Coxwell Hall and Mews Nursing Home

Updated 1 October 2022

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 Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Coxwell Hall and Mews Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Coxwell Hall and Mews Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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. Although at the time of the inspection there was a registered manager in post, they had been absent from work for a period of time and was absent at the time of the inspection. The service was being managed by an interim manager.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used the information we held about the service including the information the provider sent us in the provider information return (PIR) to help plan this inspection. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We considered the feedback provided to us from commissioners of the service. We used all this information to plan our inspection.

During the inspection

We visited the care home for two days and spoke with seven people who used the service and eight relatives to learn about their experience of the services provided. 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 spoke with six care staff, two nurses, two housekeepers, a chef, the activities coordinator, the interim manager and assistant manager as well as the operations manager. We spoke with one visiting adult social care professional.

We spoke with the nominated individual as part of this inspection. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed four people’s care files and a selection of medicine records. We reviewed records and documents relating to the Mental Capacity Act and best interest decisions. We reviewed three staff recruitment files and the service’s training and supervision record. We reviewed a selection of records pertaining to the management of the service which included audits, virtual quality assessments plus support calls, the improvement plan, a fire assessment report, maintenance records and the complaints policy and procedures.

Updated 1 October 2022

About the service

Coxwell Hall and Mews Nursing Home is a residential care home providing accommodation with personal and nursing care to up to 66 people. The service provides care to people who require support with their physical needs but also people who live with mental health needs and dementia. At the time of our inspection there were 53 people using the service.

People were accommodated in two parts of a building which were linked together. One part, purpose built called Lavender Court and the other, in the older part of the building called, The Folly. People had access to gardens from each building.

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

Staff ensured people received support to take their medicines. Some additional information was required in relation to medicines administered covertly (hidden in food or drink).

We have made a recommendation in relation to the covert administration of medicines.

Risk management processes were in place to mitigate or reduce risks to people’s health and safety. This included falls from windows of height. A fire safety assessment had been completed by an external company and recommendations from this had been completed. People told us they felt safe and their relatives were reassured by the measures staff took to keep their relatives safe.

Safeguarding arrangements were in place to help protect people from abuse. Managers and senior staff worked with external health and adult social care professionals to safeguard people.

The service was staffed accordingly so people’s needs were met and the running of the service overall, maintained. There were arrangements in place to keep the environment clean and to reduce the risk of infection.

People’s care was delivered equally and without discrimination. The environment was adapted and decorated in a way which supported people who lived with dementia. Staff worked with a wide range of health and social care professionals to support people’s access to health assessments, specialist treatments and appointments.

Staff were supported and trained to deliver people’s care and treatment in line with best practice. People’s eating and drinking needs were well supported.

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 treated with compassion, kindness and respect. Those who were important to people were made to feel welcome and their involvement encouraged and seen by staff as being integral to maintaining people’s wellbeing. People’s dignity and privacy was maintained, and their information treated confidentially.

People’s care and treatment was planned around their physical, emotional and spiritual needs. People’s individual preferences, choices, aspirations and wishes were explored and incorporated into the planning of their care. This included at the end of their life to support a pain free and dignified death.

People had opportunities to take part in social activities and staff remained aware of the risk of loneliness and self-isolation for others.

Concerns and complaints could be raised and there was a process in place to acknowledge and address these.

The registered manager was absent from the service so interim management arrangements were in place and working well. During the pandemic the provider’s quality monitoring of the service had been through virtual assessment and regular conference calls with managers, for information gathering and support purposes. The provider had subsequently commissioned an audit of the service, by an external company, to enable them to assess the service’s performance. This had resulted in an improvement plan, which the interim manager and team had made good progress against by the time of the inspection.

Audits had been completed by managers, which had identified areas for required improvement to the environment and premises. The provider explained that the refurbishment and repair work was due to commence in September 2022, having been delayed by the pandemic. At the time of the inspection general maintenance work was in progress.

The provider was making significant improvements to their IT systems which will make various management tasks easier and, for example, make record keeping easier.

Satisfaction surveys had been sent out to gather feedback from people and their relatives, on the services provided, but information had yet to be fully collated from these.

The service continued to work with commissioners including health and social care professionals to support people’s access to the service as needed. This close working had benefitted people with complex needs where other care placements had not been successful.

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 outstanding (published 3 January 2020).

Why we inspected

The inspection was prompted in part due to concerns received about people’s care and the condition of the environment. A decision was made for us to inspect and examine those risks.

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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from outstanding to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Coxwell Hall and Mews Nursing Home on our website at www.cqc.org.uk.

Follow up

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