Coppelia House

Coppelia House is a residential care home providing care and accommodation to 22 people at the time of inspection. The home can accommodate up to 30 people in one adapted building. Coppelia House is situated in a market town in Devon, on the edge of Dartmoor.

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

The previous registered manager had left the service and a new manager had been in place since December 2020.

We had received concerns about infection prevention and control measures, storage of medicines, staff training, and people receiving personal care in a timely manner.

We were assured that infection prevention and control measures were sufficient and in line with current UK government guidance. We observed staff to be using personal protective equipment (PPE) correctly and appropriately for the task they were completing. There were sufficient stocks of PPE. One staff member said, “we have had enough PPE, we have done in house and on line training with a special Covid-19 course that included the donning and doffing of PPE”, another said “we have loads of PPE so never a lack of that”. A visiting professional commented “staff were wearing PPE and when I arrived my temperature was taken”. Cleaning schedules were in place and the manager was in the process of reviewing how they could be improved.

Concerns had been raised about people sharing equipment. The manager told us that people who used equipment on a regular basis had their own. There was a stock for use if people who didn't usually need equipment needed it, for example after a fall. This equipment was then washed or sanitised after use.

Medicines were stored securely, in locked cupboards in a room secured with a key code lock.

Peoples needs were assessed and regularly reviewed. Staff knew people well, one staff member told us “we are like a small family, and all the residents are like our grandparents”. Peoples families felt they were well cared for, one told us “they seem to be very good; I think all her needs are met and I think the staff are looking after her as best as they can at the moment”. Another told us “they look after her well and she seems as contented and happy as she can be”. A visiting professional commented that “there is good care of residents, good outreach to the mental health team and good assessment of need and response to advice”.

Staff completed training relevant to their role and were supported through supervision. Staff told us “the training is very, very good. We have an in-house trainer that does moving and handling” and “we do a lot of online training”.

Systems were in place to record, investigate and respond to complaints and complaints were thoroughly investigated. Staff, professionals and peoples’ families told us that the management were friendly and approachable. One person's family member told us “we know who to go to if we have any problems and I feel confident that anything would be resolved”.

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 (21 November 2019).

Why we inspected

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 coronavirus and other infection outbreaks effectively.

We undertook this targeted inspection to check on specific concerns we had about infection prevention and control measures, storage of medicines, staff training and people receiving personal care in a timely manner. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Coppelia House is a residential care home providing personal and nursing care to 27 people aged 65 and over at the time of the inspection.

Coppelia House can accommodate up to 30 people in one adapted building. Some people were living with dementia. The service does not provide nursing care. Where needed this is provided by the community nursing team.

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

People told us they felt safe living at Coppelia House. People were protected from the risk of harm. Risks were managed safely, and safe processes were in place.

There was a relaxed atmosphere between people and staff. Staff were kind, caring and attentive. People told us, “I’m well looked after”, “They’re all kind, marvellous” and “Carers are brilliant.”

Staff had enough time to meet people's needs. Staff had the skills and knowledge to meet people's needs effectively. Staff told us they were well supported in their role.

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.

People were involved in making decisions about their care and supported to maintain their independence. Care plans contained detailed up-to-date information about each person's needs and preferences. People received personalised care from staff who knew them well.

People enjoyed taking part in social activities, going out in the local community, and spending time with family and friends.

The service was well managed. When speaking about the registered manager, staff said, “Very approachable and is really good with all the staff and residents.” Quality assurance processes ensured people received high quality care.

Rating at last inspection

The last rating for this service was good (published 31 May 2017). A focused inspection was carried out in July 2017 to check fire safety. Another focused inspection was carried out in June 2019 to check the quality and safety of care being provided.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Coppelia House is a residential care home providing personal care to 25 people aged 65 and over at the time of the inspection. The service can support up to 30 people.

Coppelia House provides care in a building adapted to meet the needs of older people who may need support with their mobility. Some people were living with dementia when we inspected.

