We inspected this service on 20 and 24 April 2017. Coxwell Hall and Mews is registered to provide accommodation for up to 60 older people some living with dementia who require personal or nursing care. At the time of the inspection there were 56 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. The registered manager worked closely with the operations manager.

At the last inspection on 14 March 2016, we asked the provider to take action to make improvements and make sure people were protected from the risks of pressure sores, choking and infection. Also to ensure people’s capacity assessments were completed in line with the principles of the mental capacity act 2005 (MCA) and that the registered manager had a good understanding of the MCA. At this inspection on 20 and 24 April 2017 we found the actions had been completed.

Risks to people relating to development of pressure sores were assessed and risk management plans were in place. People were protected from risk of choking as well as risk of infection.

The registered manager and staff had a good understanding of the MCA. Where people were thought to lack capacity, assessments in relation to their capacity had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

People who were supported by the service felt safe. Staff had a clear understanding of how to safeguard the people and protect their health and well-being. People’s medicines were stored and administered safely.

There were enough suitably qualified and experienced staff to meet people's needs. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where required, staff involved a range of other professionals in people’s care.

People received care from staff who understood their needs. Staff received adequate training and support to carry out their roles effectively. People felt supported by competent staff who benefitted from regular supervision (one to one meetings with their line manager) and team meetings to help them meet the needs of the people they cared for.

People’s nutritional needs were met and people had a good dining experience. People were given choices and received their meals in timely manner. People were supported with meals in line with their care plans.

There was a calm, warm and friendly atmosphere at the service. Every member of staff we spoke with was motivated and inspired to give kind and compassionate care. Staff knew the people they cared for and what was important to them. Staff appreciated people’s unique life histories and understood how these could influence the way people wanted to be cared for. People's choices and wishes were respected and recorded in their care records.

People had access to activities and stimulation from staff in the home. Activities were structured to people's interests. Staff knew how to best support people and what activities and changes to the home would suit the needs of people.

Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. End of life care was provided in a compassionate way.

Leadership within the service was open and transparent at all levels. The provider had quality assurance systems in place. The provider had systems to enable people to provide feedback on the support they received.

The registered manager informed us of a

We inspected this service on 14 March 2016. This was an unannounced inspection. Coxwell Hall and Mews nursing home is registered to provide accommodation for up to 59 older people living with dementia who require personal or nursing care. At the time of the inspection there were 56 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. The registered manager worked closely with the area manager.

People who were supported by the service felt safe. The staff had a clear understanding on how to safeguard the people and protect their health and well-being. There were systems in place to manage safe administration and storage of medicines. However, there was no clear guidance for people using thickener where choking was a risk.

People at risk of developing pressure sores were not always protected from these risks. People’s pressure mattresses were not always set to correct pressures.

The provider had an infection control policy in place. However, people were not always protected from the potential risk of infection. Staff wore long sleeved clothes whilst delivering care as well as handling food.

There were enough suitably qualified and experienced staff to meet people needs. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where required, staff involved a range of other professionals in people’s care.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005. However, the registered manager did not have a clear understanding of their responsibilities in relation to completing mental capacity assessments. Where people were thought to lack capacity, assessments in relation to their capacity had not been completed in line with the principles of MCA. The registered manager relied on capacity assessments carried out by other health professionals.

People received care from staff who understood their needs. Staff received adequate training and support to carry out their roles effectively. Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

People’s nutritional needs were met and people had a good dining experience. People were given choices and received their meals in timely manner. We observed people during lunch time and saw people being supported with meals in line with their care plans.

People felt supported by competent staff. Staff benefitted from regular supervision (one to one meetings with their line manager) and team meetings to help them meet the needs of the people they cared for.

There was a calm, warm and friendly atmosphere at the service. Every member of staff we spoke with was motivated and inspired to give kind and compassionate care. Staff knew the people they cared for and what was important to them. Staff appreciated people’s unique life histories and understood how these could influence the way people wanted to be cared for. People's choices and wishes were respected and recorded in their care records.

People had access to activities and stimulation from staff in the home. Activities were structured to people's interests. We observed people engaged in arts and crafts, ball games and cake baking.

The registered manager used best practice guidance in dementia care. For example, the butterfly scheme was used in the home and all staff had an awareness of it. This is a scheme used to improve the wellbeing of people with dementia. Staff discussed how to best support people and what activities a

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection. During this inspection we spoke with four people and five people’s relatives. We also spoke with two nurses, three care workers, the deputy manager and the registered manager.

