CQC report explained · a nursing home
What the CQC found at The Cotswold
Rated Outstanding: inspectors found the home performing exceptionally well.
- Safe?
- Good
- Inspectors found that medicines, safeguarding, risks, staffing, recruitment and infection control were managed safely. People said they felt safe and there were enough staff.
- Effective?
- Good
- People's needs were assessed before admission and staff had relevant training and supervision. The home supported nutrition, healthcare access, independence and lawful decision-making.
- Caring?
- Good
- People described staff as kind, caring and respectful. Inspectors saw staff protecting privacy, supporting independence and respecting people's differences and choices.
- Responsive?
- Outstanding
- Care was highly personalised and flexible. Staff used creative ideas to support people's hobbies, independence, communication, social life and end of life care.
- Well-led?
- Outstanding
- Inspectors found exceptionally strong leadership, staff morale and involvement of people in how the home was run. The home used audits, feedback, partnership working and new ideas to improve care.
What inspectors found, September 2019
Rated Outstanding overall; inspectors found safe, kind and highly personalised care, with especially strong activities, responsiveness and leadership.
This was an unannounced inspection on 13 August 2019. Inspectors spoke with six people living at the home, four relatives, eight staff members and nine outside health and social care professionals. They also checked care records, medicines records, staff files, complaints, accidents and quality checks.
The home was rated Good for Safe, Effective and Caring. Inspectors found people were protected from harm, received their medicines and had enough suitably checked staff. Staff understood people's needs, supported their health and nutrition, respected their choices and treated them with kindness and dignity.
The home was rated Outstanding for Responsive and Well-led. Inspectors found care was highly personal and flexible, with creative support for people's interests, independence and changing needs. They also found exceptionally strong leadership, staff involvement, learning and quality monitoring. The overall rating improved from Good at the previous inspection.
Personalised care
Staff knew people's histories, preferences and routines in detail. They made creative adjustments so people could remain independent and continue activities that mattered to them.
“All residents are treated as individuals and their individual needs and personalities are recognised by staff across all departments” from the report
End of life support
Inspectors found compassionate and dignified support for people nearing the end of their lives. Relatives gave very positive feedback about planning, communication and palliative care.
“End of life care was excellent. As an ex-nurse I don't think you could fault it.” from the report
Activities and relationships
There was a varied programme of activities, outings, gardening and links with the local community. People could join in or choose not to.
“There is always something going on if you want to join in” from the report
Leadership and listening
The manager and staff were seen as approachable and open to feedback. People were involved in decisions about the home, staff recruitment and improvements.
“The manager is very approachable, knowledgeable and responsive to any queries.” from the report
Inspectors raised no specific concerns in this report.
- 01How would you assess and support my relative's individual routines, interests, communication needs and cultural or emotional needs?
- 02How many regular staff would care for my relative, and how do you make sure there are enough suitably trained staff each day and night?
- 03How would you involve us in planning and reviewing end of life care if my relative's health changes?
- 04Which activities and outings could my relative join, and how would you support them if they preferred to stay in their room?
- 05What changes have you made after recent complaints or feedback, and how do you check that those changes have worked?
This was an unannounced inspection of all five key questions, including the premises and care, and the previous Good rating was reviewed. This explanation was written from the published report of 20 September 2019 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, March 2017
Rated Good; inspectors found kind, personalised care, but medicines checks and some records needed improvement.
Inspectors visited the home without notice on 17 and 18 January 2017. They observed care, spoke with people, relatives, staff and other professionals, and checked care records, medicines records, recruitment files and management records.
People generally felt safe and well cared for. Inspectors found enough staff, detailed care plans, good training, support with health and meals, respectful care, varied activities and approachable management.
There were some improvements needed. Medicines stock checks and fridge temperature records were not always right. One capacity assessment and the storage of some care files also needed attention. The manager took immediate action on the medicines issues and other recording points.
The home was rated Good overall and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. It remained Good since the previous inspection in November 2014.
Kind and personal care
Inspectors found that staff knew people well and treated them with compassion. Care was adapted to people's histories, preferences and interests.
“People were cared for by compassionate staff that knew people's needs well.” from the report
Choice and independence
People were involved in decisions about their care and supported to do what they could for themselves. Staff respected choices about daily routines and activities.
“People were involved in decisions about their care and supported to remain as independent as possible.” from the report
Staffing and training
Inspectors found enough staff to meet people's needs. Staff received induction, ongoing training and support to carry out their roles.
“There were sufficient numbers of staff in place to keep people safe.” from the report
Food and health support
People were supported to see health professionals and meet their nutritional needs. They spoke very positively about the choice and quality of food.
“People were supported to meet their nutritional needs.” from the report
Medicines checks
seriousBoxed medicine stock did not balance during three checks. On five occasions, the medicines fridge temperature was outside safe levels. The manager investigated and introduced extra checks.
“the maximum recorded temperature of medicines fridge was found to be outside the safe levels.” from the report
Capacity recording
needs fixingFor one person whose capacity changed, the record did not include a decision-specific capacity assessment about living at the home. The manager said this would be corrected.
“their ability to make the decision about residing at the home was not recorded as a decision specific capacity assessment.” from the report
Privacy of care files
needs fixingSome care files were kept in people's rooms. The manager said people would be consulted again so there was clear evidence that they agreed to this arrangement.
“However, on the ground floor, people's care plans were kept in people's rooms.” from the report
Call-bell response during handovers
minorThe management had identified that call bells could take longer to answer during staff handovers. The clinical manager was reviewing shift times and monitoring this.
“when people used the call bells during staff handover time the time for these to be answered could be longer than expected.” from the report
- 01What checks are now used to make sure medicines stock balances every time?
- 02How are medicines fridge temperatures recorded and acted on when they are outside safe levels?
- 03How do you record decision-specific capacity assessments when a person's capacity changes?
- 04Where are care files kept now, and how is people's agreement to this arrangement recorded?
- 05What has changed to prevent delays in answering call bells during staff handovers?
This was a comprehensive, unannounced inspection covering all five questions and setting the overall rating. This explanation was written from the published report of 10 March 2017 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 The Cotswold
3 rated inspections over 5 years: the service has improved, from Good to Outstanding.
- September 2019Outstandingcurrent ratingup from GoodSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Outstanding
- March 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2015GoodSafe: GoodEffective: GoodCaring: OutstandingResponsive: GoodWell-led: Good
- September 2013
Report published without a new overall rating.
- March 2013
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 6 January 2011.
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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Most charge £980 to £1,300 a week. 32 can care for a couple. 12 years' experience on average.
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