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

The service had recently introduced a consistent approach to auditing and ensuring the safe running of the service.

Prior to the inspection, the provider had recognised that they needed to act to improve the quality and safety of the care experience of people at Coppelia House. They had employed two quality managers to bring in a uniformed system of monitoring the quality across all their services. The issues we found on this inspection in respect of records relating to risk assessments, medicine records, accounting for staff training and improving audits had been identified and were now drawn into an action plan. This was to be monitored closely by the provider to ensure compliance.

Medicines were ordered, administered and disposed of safely. We have recommend that the provider keeps under review records in relation to risk assessment and medicines.

There were sufficient staff employed who were recruited safely.

The service was clean, and the staff understood the importance of keeping people safe from infection.

People and their families spoke about the staff and service they received positively. Concerns had been shared with them by the provider and they were keen to relate to us they had confidence in the provider and registered manager in resolving this. One family member said, “I feel very sad that things are not good at the moment but I’m sure things will turn around. With the support of staff and management, it will get back to the lovely home it was. I’m sure of that with all my heart.”

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 Good (published 31 May 2017). A focused inspection checking the service’s fire safety which was completed in July 2017 (published 4 August 2017) continued to rate the service as Good.

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

Why we inspected

This inspection was a focused inspection prompted due to concerns received. Please see the safe and well-led sections of this report for further details.

We have found evidence that the provider needs to make improvements. However, we did not judge this to have breached Regulations.

The overall rating for the service has remained Good. This is based on the findings at this inspection.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

During this inspection, we looked at the fire safety arrangements made by the home on the advice of Fire Prevention professionals, staff recruitment and training. The previous comprehensive inspection had been carried out on 8 and 10 March 2017 and the overall rating at that time was ‘Good’. This inspection has not changed the overall rating for the service.

This report only covers our findings in relation to the areas we looked at on this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Coppelia House’ on our website at www.cqc.org.uk.

Coppelia House is registered to provide personal care for up to 30 people. The service provides care for older people and people living with dementia. At the time of our inspection, 20 people were living at the home. There were plans for several people to move back following our inspection.

A registered manager was employed at the service. 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.

We looked around the home and saw that all areas had been made safe for people. Building work and redecoration were taking place in some areas which had been damaged by fire or smoke. The registered manager had carried out a risk assessment to identify, manage, and minimise possible risks to people. For example, bedrooms that were not in use had been closed off so that people could not access them. There were no visible fire hazards and there were clear evacuation paths throughout the home.

Action had been taken to reduce the risk of further fires in the home. For example, items that could potentially start a fire had been stored securely and additional checks had been put in place. Risk assessments and an audit had been carried out relating to the environment and equipment. Checks and services relating to fire, gas safety, electric, and lifts were all up-to-date. We saw that one fire exit door had been replaced so that it was easier to open.

Staff had completed fire training and knew what action to take in an emergency. Recruitment practices were safe. Staff files included evidence that pre-employment checks had been made including written references and satisfactory police checks (Disclosure and Barring Service or DBS). This helped to ensure staff were of good character.

The service was last inspected in November 2015 when it was rated as ‘requires improvement’ overall. We had identified breaches to Regulations 9, 11, 12 and 17 of the Health and Social

Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified that improvements were needed to how risks to people’s health and welfare were identified and managed, and how medicines were disposed of. Staff did not have a good understanding of the Mental Capacity Act 2005 (MCA) or the associated Deprivation of Liberty Safeguards (DoLS). People were not routinely consulted about their care needs and how they wished to be supported. Care records did not provide sufficient detail for staff who were unfamiliar with the home or the people living there to be able to support people safely and consistently. We also found that the quality assurance processes with the service had not identified the issues we raised. Following the inspection the provider had sent us an action plan telling us how they would put things right. At this inspection in March 2017 we found that improvements had been made in all areas. We did not identify any breaches of Regulation. However, further improvements were needed to the quality assurance processes.

