The inspection was carried out on 23 and 27 March 2017 and was unannounced.

Coton Hill House is registered to provide accommodation with personal care for up to a maximum of 45 people. There were 44 people living at the home on the day of our inspection. People were cared for in five units over two floors. The Cherry and Berwick units were on the ground floor. The River View, West View and Castle View units were on the first floor. Some people were living with dementia.

There was a registered manager in post but they were not present during the inspection. During our inspection, we met with the acting manager who had responsibility for running the home in the absence of the registered manager. 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.

The home was last inspected on the 20 and 24 October 2016 where it was rated as requires improvement. At the last inspection the provider needed to make improvements to ensure people were treated with dignity and respect: that staff followed the principles of the Mental Capacity Act to protect people’s rights: that their governance systems were effective and that suitably trained staff were effectively deployed.

At this inspection we found that significant improvements had been made in all areas of the service. However, we were unable to improve the rating in well led from requires improvement because the new systems put in place remained untested. The acting manager was temporarily covering for the registered manager and we were not sure what the management structure would look like going forward. We therefore did not have complete assurance that the changes made to improve the service would be sustained.

People and their relatives felt that they and their belonging were safe. On the whole staff were aware of the risks associated with people’s needs and how to minimise these. Accidents and incident were reviewed to establish if there were any trends or patterns.

People were protected from the risks of avoidable harm or abuse because staff were knowledgeable about the different forms of abuse. Staff were able to recognise the signs of possible abuse and knew how to report their concerns. The provider followed safe recruitment procedures to ensure people were suitable to work at the home before they started work there. There were enough suitably trained staff deployed to meet people’s needs.

People were supported to take their medicine safely. Only staff who had received training on managing medicines safely were able to administer medicines. Staff monitored people’s health and arranged health care appointments as necessary. Staff followed advice provided by health care professionals to promote good physical and emotional health.

People enjoyed the food and were offered choice. People’s nutritional needs were assessed and their dietary needs were catered for. Where people required help to feed themselves this was provided in a patient and dignified manner.

People and their relatives found staff were kind and caring. People were treated with dignity and respect and they were supported to maintain their independence. Staff had formed positive working relationships with people and their relatives.

People received individualised care that took account of their preferences and wishes. People were able to spend their time as they wished and were actively encouraged to maintain their interests.

The provider sought people’s views on the quality of care provided to drive improvements. People had not found cause to complain but felt comfortable to raise concerns with staff or management should there be a need to do so.

People and their relatives spoke highly of the acting manager and about the p

The inspection took place on 31 January 2017. The inspection team consisted of one member of the Care Quality Commission medicines team.

Coton Hill House is registered to provide accommodation with personal care to a maximum of 45 people. Some people using the service were living with dementia.

There was a registered manager at this service however, they were not present on the day our inspection. 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.

Where people were prescribed medicines on a when required basis there was insufficient information to show care staff how and when to administer these medicines or the responses to treatment they should observe. Staff did not consistently check with the prescriber the accuracy of people's medicines when they moved into the home. People's medicines were stored safely and securely. There were processes in place for handling medicines errors and staff received medicine competency assessments to ensure the on-going safe management of medicines.

The inspection was carried out on 20 and 24 October 2016 and was unannounced.

The home was last inspected on the 1 and 3 September 2015 where it was rated as requires improvement. At the last inspection the provider needed to make improvements to governance systems, staff deployment and training. At this inspection we found that improvements had not been made and other areas of the service now needed further improvement.

Coton Hill House is registered to provide accommodation with personal care for up to a maximum of 45 people. There were 44 people living at the home on the day of our inspection. People were cared for in five units over two floors. The Cherry and Berwick units were on the ground floor. The River View, West View and Castle View units were on the first floor. Some people were living with dementia.

There was a registered manager in post who was present during the inspection. 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.

There was a lack of effective leadership in the home that failed to give staff direction to recognise the needs of the people using the service. We found a lack of management oversight with regards to people’s care plans and staff practice. As a result people’s health and wellbeing was compromised.

The provider had systems in place to assess and monitor the quality of the service provided but these were not always effective in identifying shortfalls.

