About the service Old Wall Cottage is a residential care home providing personal and nursing care to people aged 65 and over, many of whom live with dementia. The service can support up to 36 people and there were 31 people at the time of the inspection living in two units (Topaz and Sapphire).
People’s experience of using this service and what we found
We found that the environment did not meet the needs of people who lived with dementia. Whilst staff understood their roles, some told us that more in-depth training specific to the needs of people who lived with dementia would enable them to do their job more effectively. We have made recommendations that the provider ensures that the environment, activities and staff training were tailored to meet these needs.
We found people were not always treated with dignity and respect and improvements could be made to make people’s dining experience more pleasurable.
We found that care plans were not always personalised in recognition of people’s individual needs and people’s end of life care choices were not always clearly documented. Some people told us activities were not varied enough and the activities we observed did not engage those with more profound dementia. Family members told us they were supported to maintain contact in a variety of ways during the COVID-19 pandemic. People knew how to make a complaint and told us they were confident this would be addressed in a timely manner.
There were quality assurance processes in place, but these did not always identify areas for improvement including environmental issues. Not all significant events were notified to CQC. People who lived in Old Wall Cottage, their relatives and visiting professionals spoke positively of the manager, as well as the owners of the service. Staff felt valued and believed they made a positive difference to people’s lives.
People told us they were well cared for and felt safe in the home. They received their medicines as prescribed, and staff had been safely recruited.
Staff were using Personal Protective Equipment correctly and there were appropriate systems in place for the testing of staff, visitors and people living at the service for the Covid-19 infection.
Capacity assessments were completed, and decisions were taken in people’s best interest where they were unable to consent to decisions.
People told us that staff were kind and always asked for their permission before they completed a task. Family members said that staff were very encouraging towards their relative. There was a relaxed atmosphere around the home, and we observed friendly interactions throughout the day.
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 monitor the service.
We have identified breaches in relation to risks associated with people’s care not always managed in a safe way and insufficient staffing levels at night-time. People did not always receive person centred care. We found there was lack of robust effective oversight of the service, and notifiable incidents were not always being submitted to the CQC.
Please see the action we have told the provider to take at the end of this report.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This was the first inspection of Old Wall Cottage since there was a change in provider in November 2019. Under the previous registered provider, the last rating for the service was Requires Improvement, published on 23 September 2019.
Why we inspected
We undertook a five domain inspection to review the key questions of safe, effective, caring, responsive and well-led. This was because the location had not been inspected since there was a change to the provider ownership.
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.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.
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.