The Cottage Residential Home is registered to provide accommodation for up to 40 people requiring nursing or personal care, including older people and people living with dementia. The registered provider also offers day care support in the same building as the care home although this type of service is not regulated by the Care Quality Commission (CQC). The service is also registered as a domiciliary care agency providing personal care to people living independently in the community.

We inspected the service on 16, 17 and 23 January 2019. The first day of our inspection was unannounced. On the first day of our inspection there were 36 people living in the care home and 6 people receiving personal care from the homecare service.

At our last inspection in June 2017 we rated the service as Requires Improvement reflecting shortfalls in the safety of the premises; medicines management; staff recruitment and quality monitoring. At this inspection we were disappointed to find the registered provider had failed to address all of these issues. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because of continuing shortfalls in organisational governance and a continuing failure to properly assess and mitigate risks to the safety of people living in the care home. We also found the registered provider was in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 due to a failure to notify us of allegations of abuse relating to people living in the care home. You can see what action we told the provider to take on these issues at the back of the full version of this report.

In other areas, the registered provider was also failing to provide people with the caring and responsive service they were entitled to expect. People in the care home did not receive sufficient physical and mental stimulation to meet their needs and people’s right to privacy was not consistently protected.

The overall rating for the service remains as Requires Improvement.

More positively, in both elements of the service, there were sufficient staff to meet people’s care and support needs. People using the homecare service were particularly appreciative of the timeliness of their care calls. Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively. Staff at all levels worked well together in a mutually supportive way. Senior staff were committed to strengthening the links between the care home and homecare service, to provide people with increasingly personalised support.

Staff were kind and attentive in their approach. People were provided with food and drink that met their individual needs and preferences. Staff provided end of life care in a sensitive and person-centred way.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm.

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.

There was evidence of organisational learning from significant incidents and events. People were invited to give feedback on the quality of the service. There were very few formal complaints and any informal concerns were handled effectively. There was an ongoing programme of improvement to the physical environment and facilities in the care home.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers (‘the provider’) they are ‘registered

This was an unannounced inspection carried out on 13 June 2017.

The Cottage Residential Home can provide accommodation and personal care for 40 older people, people who live dementia and people who have a physical disability. There were 38 people living the service at the time of our inspection. The service can also provide care for people in their own homes in Nocton, Billinghay and surrounding villages. At the time of our inspection eight people were receiving care in this way.

In this report we refer to the two services as being the ‘residential service’ and the ‘care at home service’. In addition, when we speak about issues that affect the staff working in both services we refer to them as being, ‘care staff’.

The service was run by a company who was the registered provider. 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. In this report when we speak both about the company and the registered manager we refer to them as being, ‘the registered persons’.

People had not always been assisted to avoid preventable accidents and medicines were not consistently being managed safely. In addition, full background checks had not always been completed before new staff were employed. However, there were enough care staff on duty in both services and they knew how to safeguard people from situations in which they might experience abuse.

Although some care staff had not received all of the training the registered persons considered to be necessary, in practice they had the knowledge and skills they needed. People were supported to eat and drink enough and care staff ensured that people received all of the healthcare they needed.

The registered persons had ensured that whenever possible people were helped to make decisions for themselves. When people lacked mental capacity the registered persons had ensured that decisions were taken in people’s best interests.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had ensured that most people only received lawful care. However, an improvement needed to be sustained to ensure that people living in the residential service only received lawful care.

Care staff were kind and compassionate. People’s right to privacy was promoted and confidential information was kept private.

People who used both services had been consulted about the care they wanted to receive and were given all of the practical assistance they needed. Care staff promoted positive outcomes for people who lived with dementia and people were supported to pursue their hobbies and interests. There were arrangements to quickly resolve complaints.

Although quality checks had not always effectively resolved problems in the running of the residential service, people had been consulted about the development of the services. Care staff considered that the services were run in an open and inclusive way so that they were able to speak out if they had any concerns.

During the visit we spoke with five people who lived at the home, four members of staff, the manager and two visiting healthcare professionals.

Due to the complex needs of some of the people who lived at the home we also used a number of different ways to help us understand their experiences. For example, we spent time observing the care people received and we looked at a range of records kept in the home. The records we looked at included people’s care files and information about how the home operated.

We saw people were asked for their consent before staff carried out any care task with them. Where people were unable to give clear consent to their care we saw meetings had been held to make decisions in their best interest.