People were placed at risk of harm by staff who sometimes used unsafe moving and handling practices. Risk assessments did not always reflect the support people received or required to meet their needs and staff did not always know how to support people effectively. People did not always get the support they needed when they needed it because there were not enough suitably trained staff deployed to meet their needs.

People’s rights were not always protected when they could not consent to their own care and treatment. Decisions that had been made on behalf of people were not always recorded to show how and why they were in their best interests.

We found that people were not always with respect, dignity or consideration. This was particularly evident in the Castle View unit where people’s care and emotional needs were not consistently being met.

People were not always provided with care and support that was individual or personal to them. Staff did not manager people’s anxieties well and this caused distress to them and other people.

The provider encouraged people, relatives and staff to give feedback about the service and used the information gathered to make improvements.

People’s nutritional needs were routinely assessed, monitored and reviewed. People were offered a choice of what they wanted to eat and enjoyed the food. Where required people were provided with support to eat and drink.

People were spoken to in a kind and polite manner. People were able to choose how they wished to spend their time. Whilst some chose to sit in the lounge others liked to have some private time in their rooms.

During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During our inspection we spoke with four people and one relative. Because some people living at Coton Hill House were not able to tell us themselves, we spent time observing what life was like at the home. We also spoke with five staff, the registered manager and the operations manager.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found –

Is the service safe?

People told us they felt safe and were well looked after by staff.

The environment was clean and well maintained and had a ‘homely’ feel. Risks to people and the environment had been identified and managed in a way that ensured people’s safety.

There were sufficient staff on duty during our inspection and staff were appropriately trained. We saw that staff knew and understood the needs of people who used the service and supported them in a way that maintained their safety.

The Care Quality Commission monitors the use of the Mental Capacity Act and Deprivation of Liberty Safeguards. Everyone living at Coton Hill House or their representatives were involved in making decisions about their care. Staff had received training in the Mental Capacity Act and the Deprivation of Liberty Safeguards and understood the importance of people being supported to make their own decisions in relation to their care and treatment.

Is the service effective?

All the people we spoke with told us they were fully involved in their own care and their needs were met by staff. We observed that staff knew what people’s needs were and how to support them in accordance with their plans of care.

Staff were supported in their roles through regular one to one meetings with the registered manager. This ensured they could meet the needs of people who lived at Coton Hill House.

We saw evidence that the provider worked closely with other health professionals to ensure there was a joined up approach to meeting people’s care needs.

Is the service caring?

One person told us, “We’re a happy bunch.” We observed that staff treated people with warmth, respect and compassion. Staff encouraged people to identify and take part in activities which promoted and maintained their independence.

One staff told us, “I love sitting down, talking with people and making them happy. They’re the most important thing here.”

Is the service responsive?

People’s needs had been assessed before care was provided. People’s plans of care were personalised and individual to them. Other health professionals, such as doctors, district nurses and dieticians were involved in people’s care to ensure a joined up approach to their welfare.

People told us there were a wide range of activities to take part in. One person told us, “There’s plenty to do here.” One the day of our inspection a church service was being held and people told us they welcomed this opportunity.

Complaints were listened to and acted on quickly by the registered manager and provider. This helped to ensure that people received a good quality service at all times.

Is the service well led?

People and staff told us that the provider asked their opinions on the service. Regular ‘resident’ and staff meetings were held where people and staff could raise any concerns. People also told us that they could freely talk to the registered manager at any time and knew they would be listened to.

The provider monitored the quality of care through regular audits and surveys. The results from these audits and surveys were used to maintain and improve the service.

There were systems in place to make sure that management and staff learnt from events such as incidents, complaints and concerns. This meant that people benefited from a well led service that took on board lessons learnt.

This inspection focused on the management of medicines for people who had dementia. We conducted a short period of observation whilst medication was administered. This was because people were not able to tell us their views.

We saw that people who lacked capacity to manage their own medication received good care and support. People’s health needs were closely monitored by the staff and visiting health professionals. Staff we spoke with were aware of information about cultural requirements and medicine management.

