Coral House

We found the following examples of good practice.

There was a clear procedure for welcoming visitors to the home. Health screening, temperature checks and personal protective equipment (PPE) contributed to keeping people safe. Staff were observed wearing PPE as per the home's policy and in line with current government guidelines.

Staff had received training in putting on and taking off PPE, COVID-19 and infection prevention and control. Staff understood the action they needed to take protect people from the risk of infection. There was a plentiful supply of PPE.

There were PPE stations throughout the home including places for disposal. Social distancing was encouraged. There was a dedicated visitor's 'pod' which was comfortable and could be accessed via a gate from the side of the house into the garden.

There were strict guidelines in place for accepting new admissions into the home. These included the receipt of a negative COVID-19 test result no more than 48 hours before the person arrived and a ten day period of isolation.

People had been supported to understand COVID-19, social distancing, national restrictions and PPE. There were easy read guidance and social stories on topics such as PPE, hand washing, keeping safe and the vaccine.

The home was visibly clean, free from clutter and robust cleaning schedules were in place. High touch point areas such as door handles and light switches were cleaned frequently.

Infection prevention and control (IPC) audits were carried out regularly and action taken where necessary. Staff were supported by an up to date IPC policy that provided detailed guidance.

Robust COVID-19 risk assessments were in place including actions taken to mitigate risk.

Relatives had a number of ways to stay in contact with their loved one's including face to face visits and video calls.

The registered manager told us their staff had worked extremely hard throughout the COVID-19 pandemic and it was important to look after wellbeing. Regular conversations and meetings between the staff team enabled them to share their concerns and receive support.

The registered manager told us they were supported by the provider and by other registered managers in their network. Attendance at regular registered manager meetings was a good source of support and information for the home.

About the service

Coral House is a residential care home providing personal care to people with mobility needs, dementia, learning disabilities and/or autism. The service can support up to seven people and comprises two separate bungalows next door to each other; these are referred to as Coral 1 and Coral 2. They have separate entrances but access to the other houses can be gained through a side gate. At the time of the inspection three people were living in Coral 1 and two people were living in Coral 2.

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 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 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 some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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

People told us they were happy, felt safe. Relatives said that staff had a good understanding of their loved one’s needs and preferences. Risks had been identified and measures put in place to keep people safe from harm. Medicines were managed safely and administered by trained staff.

Staff listened to what people wanted and acted quickly to support them to achieve their goals and outcomes. Staff looked to offer people solutions to aid their independence and develop their skills.

Staff were well trained and skilled. They worked with people to overcome challenges and promote their independence. The emphasis of support was towards inclusion and enabling people to learn essential life skills. Equality, Diversity and Human Rights (EDHR) were promoted and understood by staff.

People, professionals and their families described the staff as caring, kind and friendly and the atmosphere of the home as relaxed and engaging. 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.

People received pre-admission assessments and effective person-centred support. The service was responsive to people’s current and changing needs. Regular reviews took place which ensured people were at the centre of their support.

A new deputy manager had been recruited since the previous inspection. Leadership was visible and promoted good teamwork. People, professionals and staff spoke highly about the management and staff had a clear understanding of their roles and responsibilities. The registered manager, deputy manager and staff team worked together in a positive way to support people to achieve their own goals and to be safe.

Checks of safety and quality were made to ensure people were protected. Work to continuously improve the service was noted and the registered manager was keen to make changes that would impact positively on people's lives.

The service applied 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 outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 requires improvement (published 18 September 2018).

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.

Coral House is a ‘care home’ for up to seven people with learning disabilities. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home comprises two separate houses next door to each other. They have separate entrances but access to the other houses can be gained through a side gate. At the time of the inspection four people lived in Coral House 1 and one person lived in Coral House 2. At the time of the inspection there were five people living at the service.

The care service was registered prior to the publication of Registering the Right Support. People had lived at Coral House for a number of years. All of the people had come from Dorset and Hampshire. They were all supported to maintain regular contact with their families. The service reflects most of the values that underpin the Registering the Right Support and other best practice guidance whilst there are only five people living at the service. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The home had a registered manager who had been in post since November 2017. 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 the last inspection in November 2017, overall the home was rated ‘inadequate’ and we found seven breaches of the regulations. Following the inspection, the provider sent us monthly updated action plans as to how they planned to meet the regulations.

