company we refer to them as being, ‘the registered persons’.

At the last inspection the service was rated, ‘Good’. At the present inspection the service remained ‘Good’. At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. However, improvements were required in the 'well led' domain. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Suitable quality checks were being completed. However, these were ineffective. The refurbishment plan was behind schedule and previously identified issues had not been resolved. Where issues were identified it was not clear when issues would be resolved as dates for completion were not always in place.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. Background checks had been completed before new staff had been appointed.

Medicines were managed and administered safely. There were arrangements to prevent and control infections.

Where people were unable to make decisions, arrangements had been made to ensure decisions were made in people's best interests.

Staff had been supported to deliver care in line with current best practice guidance. People were helped to eat and drink enough to maintain a balanced diet. People had access to healthcare services so that they received on-going healthcare support.

People were supported to have maximum choice and control of their lives and to maintain their independence. Staff supported them in the least restrictive ways possible and the policies and systems in the service supported this practice. People received person-centred care.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. Where appropriate people had access to lay advocates. Confidential information was stored securely.

Despite the service having significant vacant hours there was enough staff on duty at the time of inspection. Recruitment was ongoing and appropriate employment checks were in place.

Information was provided to people in an accessible manner. People had been supported to access activities and community facilities. The registered manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to in order to improve the quality of care.

There was a positive culture in the service that was focused upon achieving good outcomes for people. Staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. People, their relatives and members of staff had been involved in the running of the service. The provider had put in place arrangements that were designed to enable the service to learn, innovate and ensure its sustainability. There were arrangements for working in partnership with other agencies to support the development of joined-up care.

Further information is in the detailed findings below.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who use the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

Regular checks were undertaken to ensure the environment was safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care home. One application had been submitted, proper policies and procedures were in place.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly. Therefore people were not put at unnecessary risk.

The registered manager ensured safety checks were completed for staff prior to their commencement of employment.

Staffing levels were adjusted as people's needs changed and the staff liaised with the commissioners of services.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Relatives and people who used the service told us staff discussed people's needs with them. Relatives told us they had attended best interest meetings to review changes in family members needs.

People's needs were taken into account with signage and the layout of the service enabling people to move around without difficulty and safely.

People told us they could express their views at group meetings, meetings on a one to one basis and by completing surveys.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People commented, "I like it here" and "Staff are nice." One relative told us, "I know my family member is happy here as they run in to greet staff after a weekend away."

People who used the service, their relatives, friends and other professionals involved with the service attended meeting throughout the year. Where shortfalls or concerns were raised these were addressed. People told us they felt their opinions were valued.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People received their prescribed medicines.

Is the service responsive?

People who used the service and relatives told us they could speak with staff each day and share their concerns. They told us staff acted quickly. Relatives told us they could speak with staff about their family member's needs, when that person could not make decisions for themselves.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed.. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

We saw people were comfortable and relaxed in the company of staff. Some people indicated by sign language that they were happy living in the home and liked the staff.

Staff provided support to people in a respectful and professional way. They followed care plans at all times and demonstrated a detailed knowledge of people’s needs, likes and dislikes. We saw they received the right training to do their job.

Staff made sure people had a good diet and were generally protected from the risk of infections. They did this by following the right guidance and involving other professionals in planning and delivering care.

We found some areas of the building could pose an infection control risk. However, the provider showed us they had already identified these issues and had clear and timely plans in place to manage the risks.

We saw that people who lived in the home received individualised care and support, from staff that were knowledgeable about their needs, wishes and preferences.

Staff clearly understood each person’s way of communicating their needs and wishes. They supported them to make choices and decisions about their lifestyles wherever they could do so.