The inspection took place on 27 and 29 November 2018 and was unannounced.

East Cosham House 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.

East Cosham House provides accommodation for up to 24 people, some of whom live with dementia and mental health conditions. At the time of our inspection, there were 24 people living in the home.

There was a registered manager at the home. 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.

Medicines were not always managed safely. Procedures in place were not robust and did not evidence that people were receiving their medicines as prescribed.

There were quality assurance systems in place based on a range of audits. However, we found these were not always effective and had not identified the concerns raised during the inspection, around medicines management.

People felt safe living at East Cosham House. Staff knew how to keep people safe and how to identify, prevent and report abuse. They engaged appropriately with the local safeguarding authority.

Individual and environmental risks were managed effectively. Risk assessments identified risks to people and provided clear guidance to staff on how risks should be managed and mitigated.

Thorough staff recruitment checks were carried out when a new staff member started working for the service. There were enough staff available to keep people safe at all times and staffing levels were monitored by the registered manager.

Staff received a variety of training and demonstrated knowledge, skill and competence to support people effectively. Staff were supported appropriately by the registered manager and deputy manager.

People had access to health and social care professionals where required and staff worked co-operatively and efficiently.

People were supported by staff with their nutritional and hydration needs. People were offered choice at mealtimes and menus contained a variety of nutrition and healthy foods. Where people had specific dietary requirements, these were well documented and staff were aware of how to meet these needs.

Staff were knowledgeable of the Mental Capacity Act 2005 and people’s rights were protected in line with the Act at all times. Where people were required to be deprived of their liberty, this was completed and recorded in an appropriate and timely manner.

People were cared for with kindness and compassion. Staff had developed positive relationships with people and their relatives and knew what mattered most to them.

Staff took action to protect people’s dignity and privacy at all times and encouraged people to be independent with all aspects of their daily routines where possible.

People had a clear, detailed and person-centred care plans in place, which guided staff on the most appropriate way to support them. People’s families were invited to be involved in the planning and delivery of their relatives care where appropriate.

People had access to a variety of activities to ensure they received appropriate mental and physical stimulation, and were encouraged to follow their own interests.

The service had a clear process in place to deal with complaints and we saw that concerns were dealt with in a timely and effective manner.

The provider was engaged with the running of the service and was approachable to people and staff.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the end of the full version of this report.

We carried out a comprehensive inspection of this service in November 2014 and found the provider was not meeting the legal requirements in relation to standards of care and welfare for people who use the service. Risks associated with people’s care had not always been assessed and people had not always consented to and been involved in the planning of their care. We carried out an unannounced inspection of this home on 18 August 2016 and found the provider had made improvements in these areas and was now meeting the requirements of these regulations.

The home provides accommodation and personal care for up to 24 older people, some of whom live with dementia and mental health conditions. Accommodation is arranged over two floors with stair lift access to the second floor. At the time of our inspection 21 people lived at the home.

A registered manager was 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 were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Robust processes to check the suitability of staff to work with people were in place. There were sufficient staff available to meet the needs of people and they received appropriate training and support to ensure people were cared for in line with their needs and preferences.

Medicines were administered and ordered in a safe and effective way.

Risk assessments in place informed plans of care for people to ensure their safety and welfare, and staff had a good awareness of these. External health and social care professionals were involved in the care of people and care plans reflected this.

People were encouraged and supported to make decisions about their care and welfare. Where people were unable to consent to their care the provider was guided by the Mental Capacity Act 2005. Where people were legally deprived of their liberty to ensure their safety, appropriate guidance had been followed.

People received nutritious meals in line with their needs and preferences. Those who required specific dietary requirements for a health need were supported to manage these.

People’s privacy and dignity was maintained and staff were caring and considerate as they supported people. Staff involved people and their relatives in the planning of their care.

Care plans in place for people reflected their identified needs and the associated risks. Staff were caring and compassionate and knew people in the home very well.

Effective systems were in place to monitor and evaluate any concerns or complaints received and to ensure learning outcomes or improvements were identified from these. Staff encouraged people and their relatives to share their concerns and experiences with them.

The service had effective leadership which provided good support, guidance and stability for people, staff and their relatives. People spoke highly of the registered manager and their team of staff.

We carried out an unannounced inspection of this service on 27 November 2014. East Cosham House provides accommodation and care for up to 24 older people, including some who live with dementia. The home is a large, converted property and accommodation is arranged over two floors. A stair lift is in place to assist people to move between the two floors. The accommodation provided is a mixture of single bedrooms and two shared rooms for two people. There were 24 people living at the service at the time of our inspection.

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.

People felt safe at the home. Relatives had no concerns about the safety of people. However, risk assessments had not always been completed to ensure people received safe and effective care which was unrestrictive and in line with their needs. The provider acknowledged the need for this to be addressed at our inspection.

