Archived: The Coach House (Registered Care Home)

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

People’s experience of using this service:

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The principles and values of Registering the Right Support and other best practice guidance were seen to be met in the following ways:

People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Staff understood how to communicate with people effectively to ascertain and respect their wishes.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were protected from abuse and discrimination.

The service did met the characteristics of ‘Good’ in all areas.

Rating at last inspection: at the last inspection the service was rated Good (report published in July 2016)

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

Follow up: We will continue to monitor intelligence we receive about this service until we return for a further inspection as required by our re-inspection programme. If we receive any information of concern we may inspect sooner.

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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment.

People were receiving effective care and support. Staff received training which was relevant to their role. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and where required the Deprivation of Liberty Safeguards (DoLS).

Staff told us there was an open culture and the environment was an enjoyable place to work. Staff were extremely passionate about their job roles and felt integral to the process of providing effective care to people. Family members said the management team were approachable.

The service was caring. We observed staff supporting people in a caring and patient way. Staff knew the people they supported well and were able to describe what they like to do and how they like to be supported. People were supported sensitively with an emphasis on promoting their rights to privacy, dignity, choice and independence. People were supported to undertake meaningful activities, which reflected their interests.

The service was responsive to people’s needs. Care plans were person centred to provide consistent, high quality care and support. Daily records were detailed and recorded every hour throughout the day.

The service was well led. Quality assurance checks and audits were occurring regularly and identified actions to improve the service. Staff, relatives and other professionals spoke positively about the registered manager.

One professional that we spoke with felt that staff were 'managing well with someone with complex needs'. Another professional had some concerns about the ability of staff to effectively support people with complex needs.

We found that care plans had been reviewed and contained appropriate information about each person. Inconsistencies had been resolved following the last inspection. The goals set in support plans were, however, vague and progress was not being tracked over time.

At our last inspection, we had concerns about the cleaning and maintenance of the premises. A contractor had now been commissioned to undertake the remedial work needed. Cleaning had improved and was being monitored.

Staff training had improved since our last inspection. There were fewer gaps in the training summary record. Training around epilepsy was still needed and training needs were being monitored through supervision meetings and appraisals. All staff had now received safeguarding training and were familiar with protocols.

We saw positive interactions between staff and the people living in the home. People were given the opportunity to make decisions and felt their needs were being met. One person told us they were happy living in the home. They told us that they were happy with the activities available to them ' it 'makes my day to go for a coffee or a drive. It's all I want'.

Concerns were raised with us about staff not following financial policies. We did not see evidence of this during our inspection but the manager is now looking into the concerns.

We found that a number of staff had not completed all mandatory training. Staff also felt that they did not get enough support as the manager was primarily located at the sister home. Staff were keen to have more guidance on supporting the people living in the home.

We had concerns about the maintenance of the building. The lack of maintenance posed an infection risk and was impacting on morale in the home. The issues had been reported but not acted on by the provider.

Although records were generally well written and maintained, we found some concerning inconsistencies. The manager agreed to look at them immediately. The quality management system for the home was comprehensive and there was evidence that significant improvements were being made by the new manager.