The service had a registered manager who was responsible for the day to day operation of the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Coxwell Hall and Mews is a nursing home for up to 66 older people. At the time of our visit there were 59 people living at the home who were living with dementia. The majority of these people required nursing care.

Some people were prescribed medicines which could be given in variable doses, such as one or two tablets. When staff gave these they did not always keep an accurate record. This put people at risk as they may not have the medicines they needed. This is a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see the action we have told the provider to take at the end of this report.

People and their relatives told us they or their relatives felt safe at Coxwell Hall and Mews and were protected from abuse. Staff knew how to identify if people were at risk of abuse and knew what to do to ensure they were protected.

The registered manager had knowledge of the Deprivation of Liberty Safeguards (DoLS). They understood DoLS and had made applications to apply it in practice. All applications were made lawfully and with the person’s best interests at the heart of decision making. Deprivation of liberty safeguard is where a person can be deprived of their liberties where it is deemed to be in their best interests or their own safety.

Staff understood the needs of people and we saw that care was provided with kindness and compassion. People and their relatives spoke positively about the home and the care they or their relatives received. Staff took time to talk with people or provide activities such as cake baking, soft darts and arts and crafts.

Staff were appropriately trained and skilled and provided care in a safe environment. They all understood their roles and responsibilities, as well as the values of the home. The staff had also completed extensive training to ensure that the care provided to people was safe and effective to meet their needs. Nurses had the clinical skills they needed to ensure people’s health needs were met. Staff had effective support, induction, supervision (one to one meetings with line managers) and training.

All staff spoke positively about the support they received from the registered manager. Staff told us the registered manager was approachable and there was a good level of communication within the home.

People received effective support around their personal needs. Staff supported people with to maintain their mobility and nutritional needs. Nurses assessed the health and care needs of people and provided clear guidance for staff to meet these needs.

Relatives knew how to raise concerns and felt the registered manager was approachable. Relatives told us they had no concerns, and felt the home were good at communicating changes.

The registered manager used best practice guidance around dementia care. For example the butterfly scheme (a scheme to improve the wellbeing of people with a dementia) was used in the home and all staff had an awareness of this. Staff discussed how to best support people and what activities and changes to the home would suit the needs of people.

Staff and management reflected on their work daily. This enabled them to learn from events and incidents to ensure people received effective care. This also allowed staff to express their views and resolve any issues or problems which had arisen during the day.

We spoke with six of the people who lived in the home. Some people were not able to communicate clearly with people they did not know. We observed 15 people in the dining room prior to, during and after the lunch period for approximately one and a half hours.

Two people told us that they were ‘’happy and well looked after ’’. Other people were able to indicate by nodding and smiling that they were happy. Two professionals and a family member who were visiting the home told us that they felt the home offered a very good standard of care.

We saw that staff respected people’s individuality and diversity.

We found that staff members knew the individual’s current needs and were observed meeting the person’s needs effectively.

People who used the service told us that staff were ‘’always patient and kind’’. Other people nodded and smiled in agreement.

We found that the home was keeping all the management records necessary to show that people who used the service were being looked after in the safest possible way.

This was a follow up inspection to check that the home was compliant in specific areas. We did not speak with people who used the service on this occasion.

We used a number of different methods to help us understand the experiences of people using the service because they had complex needs which meant they were not able to tell us very much about their experiences. We spoke with six relatives of people who were using the service and observed care.

Relatives of people who lived in the service told us that people were always treated with dignity and respect. Five of the six relatives we spoke with told us they were happy with the standard of care offered to their family members. They told us that they were confident that their family member was safe. Relatives told us that there were some issues around unexplained and unnoticed bruising. They told us that the home could have higher standards of cleanliness. Relatives told us that the staffs’ attitude to their family members was ‘great’. Four of the six relatives spoken with told us that there were enough staff, whilst the other two felt that there were not enough staff to give people the individual attention they needed. They told us that they were confident to discuss any concerns they had with the staff or the manager. Most relatives said that the home responded to concerns and complaints and took action to improve the situation.

People who live in the home had communication difficulties and were unable to speak to us.

We observed that people were treated with respect and sensitivity. They were confident and happy to approach staff with whom they interacted constantly.