The Coach House SBDP1 Limited

The Coach House is a residential care home that is registered to provide accommodation and personal care to a maximum of 66 people. At the time of our inspection, 64 people were living there, some of whom were living with dementia.

People’s experience of using this service:

People told us and we observed that staff were kind and caring in their interactions with them. Staff knew people well and used effective techniques to reassure people when they became distressed.

Auditing processes needed to be more robust and detailed to enable the service to identify where improvement was needed.

Further improvements were needed to ensure risk assessments and care plans were accurate and sufficiently detailed.

Staffing levels were observed to be adequate and staff were available to people when they needed assistance. However, given some of the feedback we received, we have made a recommendation that the service monitors staffing levels to ensure they remain adequate.

People’s end of life wishes were not always documented fully so staff knew how to deliver care effectively, and we have made a recommendation about this.

Improvements were needed to ensure the service was adhering to the principles of the Mental Capacity Act 2005. Best interests decisions were not always in place where people lacked capacity to consent to their care.

Medicines were being managed safely at the home. However, we have made a recommendation that the provider takes steps to ensure sufficient and detailed information is available for staff to refer to about how people have their medicines given to them.

Recruitment procedures were not sufficiently robust to ensure staff were suitable for the role.

Staff understood the need to keep people safe from abuse and what was required to do this. Some staff however had not received safeguarding training whilst working in the service.

We observed staff to be skilled when supporting people with complex physical and emotional needs. However, training for many staff was either overdue or had not been completed. The registered manager was addressing this and had booked relevant training sessions throughout 2019.

Health care professionals were involved in people’s care and referrals were made promptly.

We have made a recommendation that the provider reviews best practice guidance to ensure that the building is designed and decorated in a way that supports people living with dementia.

Rating at last inspection:

At the last inspection the service was rated ‘Good’ (Report published 13 December 2016).

Why we inspected:

We inspected this service in line with our inspection schedule for services currently rated ‘Good’.

Enforcement: Action we told the provider to take is outlined at the back of the report.

Follow up: We will continue to monitor the service through the information we receive. We have also requested an action plan from the provider to monitor that improvements will be made promptly.

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

The Coach House provides residential care for up to 66 people, some of whom may be living with dementia or have mental health needs. The home is divided into three separate units, The Coach House, Chapel View and The Willow. At the time of this inspection there were 64 people living within the home, 38 in The Willow, 22 in The Coach House and 4 in Chapel View.

There was 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.

At our last inspection in January 2015, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to person centred care and medicines administration and management. At this inspection, carried out in November 2016, we found that the provider had made sufficient progress to no longer be in breach of the regulations.

The service had processes in place to ensure that only those suitable to work in the home were employed. New staff received an induction that prepared them for their role. The provider encouraged staff training and development and this was delivered in a variety of forms. The training the staff received was relevant to their role.

People benefited from receiving care and support from positive staff who told us they were happy working at The Coach House. Staff received support from their managers and colleagues and worked well as a team. Staff morale was good and staff told us that they felt valued by the management team and provider. We saw that staff clearly understood their roles, the responsibilities that came with that and demonstrated accountability.

Everyone we spoke with said there were enough staff to meet people’s individual needs. Staff told us that they had time to spend with people engaging on a one to one basis. During our visit we saw that people’s needs were met promptly and efficiently.

Care and support was delivered in a respectful and courteous manner and staff understood the importance of empowering the people they cared for. People had choice in how they spent their day and staff respected these decisions. People’s dignity was maintained and staff were discreet when assisting people. Staff adapted their language to suit the needs of each individual.

People’s independence was promoted at every stage of the care and support delivery. Staff understood the need to maintain people’s privacy and confidentiality and respected this.

The provider had processes in place to help protect people from the risk of abuse. Staff were knowledgeable in safeguarding procedures and could tell us how they managed this. Staff knew how and where to report any concerns they may have both inside their organisation and externally.

The individual risks to people had been identified, assessed, appropriately managed and regularly reviewed. These demonstrated people’s changing needs. Although not all risks associated with the building and working practices had been recorded, the risks had been mitigated by regular maintenance checks. Accidents and incidents had been recorded and analysed to identify any trends or contributing factors in order to help mitigate future risk.

Medicines management and administration followed good practice and people received their medicines as the prescriber intended. Staff had access to supporting information that assisted in the safe handling and administration of medicines.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. DoLS applications had been appropriately submitted for some people who used the service and these were individual to them. However, although the senior management team could explain how they had assessed these people’s capacities to make decisions in relation to these applications, these hadn’t been recorded.

People, and where relevant their relatives, had been involved in the planning of care and support that people received. Care plans were individual to each person, accurate and had been regularly reviewed. Copies were in people’s bedrooms so they had easy access to these.

Staff told us that they had time to spend with people engaging in social and leisure interests. There was an activities coordinator in place and events were arranged on a regular basis which people spoke positively about.

People’s nutritional needs were met and they received enough to eat and drink. People had a choice in what they had and received any specialist diet required. Assistance at mealtimes was dedicated, supportive and inclusive.

Access to healthcare provision was available as and when required. Staff had the knowledge to identify any healthcare issues and knew what actions were required. Referrals to healthcare professionals were made promptly and appropriately and recommendations followed. The three healthcare professionals who provided us with feedback on the service all spoke highly of the service.

The provider had systems in place to monitor the quality of the service and drive improvement. This included regular audits, meetings and gaining people’s feedback in both a formal and informal manner. We saw that actions had taken place as a result.

People had confidence in the management team and told us they were approachable, visible, accommodating and knowledgeable. The provider visited the service regularly to provide support. The atmosphere of the home was welcoming and jovial and people told us they would recommend it.

The Coach House was very vibrant during the visit. There was a group sing-along taking place using musical instruments and there was lots of laughter and smiling faces. We saw staff participating in an effort to encourage communication and movement.

We saw that care and support offered to people was tailored to their individual needs. Risk assessments were ongoing and actions taken to minimise or remove the risks. Care plans, needs assessments and behaviour charts were reviewed monthly or earlier if required to ensure they reflected people's current needs. We also noted that interventions by health or social care professionals were recorded and followed through. We saw evidence of support provided by GP's, district nurses, social workers and other therapies.

We saw a good selection of menu options and choices with vegetarian options available. The home was clean and tidy and good hygiene practices were promoted. There was cleaning going on throughout the visit to minimise the risk of infection.

We saw people taking part in activities with staff. Everyone we spoke with told us or indicated to us that they were satisfied with the care and support they received.

We observed lunch being served and watched how people were treated. Overall, we saw that people were given plenty of time to sit and eat their meal comfortably, being offered appropriate cutlery or being assisted by staff to eat their meal within a homely environment.

We saw how staff supported people to leave the table and escorted them back to their room, lounge or where they wished to go. One person told us "I really enjoy my meals here, the cook makes really nice homemade dinners and we get plenty of vegetables with it". Another person said "The staff are very kind to me and help me have a bath. They take me into the garden so I can get some fresh air and it's lovely to sit outside".

One visitor told us they were completely satisfied that their relative was 'very well looked after' and said the staff worked to 'high standards' at the home'.

We saw that staff treated people with respect and dignity when attending to them by communicating at eye level and waiting for a response before doing anything else. Staff spoke to people frequently and did not leave people alone for long periods of time. We saw that staff engaged people by offering them something to do, for example, we saw one person taking part in housework.