Prestwood Coach House

Prestwood Coach House is a nursing home providing personal and nursing care to 26 people aged 60 and over at the time of the inspection, some of whom were living with dementia. The service can support up to 40 people.

People’s experience of using this service and what we found

People received safe support with their medicines from staff members who had been trained and assessed as competent. Staff members followed effective infection prevention and control procedures when supporting people.

People were supported by enough staff who were available to assist them in a timely way.

People were protected from the risks of ill-treatment and abuse as staff had been trained to recognise potential signs of abuse and understood what to do if they suspected harm or abuse.

The provider had assessed the risks associated with people’s care and support. Staff members were knowledgeable about these risks and knew what to do to minimise the potential for harm.

People were supported to have maximum choice and control of their lives and the provider supported them in the least restrictive way possible and in their best interests; the application of the policies and systems supported good practice.

The provider supported staff in providing effective care to people through person-centred care planning, training and one-to-one supervision. People were referred to additional healthcare services if needed and staff were knowledgeable about any recommendations or treatments.

People received help and support from a kind and compassionate staff team with whom they had developed positive relationships. People were supported by staff members who were aware of their individual protected characteristics like age, religion, gender and disability.

The provider, and management team, had good links with the local communities within which people lived. The provider had effective systems in place to identify improvements and drive good care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 July 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, effective, caring and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good, based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Prestwood Coach House on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Prestwood Coach House is a nursing home providing personal and nursing care to 32 people aged 60 and over at the time of the inspection, some of who were living with dementia. The service can support up to 40 people.

People’s experience of using this service and what we found

People were not always supported to have their needs met in a timely way by staff. People gave mixed feedback about whether there were sufficient staff to meet people's needs and engage with them in a meaningful and flexible way.

People were not consistently supported to receive their medicines as prescribed and in a safe way. Medicines were not consistently stored and disposed of in a safe way. Medicines records did not always contain clear guidance for staff to follow in relation to ‘as required’ medicines. The provider did not always take timely action where people had not received support with their medicines.

People’s care files did not consistently contain clear guidance to enable to staff to meet their needs. People's daily care notes did not always reflect they were supported with their care needs. People had access to health professionals, however professional feedback was mixed in relation to whether their guidance was always followed to support people's recovery.

People were supported to access regular meaningful activities however did not always have time to engage with staff outside of care tasks. Quality assurance tools were not effective at identifying where improvements were required at the service. The management team had not ensured systems were effective at sustaining quality and improvement.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not always support this practice due to staffing constraints.

People were supported by staff who knew them well. Staff understood safeguarding and made referrals the safeguarding team where required. People were supported by safely recruited staff. People were supported to maintain their independence. People knew how to complain and the registered manager acted on people’s concerns.

People were supported to maintain a diet of their choice. People were supported to access a variety of activities both inside and outside of the home.

People found the registered manager approachable. The registered manager sought and shared people’s feedback about the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 12 December 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to people’s safe care and treatment, staffing and the governance of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At this unannounced inspection which took place on the 23 and 24 October 2018 they were providing nursing and accommodation to 24 people.

Prestwood Coach House had a registered manager in place who was present throughout this inspection. 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.

Following our last inspection in April 2018 we published our report in May 2018. At that inspection we rated the key questions ‘Safe’ and ‘Well-led’ as inadequate and the remaining key questions ‘Effective’, ‘Caring’ and ‘Responsive’ as requires improvement. We rated Prestwood Coach House as ‘Inadequate’ overall.

As part of the inspection, published in May 2018, we identified eight breaches in the Health and Social Care act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, staffing, safeguarding people from abuse, consent, person centred care, complaints, governance and failure to make appropriate notifications.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the services that they provided to people to at least ‘Good.’ We received this action plan in June 2018.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At this inspection we found significant improvements had been made in all the areas previously identified. However, the provider had a proven history of non-compliance with the regulations and the improvements made need to be sustained over time.

However, owing to the history of non-compliance with the regulations we needed to assure ourselves that the improvements were sustainable over time. We recognised that the management team had introduced changes to quality monitoring systems, but owing to the short time period from their introduction we could not be assured that the improvements were embedded fully into practice. We will consider this further during future planned inspections.

