The inspection visit took place on 27 February and 6 March 2018. It was an unannounced inspection. Coxbench Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Coxbench Hall accommodates up to 39 people in one adapted building. Coxbench Hall provides accommodation and personal care for older people living with a range of health conditions, including physical disabilities and dementia. At the time of our inspection visit there were 34 people living there.

We undertook a focussed inspection of Coxbench Hall on 14 January 2017 to follow up a Warning Notice issued to the provider in November 2016. The focussed inspection only looked at two of the five questions we ask about services: is the service well led, and is the service safe.

We rated both Safe and Well-Led as Requires Improvement, and found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the management of medicines. The overall rating for Coxbench Hall was Requires Improvement. We asked the provider to complete an action plan to show what they would do and by when to improve the service to meet the requirements of the regulations. At this inspection, we found that improvements had been made. People's medicines were now managed safely and in accordance with professional guidance.

Coxbench Hall did not have a registered manager in post at the time of our inspection visit. 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 manager’s application to become the registered manager is now in progress.

People felt safe living at Coxbench Hall. There were processes and practices in place to ensure people were safeguarded from the risk of abuse. People received their medicines as prescribed. Staff worked with people, relatives and health professionals to identify risks and take steps to minimise harm. Risk assessments were tailored to each person’s needs, and staff knew what action to take to reduce risks associated with people’s health conditions. People felt supported to maintain their independence. People were kept safe from risks associated with the environment.

There were enough staff to provide the care and support people needed. Checks were carried out to ensure staff were of good character and were fit to carry out their work. The premises were kept clean, which minimised the risk of people acquiring an infection whilst using the service. Accidents and incidents were reviewed and monitored to identify potential trends and to prevent reoccurrences.

People felt staff had the training and skills to meet their needs. The provider ensured that staff maintained the level of skills and knowledge needed to support people in ways that worked for them. People told us that the food was good and that they were offered choices. People who needed assistance or encouragement to eat were provided with support in a discreet way. People were supported and encouraged to have a varied diet that gave them sufficient to eat and drink.

People were supported to access health services when needed to maintain their well-being. The provider had taken steps to ensure the environment was suitable for people's needs. The provider followed the requirements of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People felt supported by staff who provided care in a go

This unannounced inspection took place on 4 January 2017. The service was last inspected on 14 and 19 September 2016. When we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the provider not having effective systems to ensure people’s medicines were managed safely and the completion and updating of care plans and risk assessments. At this inspection we found that some improvements had been made.

Coxbench Hall is registered to provide accommodation and personal care for up to 39 people. At the time of our inspection there were 35 people living there. The service had 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 2008 and associated Regulations about how the service is run.

Daily audits of medicines were not always recorded and the storage of medicines was not in line with the home’s policy. This meant staff could not be sure that medicines were given appropriately and remained safe and effective to use.

At this inspection we found improvements had been made and the concerns raised around the Warning Notice issued had been resolved. However, we identified other areas where improvements needed to be made in the management of medicines. You can see what action we told the provider to take at the back of this report.

This unannounced inspection took place on 14 and 19 September 2016. The service was last inspected on 30 September and 1 October 2015 when we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the provider not having effective systems to ensure compliance. We asked the provider to send us an action plan to demonstrate how they would make improvements to meet the regulations. The provider sent us their action plan, and on this inspection, we found improvements had been made. However, we identified several areas where improvements needed to be made to the quality of care on this inspection.

Coxbench Hall is registered to provide accommodation and personal care for up to 35 people. At the time of our inspection, 35 people were living there. Coxbench Hall is a period building that has been adapted to the needs of people in residential care. The building has three floors, accessible by stairs and a lift. The gardens are spacious and well maintained, with several outside sheltered seating areas for people.

The service had 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 2008 and associated Regulations about how the service is run.

We found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Medicines were not consistently managed in a safe way and in accordance with current guidance and legislation. We saw on the second day of the inspection visit that action had been taken to address this.

People’s care needs were assessed and recorded and risks identified. However, risk assessments and care plans did not consistently identify steps staff should take to reduce the risk of avoidable harm. We spoke with the provider about this, and saw that improvements had been made on the second day of the inspection visit.

There were systems to monitor and review all aspects of the service, and these were undertaken regularly. However, the systems did not always identify where areas of care needed to be improved. This meant the provider was not always able to identify areas for improvement, and to make changes to improve the quality of the service for people. We saw on the second day of the inspection visit that action had been taken to improve the systems to monitor and review the quality of care.

People had their care reviewed on a regular basis, and they and their relatives were involved in this. There were enough staff to ensure that people’s needs were met in a timely manner.

People felt the care provided kept them safe, and relatives also felt this was the case. Staff understood how to keep people safe from the risk of potential abuse.

People and relatives spoke positively about staff, saying they were cared for by staff who treated them with kindness, dignity and respect. They were encouraged to continue with hobbies and interests, and to maintain relationships that were important to them. People were also cared for by staff who were knowledgeable, skilled and trained to provide personal care to the standards set by the provider.

Staff understood the principles of the Mental Capacity Act 2005 (MCA), including how to support people to make their own decisions. The provider was working in accordance with the MCA, and people had their rights upheld in this respect.

People and their relatives were positive about the quality and choice of food and drinks. We also found that people were supported to maintain their health and to access healthcare services when required.

The provider had a clear complaints policy, and people and relatives felt able to make a complaint or raise concerns. The provider investigated complaints according to their policy, and created opportunities for

This inspection was carried out by an Adult Social Care Inspector. As part of our inspection we spoke to two family members of one person using the service, four people who used the service, five members of care staff and the chef. We reviewed three people’s care records.

We considered all the evidence we gathered under the outcomes we inspected. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards.

