Archived: BLHC Coote Lane Limited

Coot Lane is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Coote Lane is registered to provide personal care for up to 24 people. There were 21 people living in home at the time of this inspection, some of whom were living with dementia. Accommodation is provided in single bedrooms, some with en-suite facilities, over two floors. A passenger lift is available to assist people to move freely around the home.

At our last comprehensive inspection in May 2017 we found improvements had been made. However, there were continuing shortfalls in relation to the way medicines were handled in the service and the lack of robust procedures to protect the rights of people who could not consent to their care in Coote Lane.

Following the inspection, the provider sent us an action plan which set out the action they were taking to meet the regulations. On this inspection of 25 September 2018, we found good progress had been made and the provider had met the action plan and was no longer in breach of the regulations. Medicines were judged to be well managed. The home was now complying with the requirements of the Mental Capacity Act 2005 to ensure that people’s rights were being upheld in line with the Act.

There was a registered manager in place. 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.

The registered manager had been in post for just over 12 months and was solely responsible for this home. People living in the home, their relatives and staff all spoke very highly of the new manager and the improvements made since her arrival and the change in management structure.

People felt safe living in Coote Lane and with the staff who supported them. Staff in the home were aware of their responsibilities in relation to protecting people from harm or abuse. Staff had received training and there was suitable guidance in place about making safeguarding referrals.

People were supported by staff who knew them well and were focussed on promoting their independence and well-being. The home assessed people prior to coming into them coming into the home to ensure that their needs could be met. This was followed by on-going assessments and care plans that were developed with the individual to set out how their needs were to be met.

Staffing levels were suitable for people’s needs. Staff recruitment was done correctly so that only suitable staff cared for vulnerable people.

There was a stable staff team who had the skills and knowledge to meet people's needs. The home had a programme of training and on-going staff supervision which ensured staff had up to date guidance and information for their roles.

People received the support they required to maintain good health. Medicines records were accurate and supported the safe administration of medicines. The home worked in partnership with external healthcare professionals. Healthcare professionals gave positive feedback on the care and of the monitoring of peoples changing health needs.

People were supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice. The staff understood their responsibilities under the Mental Capacity Act 2005 and people’s rights were upheld.

People were involved in planning their own support and the activities they wanted to take part in. There was a programme of activities for people to take part in and people were also supported to follow individual interests and hobbies.

We have made a recommendation that the service looks at ways of how technology can be used to enhance people’s lives.

Staff were caring and treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs.

People were provided with meals and drinks that they enjoyed. The staff were knowledgeable about the support people required to enjoy their meals and drinks safely and this was provided.

The home had undergone improvements to the environment since the last inspection. The registered manager and owner had developed an improvement plan for the home which included the next phase of works, such as continuing to replace furniture and carpets.

The service had audits and checks in place on the premises and quality of the service including seeking people's views. Concerns and complaints were managed appropriately.

The management structure in the home had been strengthened since the last inspection, including the appointment of a new registered manager. This had led to improvements in the service, such as with care planning and the thoroughness of audits. Staff morale, team work and communication had also improved and the staff team were very positive about the changes.

Further information is in the detailed findings below.

Coote Lane is registered to provide personal care for up to 24 people. There were 23 people using the service at the time of this inspection. Accommodation is provided in single bedrooms, some with en-suite facilities, over two floors. A passenger lift is available to assist people to move freely around the home.

At our last comprehensive inspection on 19 October 2016 we found the provider was not meeting a number of regulations. We therefore asked the provider to take action in relation to person centred care, the need for consent, good governance and staff supervision. In addition, we issued a warning notice to help ensure people always received safe care and treatment.

Following the inspection, the provider sent us an action plan which set out the action they were taking to meet the regulations. This inspection in May 2017 was undertaken to check whether the required improvements had been made.

There was a registered manager in place. They were also registered manager at another home owned by the provider in a different area of Lancashire. 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.

During this inspection we found some improvements had been made. However there were continuing shortfalls in relation to the way medicines were handled in the service and the lack of robust procedures to protect the rights of people who could not consent to their care in Coote Lane. You can see what action we told the provider to take at the back of the full version of the report.

We identified shortfalls in the management of medicines. This was because administration records did not provide evidence that people had always been given their medicines as prescribed. In addition, the use of prescribed creams was poorly documented, although there were no concerns regarding the skin integrity of anyone living in the home.

Although the registered manager had submitted DoLS applications for three people who used the service, they had failed to ensure that the necessary application was submitted for a person who was in receipt of one to one care and was unable to consent to these arrangements.

Risk assessments were in place in relation to the care people required. These had been regularly reviewed and updated to ensure they accurately reflected people’s needs. We have recommended the provider ensure risk assessments are put in place in relation to the security of the building and the smoking area used by people who used the service. We have also referred the matter regarding unsafe smoking practices to the fire authority.

