Cooksditch House Nursing & Residential Home is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service has 50 single rooms. It is registered to provide accommodation and personal care support for up to 55 people, if some people choose to share a room. At the time of the inspection there were 48 people living at the service: 31 people were accommodated in the nursing unit and 17 people receiving residential care. The service accommodated older people with a wide range of needs including chronic or long-term health needs, physical disability, mental health and dementia.

The inspection was unannounced and took place on 3 and 4 October 2018. This was the first inspection to the service since it registered with CQC on 25 October 2017. Prior to this, the service was owned and managed by a different provider.

The service was run by a registered manager and they were present on both days of the 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.

Although systems to assess and monitor the quality of the service were being strengthened, they were not always effective in identifying and addressing shortfalls in service provision.

Safe systems were not in place for the management of medicines. Some people did not receive their medicines as prescribed.

There was not a systematic approach in place to determine the number of staff required to meet the needs of people. Staffing levels had been adjusted to meet the needs of people in the nursing unit. People in the residential unit told us that they had to wait a long time to receive staff support. The provider made some adjustments to staffing levels in the residential unit as a direct result of our inspection visit.

There was inconsistency in people’s care and treatment records with regards to fluids, repositioning and personal care so it could not be assured that their needs were being met.

The activity coordinator was absent from the service and this had impacted on the opportunities available for people to take part in. The provider arranged for a member of the care staff team to work an additional three afternoons a week to provide activities as a direct result of our inspection visit. Links with the local community had been developed through open days and with a local school.

Staff understood how to support people to have a pain free and comfortable end of life, with people around who were important to them. However, not everyone who had life limiting conditions had been asked about their wishes at the end of their lives.

People and their relatives told us they felt safe and comfortable with the staff who supported them. Staff had received training in how to safeguard people and knew how to report and act on any concerns to help keep people safe. New staff were checked to make sure they were suitable to work with people.

Assessments of risks to people’s safety and welfare had been carried out and action taken to minimise their occurrence. Health and safety checks were effective in ensuring that the environment was safe and that equipment was in good working order. Accidents and incidents were monitored and appropriate action taken in a timely manner to evidence that lessons had been learned.

People benefitted from a clean environment and staff knew what to do to minimise the spread of any infection.

People were supported to access health care services when needed. The provider worked in partnership with a range of healthcare professiona