This service has been in special measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. At this inspection the service demonstrated to us that significant improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of special measures.

We have identified some areas for improvement and sustainability in the ‘is the service safe, and well led’ questions. These related to embedding safeguarding systems and procedures, complaints responses and to continually review and assess the effectiveness of the quality assurance systems so that any improvements can be embedded and sustained.

The overall rating for the service is now requires improvement. This is because although there had been significant improvements overall and all of the regulations breached at the previous inspection have been met, we are not yet able to assess whether these improvements can be embedded and sustained when the home is at full occupancy. We will review fully the sustainability of the improvements and impact on people and staff at the next inspection.

The leadership at the home had improved and there was an open, friendly and relaxed atmosphere. People and staff were very relaxed and comfortable with each other. People were supported with kindness and compassion by staff who knew them well and understood the care they needed. This was an improvement.

Medicines were safely managed and administered. Staff were knowledgeable about people’s medicines. This was an improvement.

People told us they felt safe and the safeguarding systems and processes were in the main followed to make sure any allegations were reported, investigated and risks to people were managed. However, the embedding and consistent following of these systems remained an area for improvement.

Risk management plans in relation to people’s care, health and support were completed, regularly reviewed and up to date. People had attended healthcare appointments and their health needs were being met. This was an improvement. However, some relatives still had concerns about whether all aspects of people's health care needs were being met.

People’s food and fluids and weights were now accurately monitored and reviewed to make sure they kept well. This was an improvement.

People received the care and support they needed and in the ways they preferred. Their needs and preferences were consistently assessed or planned for. People and their representatives were actively involved in developing and contributing to their care plans. This was an improvement.

The turnover of staff had reduced and there was a core staff team. Staff had the skills and had been trained to be able to meet people’s needs. This was having a positive impact on people. This was an improvement.

People’s rights were now protected and staff understood and acted in accordance with the Mental Capacity Act 2005 (MCA). This was an improvement.

The houses were clean, well maintained and there was a planned programme of refurbishment. People had been involved in choosing the new furniture and décor and helping out with the new garden design and layout.

There had continued to be improvements in how accessible information was for those people who communicated differently.

The service was now well led by the registered manager and people, staff, professionals and most relatives spoke highly of the impact and changes since the registered manager came into post. The provider had reviewed and learnt lessons from the findings of the last inspection. These had been shared and were being embedded into their governance systems.

Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, are inspected again within six months of the publication of the last report.

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 served a warning notice for the breach of the regulations at the March 2017 inspection in relation to the care people received. We inspected the key question ‘Is the service Responsive’ in June 2017 and found improvements in how responsive the service was and the care that people received. The registered provider agreed to send us a monthly action plan as to how they were meeting the regulations. This was provided every month as required. However, the action and progress plans did not accurately reflect the findings of this inspection.

At this comprehensive inspection the improvements found in June 2017 had not been sustained and we found five breaches of the regulations and two new breaches of the regulations in relation to complaints and consent. There were significant improvements in the cleanliness of the home and there was an ongoing planned programme of refurbishment.

Coral House is a ‘care home’ for up to seven people with learning disabilities in Poole. 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.

The home comprises of two separate houses next door to each other. They have separate entrances but access to the other houses can be gained through a locked side gate. At the time of the inspection four people lived in Coral House 1 and two people lived in Coral House 2.

There was no registered manager at the service. The previous registered manager left the service following the March 2017 inspection. A new manager was appointed and was in post at the June 2017 inspection. However, this manager left the service in September 2017. There was an acting manager who had been in post for three weeks at the time of this inspection, who is a registered manager for another of the registered provider’s care homes in Poole. 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.

Some people had not been consistently kept safe. This was because actions had not been taken in response to safeguarding incidents and risks to people were not fully assessed and managed. There remained some shortfalls in the management of people’s medicines.

Some people’s health care needs had not been met or followed up with health care professionals. People’s care plans were not consistently followed or updated when people’s needs had changed. People’s food and fluids and weights were not accurately monitored and reviewed to make sure they kept well. The records kept about some people were inaccurate and incomplete.

There continued to be a high turnover of staff and some staff did not have the skills and knowledge or had been trained to be able to meet people’s needs.

Staff did not fully understand the principles of the Mental Capacity Act 2005 and best interests’ decisions were not in place for some people. Some people signed their consent to written care plans they did not understand.

There were complaints procedures in place but not all complaints had been investigated or responded to.

