Cottingham Hall is situated in the north of Hull and is close to local amenities. The home is registered to provide personal care and accommodation for up to 30 older people, including those who may be living with dementia. Most of the bedrooms are for single occupancy and are located over two floors. There are two communal sitting rooms with dining space at one end. There is a large garden to the rear of the property and parking at the front.

At our last inspection, we rated the service Good. At this inspection, we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. At this inspection we found the service remained Good.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

This service was selected to be part of our national review, looking at the quality of oral health care support for people living in care homes. The inspection team included a dental inspector who looked in detail at how well the service supported people with their oral health. This includes support with oral hygiene and access to dentists. We will publish our national report of our findings and recommendations in 2019.

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The service had 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.

People told us they felt safe and staff knew how to keep them safe from harm and abuse. Staff completed safeguarding training and could describe the action they would take if they had concerns. Staff completed assessments to help minimise the risks people had. There was sufficient staff deployed to meet people’s needs and they were recruited in a safe way. Medicines were managed safely and people received them as prescribed.

People’s health and nutritional needs were met. Staff ensured people had access, in a timely way, to a range of health care professionals for advice and treatment when required. 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. Staff received training, support and supervision to enable them to feel skilled and confident when supporting people. The environment had been adjusted to take account of people’s differing needs. This included prominent signage and colour-contrasting equipment to increase visibility for people living with dementia.

People told us staff had a kind and caring approach. We observed this throughout the inspection and it was confirmed in discussions with relatives and professional visitors to the service. Staff provided people with explanations and information in accessible formats such as pictorial signs and symbols. The cook was in the process of taking photographs of all the meals they prepared so these could be used instead of a written menu board. Staff maintained confidentiality and personal information was held securely.

People had assessments of their needs and these were used to develop plans of care to guide staff in how to meet them. People told us staff were responsive to their needs and listened to them if they had concerns or complaints. People could remain at the service for end of life care. Staff involved health professionals and relatives to ensure people’s needs were met. There were activities for people to participate in.

The service was well-led. There was a quality monitoring system that consisted of audits, questionnaires and meetings to ensure people could express their views. The registered manager acted to address any iden

Cottingham Hall is situated in the north of Hull and is close to local amenities. The home is registered to provide personal care and accommodation for up to 29 older people, including those living with dementia. There were 29 bedrooms all for single occupancy and are located on both floors. All bar two of the rooms have an en suite toilet. There is a large garden to the rear of the property and parking at the front.

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

We undertook this unannounced inspection on the 23 and 24 March 2016; there were 29 people using the service at the time of the inspection. At the last inspection on 12 June 2014, the registered provider was compliant in the areas we assessed.

We found the culture of the organisation meant people were able to express their views and were listened to. The new registered manager had re-started the quality monitoring programme which consisted of audits, questionnaires and meetings. This will need to be sustained over a period of time to ensure it is embedded in the organisation. The registered manager is to send us the next bi-monthly audit which is to be completed in April 2016.

We found staff were recruited safely and were deployed in sufficient numbers to meet people’s needs. People told us they did not have to wait too long for assistance.

We found staff received appropriate training for their roles. They also received support and supervision from the registered manager and a senior manager.

We found staff knew how to keep people who used the service safe from the risk of harm and abuse. They completed safeguarding training, could recognise signs of abuse and knew how to ensure the correct agencies were informed. Risk assessments were completed which helped to guide staff in how to minimise potential risks associated with people’s activities of daily living.

We found people’s health needs were met. Staff ensured people had access to a range of health care professionals when required. We found people received their medicines as prescribed.

We saw people liked the meals provided to them. There was a healthy option at each meal and menus provided a variety of choices. We observed people were provided with drinks and snacks between meals.

We saw staff had developed good relationships with people who used the service and their relatives. We observed staff had a caring approach, listened to people and supported them in a kind and patient way. Staff supported people to make their own choices and decisions and when they were assessed as lacking capacity for this, the registered provider acted within the principles of mental capacity legislation.