People were cared for in a safe and clean environment. Procedures were in place to prevent and control the spread of infection. Regular checks were made to help ensure the safety of the equipment used. Systems were in place to deal with any emergency that could affect the provision of care.

People told us they felt safe in Coote Lane and that staff were kind and caring. People who used the service told us staff always respected their dignity and privacy. Staff were aware of the action to take should they witness or suspect abuse and were confident they would be listened to if they raised any concerns with the registered manager.

We found people were cared for by sufficient numbers of suitably skilled and experienced staff who had been safely recruited. Staff had received the essential training to enable them to deliver effective care, although the system to record when refresher training was due needed to be improved. We have recommended that the provider ensures that an accurate and up to date record is maintained of all training completed by staff.

Systems were in place to assess and monitor people’s nutritional needs. People told us they were generally satisfied with the quality of food. People also told us they had the option to have something other than the main choices offered if these were not to their taste.

Interactions between staff and the people who used the service were warm, friendly and relaxed. The staff we spoke with had a good understanding of the care and support that people required. They told us they would always try and promote the independence of people who lived in the home. All the people spoken with confirmed staff would encourage them to do as much as they could for themselves.

Care records were personalised and written in a respectful manner. The support staff would offer to people to meet their needs was clearly documented. People who used the service told us they always received the care and support they needed. They told us they were involved in developing and reviewing their plans of care.

We saw that a programme of regular activities was provided to help maintain the well-being of people who used the service.

Staff told us they enjoyed working in Coote Lane and felt they were well supported by the registered manager. Staff told us they were able to make suggestions about how the service could be improved and that their views were always listened to. Records we reviewed confirmed regular staff meetings took place.

There were systems in place for receiving, handling and responding appropriately to complaints. All the people we spoke with during the inspection told us they would be confident that any concerns they reported would be listened to and action taken by the manager to resolve the matter.

Quality assurance processes had improved. However we have recommended the provider improves audit records to show what action has been taken to address identified shortfalls.

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.

BLHC Coote Lane Limited was last inspected in January 2014 and was found to be compliant in the outcomes inspected.

Risks to people's safety and welfare had not been appropriately assessed and actions to reduce those risks were not always documented. The service had not always taken steps to manage risks to people's health and well-being. Risk assessments were not always evident in people's care plans.

Care was not always person-centred. Care plans were in place however they were not always reflective of people's current needs and wishes. They were not always reviewed on a regular basis however; changes were not made to them to ensure they were updated as people's needs changed. Staffing levels were sufficient to meet people's care needs, but not to ensure that they had the opportunity to engage in activities or to spend time talking and relaxing with members of staff.

Some quality assurance processes were carried out however; they were not frequent or effective in monitoring the service and identifying areas where improvements were required. The registered manager informed us that care plans were being redesigned with an emphasis on person centred choices. Not all had been done at the time of our inspection. We found instances where risk assessments in people's care lacked key information which staff members required to effectively manage risks. We also found that not all care plans provided sufficient detail to give staff the information they needed to provide personalised care and support that was consistent and responsive to their individual needs.

Staff members felt supported, however did not always receive formal support from the service. They did not receive regular supervision sessions but did feel they were able to raise issues as they needed to.

People told us they enjoyed the food and were offered a choice of where they would like to sit and that they could request alternatives if they did not like what was on the menu. However there was no information displayed or in the kitchen regarding allergens contained in the food produced.

People were supported to make and attend appointments with their GP and other healthcare professionals, both within the service and the local community.

People's care and treatment was planned and delivered in a way that helped to ensure their safety and welfare. Staff were trained to support people at risk of falling, developing pressure ulcers or who may not eat enough. Professional help was sought when needed.

People were happy with the quality and choice of food provided. We were told, 'The foods nice, you will never go hungry.' We found the meal served was wholesome and nutritious and portions were generous. People needing support to eat was given this with dignity.

People were cared for by staff that were supervised and trained and people had opportunities to give their views about their care and treatment.

People told us 'They always ask me if I need help. They are very good'. And 'They do chat about your care and what is wanted. I'm quite contented. I have everything I need'. People told us they could choose the gender of their carer. One person said 'is absolutely lovely. He has a lovely personality and I have no problems letting him help me with my personal care'. We were also told 'When they come to my room they always knock on the door, even if they are just bringing me a hot drink. We get well looked after'. 'They (the staff) are pleasant and very helpful. When I'm having a bath I am given the privacy I need. Just knowing they are in the background makes me feel safe and confident'.

People thought activities could be improved.

We found people had their medication administered correctly and when they needed them. People were cared for by staff of good character and who were trained. People told us there was always enough staff and described staff as being 'very well qualified', 'Very helpful', and 'Good at their job'. One person told us 'One good thing here is they (the staff) never try to make you rush.