Coxley House

Coxley House accommodates people in one building across two floors, with each person having their own bedroom with toilet and sink, with four communal bathrooms. There was a communal living and dining area, a sensory area, a main kitchen and access to a secure garden.

We found the following examples of good practice.

There were robust procedures in place to ensure visitors could enter the home safely, which included temperature checks, a requirement to provide a negative lateral flow device (LFD) COVID-19 test result and proof of vaccination against COVID-19.

The service was taking part in regular COVID-19 testing for people and staff in line with current guidance.

The management team had translated COVID-19 information and provided a translator to help one person understand the importance of COVID -19 guidelines and the legal requirement to isolate when they tested positive.

People and their relatives were given information about visiting and COVID-19 guidelines, and regularly discussed any changes and updates at resident meetings. Staff supported people to be involved and supported one person to provide demonstrations about hand washing techniques and encouraged other people to follow best practice.

Staff had ongoing IPC training and we observed staff following best practice during the inspection. Management carried out IPC audits and regular spot checks on staff, with them being asked to demonstrate donning and doffing their personal protective equipment (PPE). One staff member said, "They keep us on our toes and are always asking us to demonstrate this, also during team meetings."

The staff team used the COVID-19 outbreak as a learning experience and how they could improve their everyday IPC practices. Staff told us this was discussed in team meetings and they had a lessons learnt workshop. The registered manager said, "We all certainly learnt a lot from the outbreak and has made us emphasise more in team meetings about IPC and what we are doing to keep people and staff safe."

The home was clean, hygienic and free from odour. There were clear guidelines for staff to follow to ensure cleaning schedules and best practice was followed. The provider had implemented zoning measures and there were protocols in place for cleaning communal bathrooms if there was an outbreak.

Staff told us they felt incredibly supported in their role and highlighted the positive working environment the management team created. Staff were kept updated, had access to an employment assistance programme, with a focus on wellbeing during staff supervision. One staff member said, "They have been tremendous and are very approachable. Even when they are not on shift they check how we are doing. We are all on board and it is a very positive environment. I have 100% confidence in the managers."

Coxley House is a residential care home providing personal care for up to 13 adults with mental health needs. At the time of our inspection 12 people were living in the service who all had mental health conditions.

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

People and their relatives were positive about the kind and caring attitude of the staff that supported them. One person said, ‘It’s good here. The staff are fantastic and fabulous.”

We observed positive interactions between people and staff throughout the inspection, with staff understanding people’s needs and responding appropriately when people’s behaviours changed.

People were supported to a range of healthcare appointments and staff made the necessary referrals if people’s health changed. Health and social care professionals were confident with the knowledge and experience of the staff team.

People were fully involved in how they received their care and had regular opportunities to discuss with the staff team how they wanted to be supported.

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 were supported to take part in a wide range of events and activities and were provided with a personal budget to help with this, in order to promote their health and wellbeing.

People were encouraged to be part of their local community and benefitted from a peer recovery worker who helped to provide advice and support about managing their mental health.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of the thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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 19 April 2017).

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.

Coxley House provides accommodation and support for up to 13 people with mental health needs. The home comprises of 13 self-contained flats, and is situated in the London borough of Tower Hamlets close to community facilities. At the time of our inspection there were 10 people living in the home.

The service had a registered manager. 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.

Safeguards were in place to protect people from abuse. Risks to people’s safety and welfare were identified and actions put in place to minimise these risks.

The provider checked the suitability of staff employed by adhering to their recruitment procedures. There was enough staff employed to ensure people received safe care. Staff received training that met the needs of the people they cared for in the home.

Safe medicines practices were not always followed in relation to recording medicines that were administered. All the staff had received medicines training with the exception of one member of staff.

People were involved in planning their menus and enjoyed the meals that were provided. They had the appropriate facilities to prepare and store their own foods. Staff supported people to attend their medical appointments.

The provider ensured lessons were learnt to improve the standards of the services provided. Prevention measures had been put in place to minimise future re-occurrences of incidents. The service was quality assured to meet the specific requirements of people’s care.

People’s rights were protected in accordance with the Mental Capacity Act 2005 (MCA) and staff were knowledgeable about the requirements of the Act and the Deprivation of Liberty Safeguards (DoLS).

Staff interacted with people in caring way and the importance of ensuring people’s dignity and privacy was a priority on the provider’s agenda. People’s relationships with their families and friends were valued.

People’s care plans captured their experiences and were reviewed when their needs changed. The provider sought different ways to engage people that took into account their diverse needs.

We have made one recommendation in relation to safe care and treatment.

The service was non-compliant in two outcome areas at the previous inspection visit in September 2013. Outcome 10, Safety and suitability of premises, was non-compliant as the internal doors restricted the independence of people using zimmer frames. Outcome 14, Supporting workers, was non-compliant as not all staff had received current training for supporting people with behaviours that challenge and some staff had told us they did not feel appropriately supported to carry out their roles and responsibilities. Following the receipt of our inspection report the provider sent us an action plan, which informed us of how they would address the areas of non-compliance within an agreed timescale.

During this inspection we found that the service had made suitable alterations to the internal doors, which were now being safely used by the one person living at the service assessed to require a walking frame. Staff told us they felt well supported by the registered manager and pleased with the quality of their training. Records showed that all of the staff team had received recent training in how to support people with behaviours that challenge.

People told us they were happy living in the home and liked the way they were involved in making choices about meals and activities. One person said, 'I help to plan the menus once a week and I get to choose what I want to do.'

Staff told us about concerns they had about working with people with behaviour that challenges. Some staff said they felt unsupported by the management team when they had raised their concerns.

The premises had not been adapted to allow people living in the home to move around and be as independent as possible in activities of daily living.

The provider responded appropriately to any allegation of abuse. During our visit people did not raise any concerns about their safety.

People told us they felt safe living at the home and felt that staff were well trained and knowledgeable about mental health. One person said 'they know what they are doing. It would be terrible here if they didn't know how to do their jobs.'

Staff we spoke with received appropriate training and told us they were supported to carry out their role.