The Coach House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff described how they reflected on the culture of the service and learning arising from incidents. They told us managers held reflection practice sessions where issues were openly discussed and reviewed without blame. One staff member described this approach and told us, “Reflections are really good and helpful for all of us. Sometimes maybe I make a mistake or forget something like a blood test appointment. It is better for the team if we all sit down and talk about what happened, why and how to not do it again. Being open takes away the blame which I like very much.”

Staff we spoke with were able to tell us about lessons learned arising from some of the reflections. When we asked staff about incidents reported they were aware, even if they were not at work, and were aware of the outcomes. One staff member said, “One of our service users got scratched in the kitchen. I wasn’t on shift, but I was able to read the incident report later. The manager came to investigate, finds out what really happened and we discussed it. Our reflection considered changing the timing of observations, but we felt at that time it wasn’t necessary and to continue to be aware of the risk and monitor.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Staff told us and people confirmed that they supported people to book appointments such as mental health reviews, hospital appointments, doctors and other healthcare professionals. Staff supported people to attend these appointments and ensured any actions arising were handed back to staff and completed when required. One person told us how 1 staff member diligently pursued the GP as they did not agree with the diagnosis given. This persistence resulted in a referral to hospital where this person underwent treatment that saved their life.

Our observations through this inspection confirmed that staff understood people’s assessed health needs and risks and supported them appropriately.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People said they felt safe living in The Coach House and the systems in place enabled them to feel that way. There had been no reported safeguarding concerns for those people who received a regulated activity of personal care in the last 12 months.

Staff were aware of what abuse was and how they keep people safe from harm. Staff were clear of the incident reporting process and said when they raised an incident, that was not a safeguarding, it was discussed and lessons learned.

At the time of the inspection 2 people were subject to a Deprivation of Liberty Safeguard [DoLS]. DoLS are a legal framework designed to protect vulnerable people who lack capacity to consent to their care arrangements. The appropriate assessments were completed, authorisations sought from the local authority and people received care in the least restrictive manner.

The provider had a policy relating to managing DoLS safely and staff were able to describe how the process works and how to support people without restriction. However, to manage and review the deprivation, we discussed with the provider and registered manager the need to have a care record in place, that is regularly reviewed to ensure the conditions of the restriction are monitored. They immediately took steps to address this.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s risk assessments were completed and reviewed with people which formed the basis of the care plan to manage those risks. Care records provided clear guidance for staff and set out clear boundaries to enable people to feel supported and understand and adhere to any expectations of them, such as maintaining their independence, managing their personal care or medicines. Given the recent hot spell of weather, we looked at how the service was prepared for the risks associated with a heat wave. We found that development of risk assessments to support people at increased risk due to epilepsy or diabetes during periods of extreme heat required development. For example, hot weather and dehydration are significant seizure triggers those with epilepsy, as overheating strains the body. People were however able to communicate to staff if they felt unwell and were able to access cool spaces and fluids independently, therefore the risk of those assessments not being in place was reduced as a result, however staff should develop a care plan that focuses on staying cool, continuous hydration and medication management in relation to excessive prolonged heat episodes.

The Coach House environment was relaxed where some people lived with restrictions, such as not being able to leave unaccompanied. People understood why these restrictions were in place and were there to keep them safe and engaged with the support provided.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The environment had its limitations due to its age and layout however people told us it was comfortable and they enjoyed living there. Fire safety was robustly reviewed, with personal emergency evacuation plans (PEEPs) in place. Independent fire risk assessments were completed and actions addressed. Regular safety checks of the building were completed and when issues were identified these were addressed. For example, one person’s window required repair which was underway during this inspection. The service was clean, well maintained and observed to be free from hazards.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support.

Staff underwent robust pre-employment checks prior to starting work. We saw evidence that demonstrated a full application with no gaps in history was completed with appropriate references and evidence of identity. Staff undertook a criminal records check prior to starting work and those staff employed from overseas had the appropriate right to work in place and were working in accordance with their visa.

Staff undertook an induction covering the core areas of care and support and received regular supervisions. Staff said supervisions were positive and supportive, and enabled them to reflect on their performance and set goals. One staff member said, “In my supervision I told them I needed to go through level 3 care, so I completed that. When I did, I was then open to more things that I never knew before. It has helped me understand more about people’s dementia, and things. I am better able to support some of those residents who are ageing, where there needs are changing and the training has helped me do this.” A second staff member said they found the supervision and support positive and were confident that the provider would facilitate their adaptation training to register as a nurse with the additional training needed to be accepted.

However, although staff completed training in a range of areas, we found for some people with specific needs, training had not always been delivered. For example, risks of choking, care plan / key working in substance misuse, continence and skin care. The provider and registered manager acknowledged the gaps, caused in part through people’s changing needs, and took immediate action to review training and source appropriate courses for staff to complete. No person had experienced poor outcomes or experiences as a result of this gap. From the management team’s response, we were assured those actions would be completed in a timely manner.

Staff told us they thought staffing levels were appropriate to support people’s needs and if they were short, for example short notice absence, then managers would step in to support.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service was clean, odour‑free and well maintained. Staff followed safe personal protective equipment [PPE] practices and observed hand hygiene when supporting people, preparing meals or administering medicines. Mandatory infection prevention and control (IPC) training was completed by staff, and IPC audits were carried out. However, staff prepared food for 1 person, and staff had not completed food safety training. The registered manager acknowledged this and took immediate action to book this course.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People’s medicines were administered as prescribed by staff who had received appropriate training and ongoing checks of their competency. Staff followed best practice guidelines ensuring medicines were stored correctly and accurate records were kept when medicines were administered. People were supported to administer their own medicines. Assessments were continually reviewed to support people to maintain their independence with the goal of managing their own medicines. Staff regularly checked those medicines stored in people’s rooms to ensure they had been administered as prescribed.

A health professional commented following a review of the medicines in The Coach House that. “The team's performance in medication management continues to be very good. Congratulations to [registered manager] and the entire team for your dedication and hard work, it truly shows."

Where people had as an when medicines (PRN) such as pain medicine there was guidance in place for this medicine, so staff know when to administer this.

Medicines were regularly reviewed by health professionals such as the community mental health team or GP to ensure that medicines used to manage mood or behaviour were only used as the least restrictive option.