This inspection was completed on 24 May and 5 June 2018 and was unannounced.

Cotswold Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Cotswold Court accommodates 6 people with learning disabilities in one adapted building. There were 6 people living at Cotswold Court at the time of the inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post at the service. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run

The previous inspection was completed in March 2017 and the service was rated ‘Requires Improvement’ overall. At this inspection we found two breaches of the regulations. The recording of the administration of medicines was not completed accurately. We also found quality audits had not always identified the shortfalls in the recording of medicines and as a result no action was taken to minimise the risks to people. We carried out a focussed inspection in September 2017 to check whether the service was meeting the requirements of the regulations. At our focussed inspection, we found improvements had been made and the service was meeting the requirements of the regulations. We did not change the overall rating of ‘requires improvement’ for this service following our focused inspection because we did not review all of the key questions.

At this inspection, we found these improvements had been sustained and the service has been rated ‘Good’ overall.

People received safe care and treatment. Staff had been trained in safeguarding and had a good understanding of safeguarding policies and procedures. The administration and management of medicines was safe. There were sufficient numbers of staff working at the service. There was a robust recruitment process to ensure suitable staff were recruited.

Risk assessments were updated to ensure people were supported in a safe manner and risks were minimised. Where people had suffered an accident, themes and trends had been analysed, and action had been taken to ensure people were safe and plans put in place to minimise the risk of re-occurrence.

Staff had received training appropriate to their role. People were supported to access health professionals when required. They could choose what they liked to eat and drink and were supported on a regular basis to participate in meaningful activities.

People were supported in an individualised way that encouraged them to be as independent as possible. People were given information about the service in ways they wanted to and could understand.

People and their relatives were positive about the care and support they received. They told us staff were caring and kind and they felt safe living in the home. We observed staff supporting people in a caring and patient way. Staff knew people they supported well and could describe what they liked to do and how they liked to be supported.

The service was responsive to people’s needs. Care plans were person centred to guide staff to provide consistent, high quality care and support. Daily records were detailed and provided evidence of person centred care. People were supported to make decisions about end of life care which met their individual needs and preferences.

The service was well led. Peo

The inspection of Cotswold Court commenced on 27 September 2017 and was unannounced.

We carried out an unannounced comprehensive inspection of this service on 27 March 2017 and the service was rated as ‘requires improvement’. During this inspection, two breaches of legal requirements were found. This was because the administration of people’s medicine had not always been suitably recorded and we found a number of gaps in people’s Medication Administration Records (MAR).We also found the audits which had been implemented within the service had not recognised the gaps in the MAR charts and this meant action had not been taken to address the issues leading to these errors. We issued a warning notice for the breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The warning notice required the provider to improve their governance systems by 15 August 2017

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 27 September 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Cotswold Court’ on our website at www.cqc.org.uk. This inspection examined how the service was managing people’s medicines, the quality assurance systems around medicines and the safeguarding processes and procedures at the service.

Our findings at this inspection have not changed the current rating of ‘requires improvement’ for the key question safe and well-led. We have not changed the overall rating of ‘requires improvement’ for this service because we did not review all of the key questions. We will review all of the key questions at our next comprehensive inspection.

Cotswold Court is a large house offering accommodation and personal care support for up to six people who have a learning disability. There were 6 people using the service at the time of the inspection.

The home has a 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 and associated Regulations about how the service is run.

People felt safe living at Cotswold Court. People’s medicines had been managed safely. People told us they received their medicine as prescribed. Records of people’s medicine administration had been maintained and evidenced people were receiving their medicines as prescribed.

Quality assurance systems around people’s medicines had been improved and there was evidence these were now being used effectively to identify shortfalls within the service. Where issues had been identified, there was evidence prompt action had been taken to address these concerns.

The inspection took place on 28 March 2017. This was an unannounced inspection. The service was last inspected in March 2016. At the time of the last inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found a breach of Regulation 12 Safe Care and Treatment as the service was not managing medicines safely. We also found that regular audits of the service were not being carried out. This was a breach of Regulation 17 Good Governance. During this inspection, we found some improvements had been made since we last inspected the service.

Cotswold Court is a large house offering accommodation and personal care support for up to six people who have a learning disability. There were 6 people using the service at the time of the inspection.

There was a registered manager in post at Cotswold Court. They told us they had been working as manager in the home for five years. 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 service was not always safe. There were suitable arrangements in place for the safe storage, receipt and administration of people’s medicines. However, administration of medication was not always recorded appropriately. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment. The registered manager took appropriate steps to ensure suitable people were employed to support people using the service.

People were receiving effective care and support. Staff received appropriate training which was relevant to their role. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and where required the Deprivation of Liberty Safeguards (DoLS).

