Cotswold Lodge

Updated 2 November 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

The inspection was carried out by one inspector.

Service and service type

Cotswold Lodge 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 had a manager registered with the Care Quality Commission. This means that they and the provider are 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. Site visit activity started and ended on 24 September 2019. Calls to relatives and health professionals was undertaken on 3 October 2019.

What we did before the inspection

Before we inspected we reviewed information and notifications we had received since the last 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 used all this information to plan our inspection.

During the inspection-

We met five of the people living in the service and spoke with three. We spoke with member of the quality and compliance team. Four support staff and the registered manager. As our presence added to the anxiety of one person in the communal area we spoke with three people individually and made observations throughout the day to help understand the experience of those who could not talk to us.

We looked at the care records of two people living in the service, this included risk information and daily records. In addition, we reviewed how medicines were managed and reviewed records relating to the operational management of the service. This included two staff recruitment files, staff rotas, records of staff training, supervision and appraisal. Staff meetings and engagement with people using the service, and quality assurance information.

After the inspection

We spoke with two relatives and received feedback from two health and social care professionals who have visited the service recently.

Updated 2 November 2019

About the service

Cotswold Lodge is an adapted care home providing accommodation and personal care for eight people living with complex learning disabilities who are aged 18 years and over. At the time of the inspection six people were living in the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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

People were safe and had not been placed at risk of harm. Staff showed kindness, compassion and respect in their engagements with people, they respected and upheld their dignity. They supported people to attain a level of independence suited to their abilities and developed at a pace to suit each person.

Staff received appropriate induction and training to give them the right skills to fulfil their role and support people safely. Staff received training to raise their awareness and understanding of safeguarding issues and protecting people from abuse, they were proactive in challenging discrimination and raising alerts to the safeguarding team. Risks were appropriately assessed.

There were enough staff to provide people with good levels of care and support. People were protected because there was a safe system of recruitment in place. Medicines were stored and managed safely. The registered manager and provider analysed accidents and incidents for trends and patterns and implemented measures to mitigate further risks. People lived in a clean well-maintained environment.

Systems were in place to ensure people referred to the service had their needs assessed prior to admission to ensure these could be met. Staff monitored people’s health and wellbeing and supported them to access routine and specialist healthcare. Staff understood people’s food likes and dislikes and consulted with them to provide a varied menu.

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. Staff understood How the Mental Capacity Act 2005 (MCA) impacted on their support of people and how people could be helped to make decisions.

People had detailed plans of care and support that guided staff in how people preferred their support to be delivered. Peoples concerns were listened to and acted upon. Relatives said they felt able to express any concerns they might have to staff and were confident these would be addressed.

A quality assurance system provided the registered manager and the registered provider with a detailed overview of service quality and where improvements needed to be made. Feedback from people, relatives, and professionals helped inform this.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 21/03/2017)

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. The provider acted to mitigate these risks during the inspection and we will check if this has been effective when we next inspect. Please see the Well led section of this full report.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.