CQC report explained · a residential care home
What the CQC found at Cockington House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, September 2023
Requires Improvement; inspectors found concerns about safety, staffing, safeguarding and management oversight.
This was an unannounced focused inspection on 2 August 2023. Two inspectors observed the home, spoke with people, relatives, staff and professionals, and checked care plans, medicine records, recruitment files and management records.
The home was not always safe. Inspectors found gaps in safeguarding records, fire and other safety checks, learning from incidents, staffing and following people's behaviour support plans. Medicines were managed safely, and staff understood that physical restraint was not needed.
The home was also not always well-led. Concerns had not always been investigated, people had missed activities and support in the community, and relatives and staff had not been properly asked for feedback. A new management team had started making changes, but the provider's governance systems were not effective.
The overall rating changed from Good at the previous inspection, published in 2017, to Requires Improvement. The inspection only assessed Safe and Well-led. The other ratings used for the overall rating were carried forward from the previous inspection.
Kind and respectful care
Inspectors saw staff treating people kindly and respectfully. People's dignity, privacy and human rights were respected.
“Staff ensured they respected people's dignity, privacy and human rights. People were supported by caring staff.” from the report
Medicines were managed safely
Staff followed systems for administering, recording and storing medicines. Staff training and competency checks had been completed, and the management team acted on audit findings.
“People were supported by staff who followed systems and processes to administer, record and store medicines safely.” from the report
Updated care guidance
The management team had reviewed care records and risk assessments. These gave staff current information about how to support people safely.
“The management team had reviewed and updated people's care records and risk assessments.” from the report
Safeguarding concerns were not handled consistently
seriousSome concerns raised by relatives and staff had not been acted on. Records did not always show that allegations had been recorded, investigated and monitored.
“Records did not always evidence that all safeguarding allegations had been recorded, investigated, and monitored.” from the report
Important safety checks were missing
seriousInspectors found missing or unsuitable fire, asbestos and water safety checks. The provider said after the visit that contractors had been booked and checks would be completed.
“We found weekly fire alarm testing and an asbestos report had not been completed.” from the report
Incidents were not used to prevent repeat problems
seriousThe home did not have an effective system for sharing lessons from incidents or putting measures in place to reduce the chance of them happening again.
“Accident and incidents were logged but there was no monitoring in place to ensure lessons were learnt and measures were put into place to prevent similar issues arising again.” from the report
Feedback was not properly gathered
needs fixingPeople, relatives and staff were not routinely asked for their views. Informal concerns were not recorded or acted on, and staff meetings and supervisions had not been held.
“People, staff and relatives had not been asked to provide feedback about their views.” from the report
- 01What action has been taken to record, investigate and monitor all safeguarding concerns?
- 02Have the external fire risk and asbestos assessments been completed, and are weekly fire alarm checks now recorded?
- 03What are the current staffing levels on every shift, including overnight, and how will planned one-to-one and two-to-one support be protected?
- 04How are incidents now reviewed and shared with staff so that similar problems do not happen again?
- 05How will relatives, people using the home and staff give feedback, and when will regular meetings and staff supervisions restart?
This was a focused inspection of Safe and Well-led only; the other key question ratings used for the overall rating carried over from the 2017 inspection. This explanation was written from the published report of 6 September 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2022
Inspected but not rated; inspectors found good infection control arrangements, but some staff wore masks incorrectly and cleaning equipment was not stored safely.
This was an announced, targeted inspection on 27 January 2022. Inspectors looked mainly at infection prevention and control, visiting arrangements and whether COVID-19 staffing pressures affected care.
The home had visitor checks, supported safe contact with families, used cleaning schedules and arranged vaccination and regular testing. Inspectors were assured about most infection control measures.
Inspectors were only somewhat assured that masks were being used correctly and that cleaning equipment was stored safely. The service was inspected but not rated, so this report does not give a Good, Requires improvement or Inadequate rating.
Visitor safety
The home carried out checks for visitors and supported people to meet family and friends safely.
“Comprehensive checks for visitors on arrival. Residents were supported to safely meet with family and friends.” from the report
Testing and vaccination
Staff and residents were vaccinated and had regular COVID-19 testing to reduce infection risks.
“Staff and residents were vaccinated and underwent regular COVID-19 testing to help keep each other safe.” from the report
Masks not always worn correctly
needs fixingSome staff were not wearing face masks correctly during the visit. Inspectors were therefore only somewhat assured that personal protective equipment was being used safely.
“At the time of the visit some staff were not wearing face masks correctly.” from the report
Cleaning equipment storage
needs fixingCleaning equipment was not stored appropriately when it was not being used. This meant inspectors were only somewhat assured about hygiene practices and the layout of the premises.
“Cleaning equipment was not being appropriately stored when not in use.” from the report
- 01What has been done since the inspection to make sure all staff wear face masks correctly?
- 02Where is cleaning equipment stored when it is not being used, and how is this checked?
- 03How are visits arranged now, and how does the home keep visiting guidance up to date?
- 04What staffing pressures is the home experiencing, and what measures are in place to prevent these affecting residents?
- 05Are staff and visiting professionals still meeting the COVID-19 vaccination or exemption requirements described in the report?
This was a targeted inspection of infection prevention and control, visiting arrangements and COVID-19 staffing pressures, and the service was inspected but not rated. This explanation was written from the published report of 12 February 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Cockington House
3 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.
- September 2023Requires improvementcurrent ratingSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2022Inspected but not ratedSafe: Inspected but not rated
- November 2017Goodstayed GoodSafe: GoodWell-led: Good
- July 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2014
Registered with the Care Quality Commission on 9 January 2014.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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