19 January 2017
During a routine inspection
The Coach House is registered to provide care and support for people in their own homes. Most people receiving support from the staff were older people including those with dementia. As a result some had limited verbal communication skills so were unable to speak with us. The provider supported 54 people and five people required two members of staff for each visit.
The service had a manager who was not currently registered with us.
People and relatives told us they felt safe. However, medicines were not always managed safely. There was a recruitment policy and procedure in place which had not always been followed by the provider and manager to make sure risks of abuse to people were minimised. One person with a specific medical need had not had risks to their health and well-being managed well.
Staff and the manager had some understanding about people who lacked capacity to make decisions for themselves. However, the principles to protect their human rights had not always been followed.
Quality assurance systems were being put into place by the manager and provider to identify shortfalls. When shortfalls had been identified they had been resolved and lessons were learnt. However, these systems had not identified concerns found during the inspection. When they were highlighted the manager had taken action promptly.
There were systems in place to manage complaints and the provider demonstrated a good understanding of how to respond to them. However, the provider had not always followed the statutory obligations to notify and inform us about changes which had occurred in the service. They had not responded to requests for all information by CQC.
People were supported by staff who had received training and support from the senior staff. Formal supervisions had not been occurring regularly for all staff which meant all their training needs and concerns had been identified. At the time of the inspection this was being reviewed by the manager. People’s choices were supported and respected by staff. When people struggled to verbalise their choices staff found alternative methods to support them to communicate their needs and wishes.
People and their relatives thought highly of the staff and manager. They explained how kind and caring staff were and we observed positive interactions. People’s privacy and dignity was respected; staff told us this was always encouraged by the manager.
Staff had good knowledge of people’s care needs and personal preferences. The needs of the people were reflected in their care plans and were reviewed regularly. People’s care was responsive to their changing needs.
Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and knew the procedures to follow if they had concerns. Any concerns raised had been appropriately managed.
People's health care needs were monitored and met. They were supported by sufficient numbers of staff to meet their needs. At times there was some inconsistencies of how care was delivered because lots of staff worked with each person. There were effective systems in place if staff were running late. If staff were absent the senior staff would make sure people received their care.
People who required support with meals received it and staff understood about special diets to meet people’s care and health needs.
We made a recommendation that the provider finds out more information about the Mental Capacity Act.
We made a recommendation that the provider finds out more about staff supervision.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.