Cossham Gardens is registered to provide accommodation and personal care including nursing care for up to 21 people with complex physical needs. At the time of our inspection 20 people were using the service.

The inspection was announced. The provider was given 48 hours' notice because we visited at the weekend and, we wanted to make sure people using the service, the registered manager and staff would be available to speak with us. The inspection was carried out by one adult social care inspector.

At our last inspection in September 2016 we found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not always ensured people’s care records contained clear instructions for staff to follow.

At this inspection we saw the provider had taken the action they had identified in their action plan. As a result improvements had been made and the service was no longer in breach of this regulation.

At the last inspection, we rated the service as Good overall.

As a result of this inspection we found the service remained Good overall.

Why the service is rated good:

Overall, we found people received safe, individualised care that was usually provided by staff that knew them well.

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.

Staff understood their role and responsibilities to keep people safe from harm. Individual risks were assessed and plans put in place to keep people safe. There was enough staff to safely provide care and support to people. Checks were carried out on staff before they started work with people to assess their suitability to work with vulnerable people. Medicines were safely managed and people received their medicines as prescribed.

People received care and support from staff that understood their needs and knew them well. Staff received regular supervision and the training needed to meet people’s needs. The service had systems in place to ensure they complied with the requirements of the Mental Capacity Act 2005 (MCA). Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights. The care and support people received was highly individualised. They were offered a range of group and individual activities.

There was a clear and effective management structure in place. The registered manager and other senior staff provided good leadership and management and were themselves well supported by the provider. The safety and quality of service people received was monitored on a regular basis and where shortfalls were identified they were acted upon.

The inspection took place on 28 September 2016 and was unannounced. At our previous inspection in May 2014, no breaches of regulation were found.

Cossham Gardens is a care home that provides nursing care for up to 21 people with complex physical needs. At the time of our inspection there were 19 people living in the home.

There was a registered manager at the home. 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.

People in the home could not always be confident of fully effective care. We found good examples of recording in relation to people’s healthcare needs, but also examples where more needed to be included to ensure clear information was available to staff. We also found examples of where a particular clinical need had not been met. These issues had not impacted significantly on the person concerned but we highlighted our findings with staff to ensure that the issues were addressed.

People told us they felt safe in the home. Staff were trained in safeguarding and aware of the procedures to follow if they were concerned about potential abuse. There were risk assessments in place to ensure staff had guidance to follow and minimise the risks associated with people’s care. We found that on occasion these were not reviewed in accordance with the necessary timescale. People received safe support with their medicines. However, there were no plans in place for the use of 'as required' medicines.

People and relatives were very positive about the staff and the care they received. We observed staff providing attentive and kind care. Positive relationships were evident between staff and people in the home, and relatives were welcomed and involved where appropriate. People were supported to maintain relationships with people that were important to them. People were involved in planning their own care and their views were listened to and acted upon.

Care plans took account of people’s individual needs and wishes and provided information about important aspects of their lives. These were reviewed regularly to ensure they were up to date.

There was a procedure in place to respond to complaints. When concerns had been raised, people told us that the registered manager listened to and responded to them.

People’s rights were protected in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of those people who required applications to the local authority in line with the DoLS procedure. They were in contact with the local authority to check on the progress of their applications. In one case a person‘s DoLS application had been authorised and the registered manager had complied with the conditions outlined on the authorisation.

The home was well led and people and staff in the home felt able to approach the registered manager. Staff felt well supported and were positive about working for the organisation. There were systems in place to monitor the quality of the service provided.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to records. You can see the action we have asked the provider to take at the back of the full version of this report.

We carried out an inspection at Cossham Gardens . This helped us to answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and 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?

We saw that people's needs and preferences were clearly detailed in the care records. The staff we spoke with demonstrated good knowledge of the people they supported, their care needs and their preferences. For example one care record stated the person liked to be supported by only female carers. We saw from the records that person was supported by only female carers.