People were safe from the risks of abuse and ill-treatment as staff knew how to recognise and respond to concerns. Any concerns raised with the management team were acted on appropriately. The provider followed safe recruitment procedures when employing new staff members. People received their medicines, as prescribed, with the assistance of staff who were competent to safely support them. Risks associated with people’s care and support were assessed and action taken to minimise the risk of harm. The provider followed effective infection prevention and control methods to minimise the risk of contractible illnesses.

People had access to additional healthcare services when they required them. People received support with their diet and hydration and had meals they found varied and enjoyable. Peoples individual rights were maintained by staff members who understood the law which informed their practice. People were asked for their consent for care and treatment and, if they couldn’t make such decisions, the staff team and provider knew what to do to effectively support people. Staff members felt well supported and well trained to undertake their role. New staff members received a structured introduction to working at Prestwood Coach House.

People were supported by a caring and compassionate staff team. People received support at times when they were upset or distressed. People were supported to maintain their independence and their privacy was respected by those supporting them. People’s private information was kept securely and only accessed by those with authority to do so.

People had care and support plans that reflected their individual needs and preferences. People’s human rights and protected characteristics, like faith and disability, were identified and they received support, by staff members, to maintain aspects of their lives that were important to them. People took part in activities that they found to be enjoyable, stimulating and fun. People knew how to raise a concern or make a compliment. The provider had systems in place to respond to issues raised with them.

The provider understood their responsibility to make the necessary notifications that they were required to do so by Law. The provider’s quality monitoring systems were effective in identifying and driving improvements when they were needed.

People were asked for their opinions on the service that they received and the provider had systems in place to respond to any feedback. People knew who the management team were and had a positive relationship with them. The provider had good ties with the local community which people benefited from. The provider learnt from incidents and accidents and, if necessary, worked with people, families and staff members to minimise the risk of reoccurrence if things had gone wrong.

Prestwood Coach House is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Prestwood Coach House is registered to accommodate 40 people in one building. Some of the people living in the home are living with dementia. At the time of our inspection 26 people were using the service. Prestwood Coach House accommodates people in one building and support is provided on two floors. There is a communal lounge and dining area, a conservatory and a garden area that people can access.

There is 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.

When we completed our previous inspection on 21 November 2017 we found risks were not always reviewed or managed in a safe way. There was not always enough staff available for people and they had to wait for support. Staff understood when people were at risk of harm and how to report this; however when safeguarding incidents had occurred we could not see how lessons had been learnt. Infection control procedures were in pace however they were not always followed. It was also unclear when people lacked capacity to make decisions for themselves and when needed decisions had not always been made in people’s best interest. People were unlawfully being restricted and this had not been considered. Referrals to partner agencies were not always made in a timely manner. Concerns were raised around the training and induction of agency staff. People did not always receive care in their preferred way. Care plans were not always reviewed to reflect people’s needs and when people had cultural needs these had not always been fully considered. People were not always sure how to make a complaint. Staff did not feel listened to and when needed that action was taken. People and relatives did not always know who the registered manager was. Quality checks did not always drive improvement within the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well led to at least good. We did not receive the action plan from the provider in the time frames we set. We again requested the action plan from the provider and this was sent to us.

At this inspection we found risks to people were not managed in a safe way. We saw that people were not transferred in a safe way and care plans and risks assessments were not always reflective of people’s current needs. When care plans were in place people were not always supported in line with these. When people were identified as at risk of harm staff did not always have the necessary information to offer the correct support. As all safeguarding’s had not been considered or reported appropriately we could not be assured people were protected from potential abuse.

Correct procedures were not always followed to ensure people had taken their medicines, meaning people were placed at increased risk of receiving the wrong medicines. We could not be assured there were enough staff available for people as they had to wait for support. Infection control procedures were in place however these were not followed to reduce the risk of cross infection.

Staff received training however we could not be assured people’s competency was assessed as they did not always demonstrate an understanding in key areas such as MCA. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Where we had raised previous concerns about people not been referred to health professional we saw these had been made. However people were using equipment they had not been assessed for and guidance had not been sought from relevant professionals in this area.

People were not always supported in a kind and caring way and staff were sometimes rushed when delivering support. People’s choices and dignity were not always considered. When people were living with dementia or had communication needs the provider had not considered how to fully support these people. People and relatives thought improvements could be made to the food and drink within the home.

People did not always receive individualised care in their preferred way. Concerns had been raised about the equipment within the home. People did not always know how to complain and when people had complained these had not been responded to in line with the provider’s procedures. People and relatives were not happy with how concerns were actioned and responded to within the home. People and relatives did not also feel they were involved with planning and reviewing of their care.