We saw staff provided care for people in a way that maintained their dignity and privacy. Staff spoke with people in a friendly and respectful way. One person told us, “Four star care here ducky.” We know there was an effective system in place for people to raise concerns or complaints.

People told us they had a good range of food and drink. One person said, “Top quality food here.” Records showed us that people were involved in planning their menus.

The home was clean and hygienic during our visit and we saw the provider had systems in place to reduce the risks of infections spreading through the home.

Staff received a range of training which was based on the needs of people living in the home.

We carried out this inspection because we had received anonymous information which expressed concern about how people were being moved, how they were dressed, and how they were being spoken to by members of staff.

At this inspection we observed members of staff treating people with respect and courtesy. We saw staff knocking on doors before entering; staff also called people by the preferred name.

We saw assessments of people's needs and plans set out the care and support people needed. The assessments included information about people's likes and dislikes and things that were important to them; for example, the specific way they wanted the support they received to be provided.

We observed staff provided support and engaged with people who lived at the home positively. People appeared relaxed and comfortable in the presence of their support staff. In discussion, it was evident staff understood the needs of people they supported.

We observed members of staff lifting people using hoists. We noted two people operated the hoist at all times and people were told what was happening at every stage of the process.

We spoke with four members of staff, all of whom were able to demonstrate thorough knowledge of the moving and handling procedures in place at the home. Staff confirmed no member of staff was ever permitted to operate the hoist on their own.

We used a number of different methods to help us understand the experiences of people who used the service. This was because some people had complex needs which meant that they were not able to tell us about their experiences.

We spoke to some people who lived in the home and their relatives, and we looked at records, including personal care plans. We spoke to the manager and staff who were supporting people, and we observed how they provided that support. We also spoke to other professionals who provided support for people but did not work at the home.

We saw that people who lived in the home received individualised care and support from staff that were knowledgeable about their needs, wishes and preferences.

People said things like “I love living here,” “I have a very nice room,” and “The staff look after you really well.”

Relatives told us that staff looked after peoples’ privacy and dignity very well, and they make visitors feel very welcome.

A visiting professional told us that there was always good communication from staff, and said “This is one of my favourite places to visit.”

The people we spoke with told us that the home was a nice place to live.

We saw that people liked the food at the home and that they were given a choice about what they would like for each meal.

Information we looked at showed us that people, their families and staff were asked for their views about the running of the home by the manager and that they felt confident taking any suggestions or concerns to the manager or any of the staff.

Some of the people that we spoke with were unable to answer direct questions about their care and welfare, so we spent time observing how people were having their care needs met to help us gain a view on the experiences of people living at the home.

We observed that staff were providing support for people in a sensitive, helpful and friendly way and that they treated people with respect, whilst maintaining a positive and happy atmosphere throughout the home.

This inspection was carried out on 25 February 2015 and was unannounced. The last inspection took place on 10 May 2013.

The Cottage Residential Home provides care and support for up to 40 people, some of whom may experience memory loss associated with conditions such as dementia. At the time of our inspection there were 37 people living at the service.

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 had a good understanding of people’s needs, wishes and preferences and were respectful and compassionate towards people. Wherever possible people were supported to make their own decisions about what they wanted to do and staff respected people’s right to privacy so their dignity could be maintained.

Staff had received support from the registered manager to keep developing their skills and knowledge. They understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), which meant they were working within the law to support people who may lack capacity to make their own decisions.

There was enough staff on duty to meet people’s needs. Staff had the knowledge and skills that they needed to support people. They received training and on-going support to enable them to understand people’s diverse needs and work in ways that were safe and protected people.

We found people were supported to carry out person-centred activities on a regular basis and were encouraged to maintain their hobbies and interests.

People were provided with a choice of nutritious meals. When necessary, people were given extra help to make sure that they had enough to eat and drink.

People had access to a range of healthcare professionals when they required specialist help in order to maintain their health and well-being. We also found there were clear arrangements in place for ordering, storing, administering and disposing of medicines.

The management at the service was well established and provided consistent leadership. The provider made themselves available for people and staff to speak with and they encouraged people and staff to speak out if they had any concerns. The provider had a system in place to make sure any complaints were responded to in a timely way.

The provider and manager regularly monitored, and when needed took action to keep developing the quality of services provided.