The Coach House

The Coach House is a residential care home providing personal care to up to 9 people. The service provides support to younger people with a learning disability, who maybe autistic with a physical disability and a sensory impairment. At the time of our inspection there were 8 people using the service. People were cared for in one adapted building with bedrooms over 2 floors.

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

Right Support:

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

Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. People were supported to pursue their interests, goals and aspirations.

People had a choice about their living environment and were able to personalise their rooms. The service made reasonable adjustments for people so they could be fully in discussions about how they received support, including support to travel wherever they needed to go. Staff supported people to make decisions following best practice in decision making. Staff communicated with people in ways that met their needs.

Right Care:

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right Culture:

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments, or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs.

Staff placed people’s wishes, needs and rights at the heart of everything they did. The service enabled people and those important to them to worked with staff to develop the service. Staff valued and acted upon people’s views.

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 inadequate (published 21 December 2022). The provider sent CQC regular updates after the last inspection to show the improvements being made. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 20 December 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 13 and 15 September 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, good governance, person centred care, staffing.

We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements.

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 The 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.

About the service

The Coach House is a residential care home providing personal and nursing care to up to nine people. Although The Coach House is registered to provide nursing care the service does not provide this at present, and people requiring nursing care have been cared for in their sister service on the same site. The service provides support to people with a learning disability, autistic people, people with a physical disability, people with a sensory impairment and younger adults. At the time of our inspection there were eight people using the service. People are cared for in one adapted building with bedrooms over two floors, and each bedroom has en-suite facilities.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

The Coach House was in a campus site with other services and this does not meet the Right support, right, care, right culture guidance. People did not go off the campus site very often and some people were being restricted in what time they went to bed by staff availability. There was not a wide range of activities on offer for people and activities were often not available to people because there were not enough staff to support them.

People were not consistently supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. The provider had in place policies to supported best practice but these were not being consistently adhered to.

We have made a recommendation about the application of the Mental Capacity Act 2005.

Right Care:

The service did not always have enough appropriately skilled staff to meet people’s needs and to keep them safe. Staff told us they could not take people out as much as people wanted to go out. Some people were not being supported to be as independent as they could be with activities of daily living and some people’s communication was not being supported in a person-centred way.

Individual staff were caring and treated people with kindness.

Right Culture:

People did not always receive safe and good quality care. For example, people with epilepsy and constipation did not always receive their assessed care and support due to staff not having the correct skills, training or guidance.

The culture of the service was not always person centred. Some people did not have care plans and support that reflected their needs. Audits had not been effective in identifying and putting right shortfalls in 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 good (published 15 September 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and medicines management in the service. A decision was made for us to inspect earlier than planned to examine those risks.

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 see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to managing medicines and people’s specific health risks safely, sufficient and suitable staffing levels, person centred care and the overall management of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection we rated the service ‘Good’. At this inspection we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

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.

The provider took appropriate action to manage accidents and safeguarding incidents. Staff told us they would report any suspected abuse and knew about the procedure for this. Staff were recruited safely and medicines were stored and administered in a timely manner.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's needs were assessed before moving to the service and staff had the right skills and training to support people. People were encouraged to eat healthy and balanced diets.

People received a service which was caring. People were treated with dignity and respect by staff who were compassionate and caring. Staff treated people's private information confidentially. People were able to make decisions about how their care was provided, and were involved in reviews along with family members and the appropriate professionals involved with their care.

People received care that was personalised to their individual preferences. Staff knew people's needs and personalities well. When people or their families had complaints or concerns they were encouraged to raise them. Management saw complaints to be an opportunity to improve the service.

There were clear values throughout the service and we saw evidence that that these values were embedded from the provider right through to staff that care for people at The Coach House.

Further information is in the detailed findings below.

We considered our inspection findings to answer questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service, the staff supporting them and looking at records.

Is the service safe?

The service was safe. Practices in the service generally protected people using the service, staff and visitors from the risk of harm.

Systems were in place to make sure that managers and staff learned from accidents and incidents, concerns, complaints, whistleblowing and investigations. This reduced the risks to people and helped the service continually improve.

People were cared for in a clean, hygienic environment. Equipment at the home had been maintained and serviced regularly. We found that people using the service were protected from infection because the provider maintained appropriate standards of cleanliness and hygiene.

Each person had a care plan detailing their support and care needs. We saw that there was guidance for staff to follow to reduce risks and implements strategies to make sure people were as safe as possible.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. One DoLs application had recently been submitted and we found that policies and procedures were in place for completing this. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

The service was effective. People told us that they were happy with the care that had been delivered and that their care needs were met. One person we spoke with told us, 'I like it here'. We saw that staff were attentive to people using the service and responded promptly when needed.

Staff support was consistent and structured. People who were unable to communicate verbally used other methods, for example, a computerised communication system.

People's health and care needs were assessed with them and /or their representatives. We found that care plans were regularly reviewed to reflect any changes in a person's needs.

Is the service caring?

The service was caring. People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People we spoke with said they felt staff respected their privacy and dignity and staff were polite and caring.

Is the service responsive?

The service was responsive. People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of the people's care and support needs.

We found that people were supported to attend health appointments, such as, doctors or dentists. We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Is the service well-led?

The service was well led. There was a clear management structure in place quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities and that they felt supported by the management team. Systems were in place to ask people who used the service, relatives and staff for their views about the service. Audits of the care plans had been completed to assess the quality of the care being provided.

We used a number of different methods to help us understand the experiences of people using the service. This was because some of the people had complex needs which meant they were not all able to tell us their experiences.

We observed the interactions between people and staff. We observed how people reacted and responded to see if people indicated they were happy, bored, discontented, angry or sad.

We saw that people were asked for their consent to treatment and the provider acted in accordance with their wishes.

People who use the service indicated that they were happy at the home. They were relaxed and responsive in the company of staff. Staff engaged with people in a warm and positive way and supported people where needed. Records showed that people had the care and support they needed to remain well and healthy.

We saw that the provider had measures in place to help safeguard people from abuse. We saw that there were measures to check that people were reliably provided with the facilities and services they needed.

People who use the service had their medicines at the times they needed them and in a safe way.

We saw that there were enough qualified, skilled and experienced staff to meet people's needs.