CQC report explained · a nursing home
What the CQC found at Old Wall Cottage Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People told inspectors they felt safe. Risks were assessed and managed, medicines were handled safely, infection control was effective and there were enough staff to meet people's needs.
- Effective?
- Good
- Care was based on people's needs and recognised guidance. Staff were trained, people received support with food and drink, and healthcare professionals were involved when needed.
- Caring?
- Good
- Inspectors saw staff treating people with kindness, dignity and respect. People were offered choices and supported to remain as independent as possible.
- Responsive?
- Good
- Care plans reflected people's preferences and changing needs. Activities had improved and included people cared for in their rooms.
- Well-led?
- Good
- Management systems were described as robust and up to date. Audits identified learning from incidents, and communication between staff, families and other professionals was effective.
What inspectors found, February 2023
Rated Good; inspectors found safe, kind and personalised care, with clear improvements since the previous inspection.
This was an unannounced follow-up inspection on 11 January 2023. Inspectors spoke with people, family members, staff and healthcare professionals. They also reviewed care records, medicines records, staff files and management records.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines management, good infection control, suitable training and effective support from health professionals.
The home had improved since the previous inspection, which was rated Requires Improvement. Activities had improved, the environment was better suited to people living with dementia, and management systems were stronger. The provider was no longer in breach of the regulations identified at the last inspection.
Safe staffing
Inspectors observed call bells being answered promptly and found enough staff to meet people's needs. The home had also added an early morning shift after listening to staff.
“During our inspection we observed that call bells were answered promptly, people's needs, and requests were dealt with quickly by staff.” from the report
Kind and respectful care
Staff were warm, patient and friendly. They understood people's communication preferences and supported dignity, choice and independence.
“Throughout the inspection we observed staff to be warm and friendly.” from the report
Improved activities
Activities were provided seven days a week and were based on people's interests. People cared for in their rooms were included.
“There was an activities team who planned and provided activities 7 days a week.” from the report
Personalised care
Care plans recorded people's histories, preferences and changing needs. Families were encouraged to take part in care planning.
“People received personalised care that reflected their needs and preferences.” from the report
Stronger management oversight
Management audits covered accidents, safeguarding, falls, medicines, infection control, care plans and call bell responses. Learning was shared with staff.
“The registered manager carried out a monthly management audit which looked at all aspects of the home.” from the report
Inspectors raised no specific concerns in this report.
- 01How do you make sure activities continue to include people who are cared for in their rooms?
- 02How do you assess and manage my relative's specific risks, such as falls, nutrition, hydration or skin problems?
- 03How will you keep staffing levels sufficient when people's needs change?
- 04How are families involved in reviewing and updating care plans?
- 05How do you use accident, fall and medicines audits to make further improvements?
This was an unannounced follow-up inspection after the previous Requires Improvement rating; inspectors reviewed all five key questions and infection prevention and control. This explanation was written from the published report of 2 February 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, September 2021
Rated Requires Improvement; inspectors found kind staff but risks, night staffing, personalised care and management oversight needed improvement.
This was an unannounced inspection on 13 April 2021. Two inspectors spoke with people, staff and relatives, and reviewed care plans, medicines, recruitment files and management records. They also checked infection prevention and control.
The home was not always safe or effective. Some risk assessments lacked clear instructions, and one person at high risk of choking was found eating without the support set out in their plan. Inspectors also found more incidents at night, when staffing was lower.
People were often positive about staff and said they felt safe and well cared for. However, inspectors found problems with dignity, meal choices, activities, dementia-friendly surroundings and personalised care plans. End of life choices were not always recorded clearly.
All five areas were rated Requires Improvement: Safe, Effective, Caring, Responsive and Well-led. The home had to send the CQC an action plan, and the CQC said it would continue to monitor the service.
Safe recruitment
The home completed the required recruitment checks before staff started work. Nurse registration checks were also carried out regularly.
“The provider had systems in place to ensure safe recruitment of staff.” from the report
Medicines
Inspectors found that medicines were administered by qualified nursing staff and recorded in line with prescriptions. Time-critical medicines were given at the prescribed times.
“Medicines were administered by qualified nursing staff and reviewed regularly by the GP.” from the report
Kind relationships
People and relatives spoke positively about staff, and inspectors observed friendly interactions. Staff usually asked for permission before carrying out care tasks.
“There was a relaxed atmosphere around the home, and we observed friendly interactions throughout the day.” from the report
Contact with relatives
The home supported relatives to keep in touch in different ways during the COVID-19 pandemic, including visits in a visiting pod.
“Family members told us they were supported to maintain contact in a variety of ways during the COVID-19 pandemic.” from the report
Risk management
seriousSome risk assessments did not tell staff clearly how to reduce risks. One person assessed as being at high risk of choking was found eating in a position that increased the risk.
“People were not always supported in line with their risk assessment.” from the report
Night staffing
seriousThe manager's dependency assessment identified a need for an additional carer at night. Inspectors also found more unwitnessed incidents at night when staffing was lower.
“Inspectors noted in the accident and incidents log that a significant number of unwitnessed incidents occurred at night-time, when one nurse and two carer workers were on duty.” from the report
Dementia-friendly environment
needs fixingSome areas were noisy and lacked quiet spaces, meaningful destinations and suitable personal space for people living with dementia.
“The design and decoration of the home did not always meet the needs of people who lived with dementia.” from the report
Dignity and choice
needs fixingInspectors found examples where privacy, dignity and choice were not handled consistently. People were not always offered a clear choice or explanation about their meals.
“People were not always treated with dignity and respect.” from the report
Personalised care and activities
needs fixingCare plans lacked enough detail about individual preferences and routines. Activities did not consistently engage people, especially those living with more profound dementia.
“People were not always provided with activities that met their preferences and interests.” from the report
Management oversight
seriousQuality checks did not reliably identify problems or confirm that earlier actions had been completed. Significant incidents were not always reported to the CQC.
“Effective management systems were not in place to assess, monitor and improve the quality of service people received.” from the report
- 01What extra night staffing has been put in place following the dependency assessment?
- 02How are risk assessments now checked to ensure staff have clear instructions and follow them, particularly for choking and falls?
- 03What dementia-specific training do staff now receive, including training about behaviour that challenges?
- 04How have care plans been changed to record personal routines, preferences and end of life choices?
- 05What activities are now available for people with profound dementia, and how is their engagement checked?
This was an unannounced inspection of all five key questions, with infection prevention and control checked under Safe; it was the first inspection since the provider changed in November 2019. This explanation was written from the published report of 21 September 2021 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 Old Wall Cottage Care Home
5 rated inspections over 7 years: the service has held its Good rating throughout.
- February 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2021Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- December 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- September 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- March 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2019
Registered with the Care Quality Commission on 12 November 2019.
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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