Coralyn House

Coralyn House is a residential care home providing accommodation and personal care to four people with a learning disability at the time of the inspection. The service can support up to five people in one residential property.

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

People were not protected in a safe environment. We identified risks in the environment which had not been recognised or addressed by staff or the provider. Staff had not all been recruited in line with regulations. There were enough staff on duty to meet peoples needs. Improvements had been made to meet the needs of people whose behaviour may challenge. Staff knew how to report any safeguarding concerns and had completed training in this. People received their medicines as the prescriber intended, robust systems supported this. Improvements needed to be made to the condition of surfaces in the kitchen to promote better infection prevention and control.

The environment of the home needed improving, redecoration of the home since our previous inspection where we identified this had been very limited. People had enough to eat and drink, where people were at risk of not maintaining healthy nutrition, staff worked with professionals to improve this. The registered manager ensured people had access to health professionals when required. Staff told us they received training in essential areas such as health and safety, but we found that part time staff had not undertaken adequate training.

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 were kind and caring and encouraged people to promote their independence. Staff were respectful and courteous in their interactions with people, although residents’ meetings needed to be more respectful and focussed on the views and needs of people.

People were able to undertake activities of their choice and use facilities in the community. Improvements had been made in ensuring the accessible information’s standards were followed. Staff were working with people to explore any wishes or preferences they wanted considered at the end of their lives.

The service didn’t consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The provider did not fully understand these principles and had not undertaken additional training to further develop their knowledge to ensure they followed best practice guidance in supporting people with a learning disability.

There was a lack of clear governance in the service and the provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant safety issues were not identified and rectified by the provider. The service has not sufficiently improved since our last inspection.

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 requires improvement (published 23 April 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, sufficient improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, fit and proper persons employed, premises and equipment, and good governance.

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

¿ We received feedback that staff were kind and caring, however some interactions were not always appropriate or respectful.

¿ Measures were not always in place to ensure people and the environment they lived in was safe.

¿ The service required re-decoration. While there was some involvement from those living at Coralyn House, the service was decorated in the same style throughout and did not demonstrate personalisation or people's individuality.

¿ Staff were recruited safely and staff had time to spend with people.

¿ People received their medicines when they needed them.

¿ Staff received training to provide them with the knowledge to fulfil their role, however further training was required to ensure staff could meet people’s individual and specific needs.

¿ Staff felt supported and had regular supervision.

¿ People were supported to maintain good health and medical appointments were recorded.

¿ People were supported to eat and drink enough.

¿ Incidents were not monitored for any themes or trends to see if any improvements could be made to how people were supported.

¿ People’s independence was not always promoted. There was limited encouragement or involvement in daily living tasks, for example, meal preparation.

¿ Capacity assessments had not always been completed in line with the Mental Capacity Act 2005. Where people had capacity, they had signed to agree to the support they received.

¿ We received mixed feedback about people accessing the community and the range of activities available. Despite this, people told us they took part in activities.

¿ End of life planning required further development. We have made a recommendation that the service consults a reputable source to further develop end of life planning.

¿ The registered manager had not kept up to date with current best practice and lacked knowledge of the Accessible Information Standard and the values and principles of ‘Registering the Right Support’. The outcomes for people using the service did not always reflect the principles and values of current best practice. We made a recommendation that the registered manager further develops these areas and their implementation within the service.

¿ There was a lack of effective systems to monitor the quality of the service and to ensure that the service continuously improved.

There were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was due to ineffective risk management, the environment, inappropriate staff interaction, ineffective quality assurance processes and a lack of continuous improvement.

Rating at last inspection: Good (report published 19 April 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.

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

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

Following the inspection the provider wrote to us to say what they would do to meet the legal requirements. We undertook an announced comprehensive inspection on 20 June 2016. The provider was given 24 hours’ notice before we visited the home. This was because we wanted to make sure that the people who lived there would be available to speak with us during the inspection. At our comprehensive inspection on 20 June 2016, we found that the provider had taken sufficient action to achieve compliance with the Warning Notice.

You can read the report for previous inspections, by selecting the 'All reports' link for 'Coralyn House' on our website at www.cqc.org.uk

Coralyn House provides residential care without nursing for up to five women with learning disabilities. At the time of our inspection, there were four women living at the home. The service is owned by the registered provider, who is also registered as the manager of the home.

People living at the home felt safe and were happy living there. The manager and staff demonstrated a good understanding of the needs of the people they supported. Staff spoke to and treated people in a respectful and caring manner and interactions between people and staff were relaxed and friendly. They knew the people they cared for well. People had the freedom to make their own choices, and staff encouraged people to be independent. People enjoyed activities that were home and community based.

Improvements had been made to the systems in place to protect people from the risk of harm and to keep them safe. Staff were trained and had appropriate skills needed to support people living in the home. There were systems in place to monitor the safety of the environment and equipment used within the home minimising risks to people.