Concerns with the management of the home were raised and people, relatives and staff did not feel supported or listened to. The provider had not taken the necessary action to comply with the regulations. The audits that were completed were not effective in identifying concerns or used to drive improvements within the home. People’s suggestions were not always acted on or used to make changes. People’s information was not stored in a confidential way and the provider did not always notify us of significant events that occurred within the home.

The provider ensured staffs suitability to work within the home and people were happy with the care staff that supported them. People were able to make choices about how to spend their day and encouraged to maintain relationships that were important to them. People were provided with the opportunity to participate in activities they enjoyed. The provider was displaying their rating in line with our requirements.

Staff had protective equipment including gloves available when needed. Staff understood whistleblowing procedures. When people had as required medicines there were protocols in place for when medicines could be administered. People had the opportunity to attend health appointments when needed. Information relating to current legislation was available for staff to consider.

The overall rating for this service is Inadequate and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service had a registered manager 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.

When we completed our previous inspection on 22 October 2015, the service was rated as good overall. We rated the well led domain as requires improvement as we found there was a lack of confidence that concerns raised would be dealt with and people did not always know who the registered manager was. Quality checks were in place but did not always bring about change.

At this inspection we found staff did not always feel listened to and when they raised concerns they felt action was not always taken. People did not always know how to complain and people did not know who the registered manager was. There were quality monitoring systems in place however they did not drive improvements within the service. The provider did not always notify us of significant events that had occurred within the home.

Risks to people were not always managed in a safe way and assessments were not always reviewed to reflect people’s current needs. There were not always enough staff available for people and they had to wait for support. The provider did not assess people’s dependency levels within the home to ensure there were enough staff available. Referrals to health professionals were not always made in a timely manner. When professionals had made recommendation these were not always followed placing some people at risk. Infection control procedures were not always effectively implemented within the home, increasing the risk of cross infection for people.

Care plans and risk assessments were not always reviewed to reflect people’s current needs. People preferences or cultural needs had not always been fully considered. When people lacked capacity to consent this was often unclear and we could not see how decisions were made in peoples best interests. People were being unlawfully restricted as authorisation for DoLS had not been considered. There was lack of understanding from both staff and the registered manager with regards to this. Therefore people are not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice.

People were happy with the staff and people were treated in a kind and caring way. People were encouraged to be independent and make choices about their day. People enjoyed the food and were offered a choice. They also had the opportunity to participate in activities they enjoyed. People were supported to attend health appointments when needed. Medicines were managed in a safe way. Advanced decisions had been considered for people and end of life care had been anticipated by the provider.

Staff understood when people were at harm and to report safeguarding concerns. The provider had a system in place to ensure staffs suitability to work with the service. The provider sought feedback from people and relatives. When formal complaints and been made the provider had responded to these in line with their procedures and people were happy with the outcome. The provider ensured there was enough protective personal equipment available for people. Staff received an induction and training that helped them support people. The provider worked alongside other agencies and they were displaying their previous rating in line with our requirements.

This is the first time the service has been rated Requires Improvement. We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with seven people who lived at the Coach House. All were complimentary of the staff and the care they received. People told us that staff were polite and respected their privacy and independence. They told us that staff were available to deliver personal care and offer support when needed. One person said: 'I am encouraged to be as independent as possible, but the staff are always around to help'.

The staff we spoke with were knowledgeable about the care needs of the people living at the home. People at the home were supported with health care needs and received consultations from their general practitioner and other health professionals when required. People told us they received their medication in a timely manner.

There was a policy in place to ensure people living at the home and their family could formally raise any concerns or complaints. The policy ensured that all complaints were investigated and responded to.

During our inspection we observed that staff were polite and attentive, supporting people where appropriate. Plans of care for people were available. We spoke with nursing staff and care staff about the care provided at the home. Staff were knowledgeable about the care requirements for people.

We asked staff about their understanding of safeguarding (protecting vulnerable adults). Staff we asked told us how they would raise any concerns they may have. All said they were able to speak with senior staff or management.

The home had an induction programme to ensure all new staff employed at the home were supported within their role. Staff told us they had training provided and had one to one meetings with the manager.

There was a process for the on going quality monitoring of the service provided at Prestwood House and Prestwood Coach House. The current systems were being reviewed and updated to ensure the organisation continued to gather feedback on the quality of the service it provided.