People told us they felt safe at the home. One person told us “I feel safe here they do a good work. They always ask me all the time how I want things done. I am happy”. Another person told us “it is safe here I love it”. One relative told us “I am reassured that my relative is here. They are safe here there is no question about that”.

Is the service effective?

Peoples' needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans were person centred and took account of the person's likes and dislikes.

Before people received care and treatment they were asked for their consent and the provider acted in accordance with their wishes. We saw four care records and found that they contained a life history and information relating to their current capacity. We saw evidence that people who used the service and their relatives had been involved in developing care plans. We spoke with five staff and they all showed understanding of consent issues and were aware to maintain confidentiality.

Is the service caring?

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. We looked at four care plans and found they met the assessed needs of the person who used the service. We spoke with four people who used the service and two relatives. People felt that they were involved in their care. One person told us “I am very much involved in my care. They don’t do anything without asking me first to make sure I am comfortable with it. It is a good home”. Another person told us “staff are very kind and caring. The care here is excellent” and “all staff are kind and caring”.

Is the service responsive?

We saw that when people attended hospital a transfer information form was completed. This included next of kin contact details, current medication and GP contact details. This also included the reason for transfer. We saw the service had a policy for discharge/transfer of a person to another service. This gave staff clear instruction on the procedure to follow and protected the person's confidentiality. This meant that people’s information was handled confidentially.

Is the service well-led?

We saw that the provider had a good audit system in place. The care coordinator showed us the audits which were completed on a weekly and monthly basis. These included an audit for medication which was completed every month. In addition to this, audits were in place for mattresses, bed rails, pressure area care, falls care records, infection control and health and safety. We saw that where issues had been highlighted an action plan was put in place to address them. We saw that where issues had been highlighted an action plan was put in place to address them. This meant that the provider had effective system in place to regularly assess and monitor the quality of service that people received.

People who used the service and their relatives told us they were given questionnaires to complete regularly to indicate if they were happy with the care, treatment and the services provided and that their response had always been positive. One person told us “it is a very gentle place. It is comfortable and not restrictive. The good thing is that I have a choice of what I want to do”.

During our visit we spoke with various members of staff and people during the day that included two nurses, three care staff, an administrator and two relatives. The two family members we spoke with were positive about the care and treatment their relative received. We were told “The care is second to none” and “I can come here anytime I like to visit”.

We were helped with the inspection process by a senior member of staff and administrator, as the manager was unavailable.This included being given a tour of the home, and being shown various records associated with people’s care needs, staffing levels and the management of the home.

During the day we saw that people were involved in taking part in different activities of their choice. This included a day trip to Worcester, a visiting music and movement activity and a karaoke activity planned for the evening. We observed staff supporting people with their midday meal in a respectful manner, talking to people about the food they offered and involving people in conversations.

People were looked after in comfortable and safe surroundings. The tour of the home showed a clean environment that was in a good decorative order with on-going maintenance that had been planned to make improvements.

Processes in place ensured people’s views and those of their relatives were heard and acted on. There were systems in place to audit and monitor all aspects of people’s care and safety on a regular basis.

There was a relaxed atmosphere in the home. We saw activities taking place with staff who were interacting with people in a caring way. We spoke with three people who told us they were involved with their care, that they were respected and listened to by staff and that they felt safe. Comments included “I get on with staff really well, a good bunch of people” and “Nice homely atmosphere with all the facilities that I need.”

We spoke with the relatives of two people. One of them said they were “very happy” with their relatives “superb’” care. Another relative also confirmed that they also were happy with the care.

We spoke with five staff. They demonstrated that they were confident and knowledgeable about people’s individual needs and the way they should be cared for.

We looked at various records kept at the home. People's needs had been assessed and care plans had been developed. We found detailed individual information about people’s care. There was some information that had not always been reviewed and updated. Other records seen showed us how people were being kept safe and how staff had been trained to meet people’s needs.