There were safe recruitment practices in place and appropriate checks were conducted before people started work ensuring that staff were suitable for their role. There were processes in place to ensure new staff were inducted into the home appropriately. Staff received supervision and annual appraisals. This was an improvement to the processes we saw at our last inspection.

Staff were aware of the importance of gaining consent for the support they offered people. The manager and staffs understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards legislation had improved.

People were supported to maintain good health and had access to a range of health and social care professionals when required, and their nutritional needs and preferences were met. People received their medicines when they needed them, and there were enough staff to help them when they needed assistance. This was an improvement to what we found at our last inspection where we raised concerns.

People received care and treatment in accordance with their identified needs and wishes, care plans documented information about people’s personal history, choices and preferences, preferred activities and how people communicated.

The manager had identified a process to monitor and evaluate the quality of care provided at the home. However, this was yet to be implemented. There was a complaints policy and procedure in place, and information about how to make a complaint was displayed.

The atmosphere in the home was open, friendly and welcoming. People and staff found the manager to be friendly, open and welcoming and felt able to raise concerns. Staff were happy in their job and felt valued by the manager.

Coralyn House provides residential care without nursing to five people with learning disabilities.

The service is owned by the registered provider, who is also registered as the manager of the home.

Risks had not always been managed to keep people as safe as possible. Risk assessment’s had not always been completed or updated when necessary, including when people had fallen.

This meant that staff did not always have the information they required to ensure people received safe care.

We could not be confident that people were receiving their medication as prescribed. Not all staff who administered medicines had been trained and assessed as being competent. Current legislation was not being followed regarding the storage, disposal and recording of the administration of medicines. Audits of medicines were not being completed to identify any areas for improvement.

There were sufficient numbers of staff on duty to meet the needs of the people who lived there although records of changes to rotas were not kept.

The recruitment procedure had not always been followed, this meant that one person had been employed without a criminal records check taking place. Staff did not receive induction training when they commenced employment, and did not receive regular supervision or appraisal.

This meant that staff did not receive the appropriate support or professional development to enable them to carry out the duties they are required to perform effectively.

The manager did not undertake a review of the home using a quality assurance system. Areas in need of improvement and oversights were not identified or addressed. Records regarding the safety of the building were not always completed. The home did not have contingency plans in place to be implemented in the event of an emergency.

This meant that the provider did not do all that is practicable to mitigate risks associated with the premises.

The manager was not aware of what training or competency assessments staff needed to complete. Not all staff had received the training the required to meet peoples assessed needs. Staff were not able to recognise or respond to all forms of safeguarding concerns.

This placed people at risk of receiving care that was not safe.

The requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) had not been complied with. This meant that where people were being restricted from leaving the home on their own to ensure their safety, this had not always been done in line with the legal requirements. The manager and staff did not have a good understanding of the principles of people being assessed as having capacity or making best interests decisions, particularly around choice, consent and managing people’s finances.

People’s dignity and respect was not always maintained. Consideration was not always given to how people should receive care that ensured their privacy was maintained.

People were happy with the food and drink that was provided, and were included in menu planning, however people were not involved in the purchase and preparation of food although they wanted to be. The home did not promote peoples independence or self-help skills.

Care plans did not contain all of the relevant information that staff required so that they knew how to meet people’s needs. We could not be confident that people always received the care and support that they needed.

People living at the home were able to enjoy outings and holidays on occasions, however opportunities to partake in activities during evenings and most weekends were limited and centred around watching television or shopping in the locality.

The manager was not clear about who was responsible for the day to day running of the home. The manager was unable to answer many of our questions unless she spoke with her husband who was also employed by the home and who undertook the majority of management tasks at the home.

At this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see details of the breaches and the action we have taken at the back of this report.

We spoke with all of the people who lived at the home, although in some cases due to their needs we were not able to have long conversations with them. Two people said, "I like living here." Another person said, "I love living here; I'm happy." We observed the care and attention that people received from staff. All of the interactions we saw were appropriate, respectful and friendly.

The accommodation was adapted to meet the needs of the people living there. We found the home was warm, clean and was personalised to the people who lived there.

People's support plans and risk assessments reflected their needs and were up to date. Staff we spoke with were aware of the contents of the support plans, which enabled them to deliver appropriate and safe care. People were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

Staff recruitment systems were robust. There were enough qualified, skilled and experienced staff to meet people's needs.

Care was planned in a way that provided support to people with their daily activities of living. People were encouraged and supported to be involved in the local community.

We saw that people lived in a safe and comfortable home.

Appropriate checks were not always undertaken before staff began working with vulnerable adults.

We saw that there were effective systems in place to assess and monitor the quality of services provided at the home.