A registered manager was employed at the service. 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.

Improvements had been made to the quality assurance processes which had led to medicines being disposed of robustly, care plans containing good details of people’s needs and risks to people’s health and welfare being minimised. We also found people were routinely consulted about their care needs.

People’s needs were met by kind and caring staff. One visitor told us “Staff are all very kind and friendly – consistently so.” People told us “All staff are kind and helpful, some are very, very kind.” People’s privacy and dignity was respected and all personal care was provided in private.

The registered manager was open and approachable. People were confident that if they raised concerns they would be dealt with. Staff spoke positively about the registered manager and said they felt well supported. One told us “[registered manager] will always make sure things are sorted.” People also knew the registered manager well and told us they were always available to speak to.

There was a positive and welcoming atmosphere at the home. Staff told us they thought there was an open and honest culture in the home. One staff member said “You can talk about anything”. Staff told us they enjoyed working at the home. One said “It’s not like coming to work it’s a pleasure to be here with them [people].” Another said “It’s a friendly loving home, a happy place for residents and staff.”

People’s human rights were upheld because staff displayed a good understanding of the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS). Discussions with the registered manager indicated that where necessary people’s capacity to make decisions had been assessed and decisions taken in their best interests. However, the forms relating to these assessments had not always been fully completed.

People’s medicines were stored and managed safely. However, there were no clear directions for where topical creams should be applied. Risks to people’s health and welfare were well managed. Risks in relation to nutrition, falls, pressure area care and moving and transferring were assessed and plans put in place to minimise the risks. For example, pressure relieving equipment was used when needed. Although care plans and risk assessments were updated following any accidents or incidents, the incidents were not routinely analysed to look for patterns.

People’s needs were met by ensuring there were sufficient staff on duty. People, visitors and staff told us they felt there were enough staff available to meet people’s needs. During the inspection we saw people’s needs being met in a timely way and call bells were answered quickly.

Staff confirmed they received sufficient training to ensure they provided people with effective care and support. There was a comprehensive staff training programme in place and a system that indicated when updates were needed. Training included caring for people living with dementia, first aid and moving and transferring.

Staff knew how to protect people from the risks of abuse. They had received training and knew who to contact if they had any suspicions people were at risk of abuse. Robust recruitment procedures were in place. These helped minimise the risks of employing staff who was unsuitable to work with vulnerable people.

People received individualised personal care and support delivered in the way they wished and as identified in their care plans. People’s care plans contained all the information staff needed to be able to care for the person in the manner they wished. Care plans were reviewed regularly and updated as people’s needs and wishes changed.

People and their relatives were supported to be involved in planning and reviewing their care if they wished. Relatives told us that they could visit at any time and were always made welcome. They also said that staff always kept them informed of any changes in their relative’s welfare.

Not everyone living at Coppelia House was able to tell us about their experiences. Therefore we spent some time in the dining room at lunch time and used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We saw good interactions between staff and people living at the service. Staff took time to ensure people received any assistance they needed.

People were supported to maintain a healthy balanced diet and people told us there was a good choice of food. People were supported to maintain good health and had received regular visits from healthcare professionals. A visiting healthcare professional told us “It’s a great home.”

There were regular activities available for people to participate in. These included singing, word games, crafts and gentle exercises as well as outside entertainers. We saw people enjoying a visiting entertainer and taking part in a quiz.

There were 23 people living at Coppelia House when we inspected, including some who were there for a short stay only. We looked around the home and spoke with some people who we met in their bedrooms. We observed some of the support that people who were using other areas received from staff. We also spoke with two people's relatives, two visiting health professionals, the Registered Manager, the provider's representative, and five ancillary or care staff. We looked at three people's care records and records relating to the management or running of the home.

The manager was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

Below is a summary of what we found. The summary is based on what we were told by the people we spoke with, including the staff, what we observed and the records we looked at.