People were protected by staff who had been trained and had a good understanding of abuse against people. Staff were confident to report any concerns they may have through the appropriate channels. However the registered manager and staff had not identified that people’s human rights were not being recognised and protected in some of the restrictions they placed on people.

There were sufficient staff to meet the needs of people. There were robust recruitment and training processes so people were cared for by people who had the right skills to meet their needs.

People were supported by competent staff to take their medicines safely. Staff gave people a choice of nutritious food and drink.

Staff at the home had not been guided by the principles of the Mental Capacity Act 2005 (MCA) when working with people who lacked the capacity to make decisions. The registered manager and staff had not always sought people’s consent to their care. The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. One person living at the home was subject to a DoLS. Whilst all appropriate actions had been taken to support this person, the registered manager and staff did not have a good understanding of when DoLS should be implemented.

People had access to health and social care professionals when they were required. External professionals were well received by staff and advice and support was followed by staff who cared for people at the home.

People said staff were very caring and supportive. Staff knew people at the home well and were skilled in meeting their needs. They addressed people in a calm and dignified way. They were respectful of the people they supported and ensured their privacy and dignity was maintained at all times.

Individualised plans of care provided information about people’s needs. Staff encouraged people to participate in activities. People had fun participating in an activity of singing and dancing together. People were happy in the home.

People were provided with opportunities to express their views on the service through quality assurance surveys and through discussions with the manager and staff. Meetings were held with people and their relatives/representatives to allow them to express their views.

Whilst an extensive programme of audit was completed by the registered manager to ensure the welfare and safety of people they had not identified the lack of risk assessments in place for some people. Processes were not in place to ensure people who consented to plans of care and treatment for people had the legal authority to do so.

People who worked and lived at the home felt able to express any concerns they had and these were responded to promptly. The registered manager promoted an open and honest culture of communication in the home and people responded well to this. Complaints, incidents and accidents were investigated thoroughly and lessons learned were shared with staff to prevent reoccurrence of these issues.

We found a number of breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2010, which correspond with 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 this report.

We carried out a routine inspection on 14 August 2013. There were 18 people living at the home. During our inspection we spoke with the registered manager, the registered provider, five staff members, and five people who lived at this home.

Care was provided over two floors with chair lift facilities for those people who could not manage the stairway. People were able to personalise their rooms with their own possessions and could access their rooms whenever they chose. We saw that most people chose to move around on the ground floor of the home interacting with others during the day. Two communal lounges and a dining area were available for people to utilise with staff present in these areas.

During our visit we used our SOFI (Short Observational Framework for Inspection) tool to help us see people's experiences of the care and support they received. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences.

We saw that clear care plans were in place to support people who lived in this home. Staff treated people in a kind and gentle manner respecting their dignity at all times. Staff we spoke with knew people living at this home very well. People had their care discussed and agreed with them or their representative.

People told us they were happy living at this home and that, “The staff are wonderful.”

The visit took place to follow up compliance actions made in the last inspection report for the visit on 16 July 2012 regarding food and nutrition for people and the maintenance of people’s care records.

We spoke to four people living at the home who told us they received the care and support they needed. People also said care was provided in they manner they preferred. People said they were bale to make choices in how they spent their time, in the food they ate, the times they went to bed and got up in the morning. We saw that care records reflected people’s individual preferences.

We looked at care records and the arrangements for ensuring people received an adequate diet. These showed people’s weight was monitored and the home liaised with specialist services so that people’s nutritional needs were addressed.

During the lunchtime we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We spent 40 minutes observing at lunchtime and found that people had positive experiences. Staff were observed assisting people in a calm, friendly and polite manner. We observed staff to be tactful when supporting people to eat who had behaviour needs.

We spoke with four relatives, 11 people living at the home and six staff. People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience people who have experience of using services and who can provide that perspective.

Some people were unable to tell us about their experiences due to their cognitive problems. To help us to understand the experiences of people, we used a Short Observational Framework Inspection tool (SOFI), which is a specific way of observing care

to help us understand the experience of people who could not talk with us. We observed how people spent their time, the support they received from staff and whether they had positive outcomes.

We observed interactions between the staff and people who use the service. People told us that they were treated with respect and that the staff were kind, courteous and supported them as needed. People were satisfied with the food provided. Comments included “I always enjoy the food.” Another person told us that the food was good and “if you wanted something different, they give it to you.” Relatives said that they were happy with the care and they felt that the staff treated people with respect.

We spoke with four relatives who were visiting them on the day of our inspection. They told us that the home communicated well with them and had involved them in their relative's care and were kept informed of changes in their relative's condition.

People told us they felt safe. They said they knew how to raise concerns and said that they would talk to the care staff or the manager. Two people commented that they would tell their relatives. One person said’ you can tell the staff if you have any problems” they do listen”.