People using the service were supported to be independent with the appropriate use of equipment. Equipment was maintained to ensure it remained safe to use.

People’s needs were not always clearly assessed. Staff did not always have clear and sufficient detail on how to provide support to meet people’s assessed needs.

Accurate records were not always being kept to ensure people received safe and appropriate care.

Is the service effective?

Staff meetings and staff supervision provided opportunities for staff to discuss issues important to them and identify improvements to the service.

Plans had been made to deal with foreseeable emergencies and staff we spoke with told us they felt confident in dealing with any emergency, such as a fire.

Is the service caring?

One person told us, “The carers got the GP to check my cough this week. Staff are very attentive and very cheerful.”

During our inspection visit we observed staff asking people if they felt ok in a friendly and caring manner. One person told us, “The staff are lovely.”

The manager had used the views of people using the service, their relatives and staff to plan improvements to the service.

Is the service responsive?

Staff’s knowledge of the care people required varied. This was because people’s assessed needs had not always been clearly recorded in a care plan.

Is the service well led?

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service. Staff completed accident report forms appropriately. These were checked by managers for identification of any improvements that could be made to reduce or minimise further risks to people.

The people who used the service and relatives all said they were happy with the care at Coxbench Hall. One person told us, “I like being here and being looked after. The care is wonderful, everybody’s friendly, and it feels like home.” Another person commented, “I am very well-looked after and have made so many friends since I’ve been here.”

People told us the food was good and they had a say in what was provided. One person said, “We had a talk about menus last week and I asked for smoked haddock. The next thing I knew it was on the menu.”

People said they felt safe in the home and trusted the staff. One person told us, “If I was not happy about anything I would tell Olive (the registered manager). You can tell her anything and she will sort it out.”

Records showed people received their medication on time and when they needed it. One person said, “The staff look after my tablets and bring them to me three times a day. There’s never been a problem and my medication has never been late or ran out as far as I know.”

The people who used the service, relatives, and staff members all said the home was well-staffed. One person said, “There’s always someone around to help when you need them, we have lots of staff here.” A relative commented, “There is no shortage of staff at this home.” And a staff member said, “The staffing levels are very good for the needs of the residents.”

We spoke with four people using this service and two family members. We also spoke to five staff members and one visiting health professional.

We found that people were fully involved in discussions about their needs and care. One person said that they were “looked after well, the home is clean, the staff are friendly and the food is good.” Another person using the service for eight weeks told us that “the place is marvellous, with nice spacious grounds. The staff are marvellous.”

One relative said that the service is “great, good value for what you get and a lovely place.” Another relative said their family member had “a lovely room which has been recently refurbished and has a nice view. The staff are so nice and helpful and I would recommend Coxbench Hall.” We saw that staff were aware of people's individual needs and knew how best to support people make choices for themselves.

We found that staff were well supported in their work. One member of staff talked of the “warmth of the team”. Another member of staff told us “if I win the lottery, I would not give up my job here”. A visiting health professional told us “staff are helpful and the residents seem happy.”

We found that the care home is well managed, and that clear lines of responsibility were in place. The effect on people living in the home was that people were receiving consistent standards of care and service.

This inspection took place on 30 September and 1 October 2015. The first day was unannounced.

Coxbench Hall is a residential care home providing accommodation and personal care for up to 39 older people. There were 32 people living there at the time of our inspection. Coxbench Hall is a period building that has been adapted to the needs of people in residential care. The building has three floors, accessible by stairs and a lift. The gardens are spacious and well maintained, with several outside sheltered seating areas for people. All but two of the bedrooms have ensuite toilets, and there are bathrooms and shower rooms on each floor.

There was a registered manager at the service at the time of 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.

At our previous inspection on 4 July 2014 we found that there were two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 relating to the care and welfare of people who use services, and records. We asked the provider to send us an action plan to demonstrate how they would meet the legal requirements of the regulations. During this inspection we looked at whether improvements had been made.

At this inspection we found improvements had not been made in relation to care and treatment records. Staff were not consistently completing risk assessment and plans associated with people’s care. There was also evidence that one person was at risk from staff not making a timely referral to healthcare services.

We found a breach 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.

Staff were trained in how to protect people from the risk of abuse and avoidable harm. They knew how to recognise and report their concerns to the registered manager, provider, and local authority if required.

The provider had recruitment procedures and staff were subject to a probationary period. The provider had clear guidance and policies about what they expected from staff. Regular supervision and training was given to staff to ensure that they maintained the level of caring skills required by the provider. This showed that people were cared for by staff who were suitable and skilled to meet their needs.

Enough suitable skilled and experienced staff were available to meet people’s needs. People were supported to be as independent as possible, and had a call system that enabled them to alert staff quickly if they needed assistance. Staffing levels were adjusted according to people’s needs.

Medicines were stored, administered, recorded and disposed of in accordance with professional guidance and regulations. Staff were trained in safe administration of medicines.

Staff sought and obtained people’s consent before providing care. Where people declined support offered, staff respected their wishes and checked to make sure people had not changed their minds. Where people lacked capacity to consent to their care, staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). However, care plans did not always accurately record assessments of capacity.

Staff provided meals that were balanced and nutritious. They had a good understanding of people’s dietary requirements and supported people appropriately.

People were involved in planning and regularly reviewing their own care. They felt able to speak to staff about concerns or ideas for improving the service. The provider actively sought the views of people, relatives and staff about the service, and there was evidence of changes being made as a result of this.

The home supported people to take part in a range of activities during the week, and there were regular opportunities to maintain contact with family, friends and local communities.

The service had an open culture where people and staff felt supported to express their views about care. However, the provider’s monitoring system did not always identify issues or concerns about the quality of care.