This is a summary of what we found:

Is the service safe?

People told us they felt safe at the home. Care was planned and delivered in a way that was intended to ensure their safety and welfare. There was management of risks relating to individuals' needs, such as to prevent malnutrition and falls.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. A policy was in place, with relevant staff trained to understand when an application should be made and having experience of how to submit one. Applications had recently been submitted by the service, in line with the safeguards, and the outcome was still awaited at the time of our visit. This was to ensure no-one was being restrained or deprived of their liberty inappropriately.

Records were kept to protect people from inappropriate or unsafe care and treatment. A system of checks, maintenance and regular involvement of external companies meant that equipment was kept available and fit for use. We found, however, that recruitment systems were not robust enough to fully protect people from unsuitable staff.

Is the service effective?

People were positive about the support they received. They looked content and at ease with care and ancillary staff. We saw one person undertaking activities that their care records stated that they enjoyed, as well as a group activity where everyone was supported by staff to join in. Staff we spoke with evidenced that they understood people's care and support needs, and that they knew them as individuals. The home's annual quality assurance survey showed that the majority of people were satisfied with the support they received.

Is the service caring?

People's comments about their care included 'Absolutely first rate. The staff are incredibly caring. They handle me with as much care and attention as the nurses in hospital.' Another person commented 'Very good. The staff are very friendly and always do as you ask. If you want any help, they do it wonderfully.' A third person said 'We can have whatever help we want.' We observed that staff took time to listen to people and did not rush people when supporting them. The language in care records was appropriate, and reflected a caring individualised approach to meeting people's needs.

Is the service responsive?

People's needs had been assessed and reviewed, with care planned to meet their needs. People told us that staff listened to them and did as they asked. Records showed that staff sought advice from other care-related professionals, such as mental health nurses, community nurses, GPs or Speech and language therapists, working with them to meet people's changing needs.

Is the service well-led?

A variety of quality assurance processes were in place. Effective systems were also in place to identify and manage risks to the health and welfare of people living at the home and others. These included risk assessments and regular monitoring, which were either carried out by the provider or staff at the home. Staff told us they had a safe working environment in their opinion.

We saw that people had opportunities to give their views of the service through surveys and meetings. Action plans and conversations with staff showed that people's views were acted on to improve the service. People we spoke with had not had to make a complaint. They and visiting health professionals reported that staff and the Registered Manager were very responsive to their comments or queries. Staff also told us that changes were made as a result of their views or suggestions.

People we spoke with said they felt they had their care needs well met, agreed to the care they received and were able to make choices as part of their daily lives. One person said 'I am very happy. I am looked after extremely well.' We saw that people had their care needs met and had access to specialist health services as required. Medicines were well managed.

People had access to adequate food and drinks and spoke positively about the food provided.

Effective systems were in place to maintain the cleanliness and d'cor at the home. We saw that the design, layout and security of the premises safely met the needs of everyone who received care and treatment including those with disabilities.

People said they 'loved all the staff' and felt safe living in the home. People appeared relaxed in the company of staff. Staff knew what to do if they suspected abuse. People knew how to complain and felt confident that their complaints would be listened to.

Staff said they thought the 'training was one of the strengths at the home.' Staff had been supported and supervised appropriately.

People and their relatives knew how to make a complaint but had not needed to do so.

We spent forty minutes observing life in the lounge. We call this a short observation framework tool (SOFI). During this time we observed staff being polite, respectful and kind. We heard friendly banter and affection being mutually shared. We did not see any negative interactions.

People were complimentary about the staff and the care they received. They said they felt safe living at the home and thought there were enough staff on duty. People were asked their views on the care and service they received. They knew how to complain and felt satisfied complaints would be dealt with appropriately.

People told us they enjoyed the range of activities offered and were involved in the planning of these.

Medication was well managed at the home and there were systems to monitor the quality of the service provided at the home.