People had assessments and plans of care which provided staff with good information about how they preferred to be cared for. Staff had time to read care plans and passed on relevant information to each other in handovers.

There were activities provided to people for three hours each day during the week. Some people said they would like more activities; this was mentioned to the registered manager to check out with them.

We found there was a complaints procedure on display and people told us they felt able to complain knowing it would be sorted out for them. People were asked if they had any complaints in meetings which took place regularly.

We found the service was safe, warm, clean and tidy. Staff had appropriate cleaning materials and protective items such as gloves, aprons and hand sanitiser. Any equipment used was serviced to ensure it remained safe.

The inspection was carried out by two inspectors and an Expert by Experience. At the last inspection on 18 and 19 February 2014 we issued a warning notice for the lack of quality monitoring and several compliance actions for breaches of other regulations. We followed up those issues with this inspection. 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?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them, and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service were treated with dignity and respect by the staff. Improvements had been made in the way staff moved and handled one specific person and in how staff ensured people’s preferences about getting up in the morning were adhered to.

Risk assessments were completed so staff had guidance in how to support people in ways that minimised the risks.

There had been improvements in the way staff were recruited. All employment checks were now completed before staff started work.

There had been improvements in the numbers of staff on duty, which meant there was sufficient staff on duty during the day and night. The number of staff on duty took account of people’s care needs.

There had been improvements in how infection prevention and control was managed. The service was safe, clean and regular checks of equipment and hygiene were carried out.

The service had policies and procedures to provide staff with guidance about their role and tasks. Records about the care people received and other records used for the running of the home were accurate and held securely.

Is the service effective?

People were able to make choices about aspects of their lives and could take part in some activities inside the service.

People’s health and social care needs were assessed with them and there was input from relatives. Specialist needs in relation to diet, falls, mobility and equipment were identified and planned for.

Visitors told us they could see people in private and were made to feel welcome at all times.

There had been improvements noted in staff training. Staff told us they received training relevant for their role and they were supported by management.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed encouragement and patience when supporting people.

People’s preferences, likes and dislikes had been recorded and care and support was provided in accordance with people’s wishes and choices. Staff demonstrated they knew people’s needs and preferences.

Is the service responsive?

We observed staff involved people and offered each one choice in regard to their needs. The staff approach to people who used the service was respectful and friendly.

People had access to a range of health and social care professionals such as GPs, district nurses, dieticians, social workers, dentists, opticians and chiropodists. There was evidence the staff team sought appropriate advice, support and guidance during emergency situations.

People said they would like to have more activities and the manager was addressing this by recruiting a designated activity coordinator.

People told us they felt able to complain and make suggestions about the service during meetings and on a day to day basis.

Is the service well-led?

We found improvements had been made in the way the service was managed and in the way the quality of the service was monitored. Throughout the day, we observed the manager was out and about around the home. He regularly stopped to speak with people who used the service in the lounge areas. We observed the manager to be approachable and people who used the service spoke highly of him.

A quality assurance system that included checks and obtaining people’s views had been implemented. Records showed us that shortfalls identified during these checks were addressed promptly.

Staff told us they were well supported by the manager and had supervision meetings and annual appraisal. Staff meetings were held so information could be exchanged and views expressed.

What people who used the service and those that matter to them said about the care and support they received.

Comments included, “What I like about this place is that I have choices and it makes life a lot better for me”, “Everyone is very friendly and helpful, staff treat me well and there is a lot of personal attention given to individuals”, “Staff are always kind and thoughtful”, “Staff listen to me when I tell them anything” and “You can go where you like and do what you like.”

Comments about care and welfare included, “They fetched my breakfast to me in bed because I said I didn’t feel very well” and “Carers are very good; they look after me very well.”

People spoken with told us they were treated well by staff and said, “I feel safe with all of the staff, even the younger ones.” A visitor said “I know she is safe when I’m not here and that makes me feel confident with the staff.”

