This comprehensive inspection visit took place on the 17 April 2018 and was unannounced
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.