The service was caring. People and their relatives spoke positively about the staff at the home. Staff demonstrated a good understanding of respect and dignity and were observed providing care which promoted this.

The service was responsive. Care plans were person centred and provided sufficient detail to provide safe care to people. Care plans were reviewed and people were involved in the planning of their care. People were supported to access and attend a range of activities. There was a complaints procedure in place and where complaints had been made, there was evidence these had been dealt with appropriately.

Some improvements were required to ensure the service was well-led. Quality assurance checks and audits were occurring regularly but did not always recognise shortfalls within the service. This was identified at the previous inspection but sufficient improvements had not been made at this inspection.

Staff, people and their relatives spoke positively about the registered manager. The registered manager and staff were aware of the vision and values of the service and worked hard to provide a service which was person centred for each individual.

We found two 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 this report.

The inspection took place on 1 March 2016. This was an unannounced inspection. The service was last inspected in July 2013. There were no breaches of regulations.

Cotswold Court is a large house offering accommodation and personal care support for up to six people who have a learning disability. There were six people using the service at the time of the inspection.

There was a registered manager in post at Cotswold Court. They told us they had been working as manager in the home for four years. 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 were suitable arrangements in place for the safe storage, receipt and administration of people’s medicines. However, administration of medication was not always recorded appropriately.

Regular audits of the service were not being carried out. The registered manager had not asked people for their Feedback about the service.

Risk assessments were implemented but these were not always updated to reflect current level of risk. This meant that there were occasions when there were no guidelines for staff to follow to minimise risk to people.

People and their families were provided with opportunities to express their needs, wishes and preferences regarding how they lived their daily lives. This included meetings with staff members and other health and social care professionals.

People were supported to access and attend a range of activities. People were supported by the staff to use the local community facilities and had been supported to develop skills which promoted their independence.

People’s needs were regularly assessed and care plans provided guidance to staff on how people were to be supported. The planning of people’s care, treatment and support was personalised to reflect people’s preferences and personalities.

The staff at the home had a clear knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely.

Where people lacked capacity, best interests meetings had taken place involving other professionals ensuring decisions were made in peoples’ best interests.

The staff recruitment process was robust to ensure the staff employed would have the skills to support people. Staff were knowledgeable about people. They had received suitable training to support people safely enabling them to respond to their care and support needs.

The service maintained daily records of how peoples support needs were met. Staff respected people’s privacy and we saw staff working with people in a kind and compassionate way responding to their needs.

There was a complaints procedure for people, families and friends to use and compliments could also be recorded. The service took time to work with and understand people’s individual way of communicating so that the staff could respond appropriately to the person.

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 this report.

We were able to meet with the five people who lived in the home but two of them went out soon after our arrival to pre-planned social functions. One person told us “I like living here and everyone is kind to me”. Staff were knowledgeable about each person and the way they liked to be looked after. Assessment and care planning arrangements took account of each person's specific needs, choices and preferences. The five people received an individually prepared package of support and were able to pursue different community activities.

We found that people were safe and the provider had taken steps to ensure that they were safeguarded from harm.

People needed support with their daily medicine regimes and this was provided by staff who had been trained to administer medicines safely. Management of medicines was safe.

People were looked after by a staff team who had been recruited and selected properly. All appropriate checks had been undertaken before the staff member was allowed to work in the home. This meant that workers who were unsuitable to work with vulnerable people did not work in Cotswold Court.

People who lived in the home, their representatives and staff were asked for their views about their care and support. The support people received was regularly reviewed and their home was kept safe.

Cotswold Court can accommodate up to six people but there were only five people in residence when we visited. The five individuals had differing ways of communicating and had learning disabilities, but were each given the opportunity to make decisions about their daily lives and the way in which they were looked after. Staff told us that some people were able to express their views and could give verbal consent whereas others used behaviours to show their agreement or non agreement. Staff spoke about the importance of ensuring that people were in agreement with the support they were to receive.

People received the care and support they needed because care planning arrangements took account of their needs, choices and preferences. Those plans we looked at were based upon the person's individual needs and provided specific details about the way that care and support was to be provided.

Staff demonstrated that people living in the home were protected from abuse or the risk of abuse because they had a good awareness of safeguarding issues.

The annual questionnaire survey was completed in July-August 2012 and forms had been completed by people’s families and a visiting healthcare professional. The provider may like to note that the views and opinions of the people who lived in the home had not been gathered as part of this exercise.

People told us that the staff were very helpful and respectful and asked them their views about their care and support. They said that they had opportunities to go out into the local community and to make choices. People told us that their key workers had developed care plans with them and they were able to say what help and support they needed and say what they liked and did not like. They said that their key workers reviewed the plans with them and asked what changes they wanted. People told us that they felt safe and secure in the home. They said that the staff asked them their views about the service and about how the home was run.