A visiting health professional told us, “It is clean, tidy and smells fresh.”

During the inspection we spoke with five people who used the service and their relatives. They all spoke positively about the care and support they received. One person told us "We are well treated here it is very good." Relatives also confirmed the standard of care was good.

We found people experienced care, treatment and support that met their needs and protected their rights. We saw that risk had been assessed and each person had individual management plans in place for various areas. Care plans reflected people's needs and were updated where required.

People were supported to be able to eat and drink sufficient amounts to meet their needs. There was a varied menu and healthy choice of food available. People told us the food was good and they had plenty of choice.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We found staff had received appropriate training and their skills were evaluated through supervision and appraisal.

The provider had a complaints procedure in place.There was a complaints book and information found around the home gave people and visitors knowledge about how to complain if they were unhappy about the care and treatment at the service. People to us they were able to raise concerns with the manager and staff and these would be acted upon.

We used a number of different methods to help us understand the experiences of people who used the service including observing care practices.

People who used the service told us that the care was very good and choice was promoted. Some commented, “It’s lovely here”, “It’s excellent and I am very happy here” and “It’s my home.”

People told us, “The activities are good, we often have singers coming in” and “We have coffee and a discussion group – I particularly enjoy this.”

People told us the care and support they received was excellent and commented, “I can have a bath when I want one” and “The staff come very quickly if you press the buzzer.”

We spoke with two relatives who told us they were happy with the care and the staff were very good.

We also spoke with two visiting health care professionals who told us the staff and management were welcoming and listened to any advice given. They commented, “The staff are excellent, I have no concerns whatsoever” and “The Staff listen to any advice given.”

We spoke with people who used the service about the environment and they told us the home was clean, homely and warm. Some comments included, “It’s lovely and clean” and “My room is perfect.”

People told us they were consulted about their care and everyday life. They also confirmed that complaints were listened to and acted upon.

Prior to our visit we spoke with the local authority contracting and commissioning department and safeguarding teams. They told us they had no concerns or ongoing investigations in relation to the home.

We received information of concern alleging some people who used the service were supported to get up at 4.30am to 5am. We were also told staff used lukewarm water to wash people at night, as hot water through the night was not available in all bedrooms. This information was shared with the local safeguarding and commissioning teams and a joint visit was carried out at 6am on 18 February 2014. We also returned the following day to look at further issues. Due to the level of concerns we found, the provider has voluntarily agreed not to admit anymore people until we are satisfied improvements have been made.

We found everyone did not have an up to date plan of care that gave staff guidance in how to care for them. We also found that risk assessments were not always completed or updated when people’s needs changed. These issues meant staff may not have full information about how to care for people. People spoken with told us they liked living at the home. Comments included, “The meals are marvellous” and “I like it here; this is my home."

We found some people were supported to get up, washed and dressed very early. We also found staff were not using correct moving and handling techniques for some people, which placed them at risk of harm.

We found the service did not have appropriate infection prevention and control systems in place. For example, with regards to hand washing and collection of soiled laundry. Soap and paper towels were missing from communal toilets, bathrooms and the staff toilet.

We found medicines were managed appropriately and people received them as prescribed.

We found that in some instances full employment checks had not been carried out before staff started work at the service and new staff did not always complete an induction. This meant the provider could not be sure the staff were suitable to work with vulnerable people.

We found there was a shortage of night staff on duty four nights a week, which placed people who used the service at risk of not receiving adequate care. People spoken with were complimentary about the staff. Comments included, “The staff are friendly; they are great”, “The staff don’t get me up or wash me or anything, I’m allowed to be as independent as I want”, and “I get up myself so get a cup of tea when I see staff; the staff are very good.”

We found there were significant gaps in essential training, staff supervision and appraisal. This meant we could not be sure staff had the required skills, knowledge and experience to care for the people who used the service.

We found the manager had spent the last eight months managing two services for the company, which had taken their main focus away from Cottingham Hall. This had led to a shortfall in management oversight and slippage regarding checks and audits.