We saw that people who had dementia were given help and assistance with their medication care needs. Staff demonstrated a good understanding and knowledge of the individual needs of the people in their care. Care plans were detailed and provided staff with clear instructions on how people should receive their medication and why. We found good record keeping regarding the administration of medicines

The home had sufficient staff to ensure people’s safety and wellbeing regarding medicines management. Staff had attended training courses to equip them with the knowledge and skills to carry out their duties.

The provider had systems in place to assess and monitor the quality of the service provided regarding medication.

People who used the service who spoke with us said that they were well looked after. They told us that the staff always asked them how they would like things to be done, always respected their privacy and treated them with respect. They said staff talked to them about how they liked their care to be provided.

Staff provided health and social care support well. Community services were accessed to support people with dementia related problems. This provided a link between the home and the GP.

Staff spoke of their awareness of how to keep people safe from harm. Staff spoke of the training that the provider had arranged for them to attend regarding recognising abuse and how to report it.

The provider could assure people who used the service that relevant checks had been robustly carried out when they employed staff. People were cared for by staff that were trained to do their work and carry out their roles once employed.

People who used the service told us that staff usually came promptly when they needed help. People said there was usually enough staff on duty. A relative told us that staff were around when they visited. They said that the staff were competent and always acted professionally.

People we spoke with said their comments were listened to. A visitor said that they would not hesitate to talk to staff if something was wrong. The provider had a system that monitored complaints to identify any particular trends.

We carried out this review to check on the care and welfare of people who used this service.

We did not review every outcome for this provider. We were proportionate in our approach and focused on outcomes four and 16.

We met with people who used the service and staff. People we spoke with shared their experiences of the service that they received. We observed people who used the service and staff interaction in the various lounges and around the home.

People told us that they had been involved in discussions about their needs and development of their care records. One person said “I am only here for a short time to get better but I have enjoyed the activities available. Staff ask me questions about how I am and have been very kind to me”.

People told us that the staff were available to speak with whenever they needed them, day or night. Comments included, “The staff do listen to me and they are always willing to have a chat if something is bothering me”.

People who used the service told us that they were happy with the meals provided and said the service was able to meet their dietary needs. One person said, “There is a very good choice of food and alternative meals are always made available if you do not like the main option”. People told us their rooms were comfortable and that staff respected their privacy and dignity.

We spoke with staff who had different roles in the home. They told us they enjoyed their work and were well supported. They said they were provided with training opportunities to meet the specific needs of the people who used the service and to keep them safe.

The inspection took place on the 1 and 3 of September 2015 and was unannounced.

Coton Hill House is registered to provide accommodation with personal care for up to 45 older people who may have dementia. There were 36 people living at the home on the day of our inspection.

There was no registered manager in post however, the new manager started work on1 September 2015 and had submitted an application to become the registered manager of the home. The operational manager had been overseeing the running of the home in the absence of a manager and was also present during the inspection. 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 were not effectively deployed to meet people’s needs and therefore there were times when people had to wait for support and staff could not assure us they could keep people safe.

People with dementia did not always receive appropriate support as staff had not received adequate training to enable them to meet their needs.

The provider had systems in place to monitor the delivery of care and to promote people’s safety and wellbeing but these were not consistently completed.

People told us they felt safe because of the way carers looked after them. Staff had received training to enable them to keep people safe and knew how to identify and report concerns of abuse. Staff were aware of the support people needed to reduce the risk of harm.

People received their medicines safely and when they needed them. People had access to health care professionals as and when needed.

People benefitted from the support of staff who knew them well. People were always asked before support was given and their wishes were respected. Where people were unable to make decisions for themselves best interests decision had been made on their behalf.

People told us they enjoyed their food and were given a choice of what they would like to eat. We observed that people’s nutritional needs had been assessed and regularly reviewed.

People told us that staff were kind and treated them with dignity and respect. People and their relatives found staff polite and approachable. People were supported to maintain their independence and individuality.

People were supported to keep in contact with people who were important to them.

People and their relatives were happy to speak to management if they had any concerns or complaints. Where people had complained their concerns had been investigated and the management had taken action to prevent re occurrence.

The provider had systems in place to gain people and relatives views of the service provided in order to develop the service.