The home was not well-led. This was because the governance at the home was still not effective and there had not been any consistent effective management at the home to drive improvements. Relatives and health and social care professionals also raised concerns about the frequent change in managers and staff turnover at the home.

Staff were caring and treated people with dignity and respect. People and staff had good relationships. People had access to the local community and had individual activities provided. People were involved in planning, shopping and preparing their meals.

The houses were clean and there was a planned programme of refurbishment. People had been involved in choosing the new furniture and décor.

There were improvements in how accessible information was for those people who communicated differently.

The acting manager and operations director took action to address any of the shortfalls identified during the inspection. They had started to implement changes at the home but these had not yet had much impact on the people because they had only been in post for a short period of time.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The registered manager has been in post since August 2016 and was registered in November 2016. There had been three registered managers at the home over the last two years with the regional manager providing part time cover in between managers. 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.

Coral House is a care home for up to seven people with learning disabilities in Poole. The home comprises of two separate houses next door to each other. They have separate entrances but access to the other houses can be gained through a locked side gate. At the time of the inspection five people lived in Coral House 1 and two people lived in Coral House 2.

We inspected Coral House in December 2015 and identified five breaches in the regulations and other areas for improvement.

At this inspection we identified four repeated breaches and three new breaches of the regulations. We made adult safeguarding referrals to the local authority as a result of the concerns we identified during the inspection.

Any risks to people’s safety were not consistently assessed and managed to minimise risks. People’s needs were not reassessed when their circumstances changed and care plans were not updated or did not include all the information staff needed to be able to care for people. Action was not taken in response to risks or changes in people’s needs such as contacting the health and social care professionals involved with people. People particularly at risk were those nutritionally at risk, and those with complex health, care and support needs. Some people’s health care needs were not always met because the healthcare they needed was not arranged, followed up or delivered. These shortfalls were repeated breaches of the regulations.

People’s medicines were not always safely managed or administered and this was a breach of the regulations. This was because some people did not have their creams applied and medicines as prescribed and staff did not have clear instructions when they needed to give some people ‘as needed’ medicines or topical creams. The advice of the pharmacist had not been sought for one person’s covert medicines.

Some people needed their foods and fluids monitored because of their complex health needs and because they were prescribed dietary supplements. However, action was not taken when shortfalls in people’s nutritional intake changed, they were not having their prescribed dietary supplements and/or there were gaps or inaccuracies in their monitoring and medication records. This was repeated breach of the regulations.

There had been a high turnover of staff since the last inspection. This meant people were not consistently supported by a staff team that had the competence and skills to do so. Staff had not received the training they needed to be able to meet people’s needs. These shortfalls were a breach of the regulations.

Some areas of the houses and people’s equipment were not kept clean and or were damaged and this increased the risks of the spread of infection.

People who lack mental capacity to consent to arrangements for necessary care or treatment can only be deprived of their liberty when this is in their best interests and legally authorised under the MCA. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). Two of the people living at the home were unlawfully deprived of their liberty. The registered manager had not recognised the risk of deprivation and made applications for a deprivation when these were required. This was breach of the regulations.

Although there were some improvements in records there continued to be shortfalls in the records kept about people and the management of the home. These shortfalls were repeated breaches of the regulations.

The home was not well-led. This was because the governance at the home was not effective and there had not been any consistent effective management at the home to drive improvements. Relatives and health and social care professionals also raised concerns about the frequent change in managers, communication systems and staff turnover at the home.

People received care and support in a personalised way. Staff were caring and treated people with dignity and respect. People and staff had good relationships. People had access to the local community and had individual activities provided.

Staff recruitment practices were safe and relevant checks had been completed before staff worked with people.

The registered and regional manager took some actions during and following the inspection in response to shortfalls we identified.

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.

As part of our enforcement action and regulatory response to the repeated breach of regulation 9 person centred care, we issued a warning notice.

There was no registered manager in post at the time of the inspection. The acting manager started work at Coral House in May 2017 and was planning to submit their application to be registered. 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.

This inspection was unannounced and took place on 20 June 2017. At the last inspection in March 2017 the service was not meeting the requirements of the regulations and CQC took enforcement action. The ‘Is the service Responsive?’ question was rated as ‘Requires improvement’ and we issued a warning notice in relation to a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. This focused inspection was carried out to review the actions taken to address this shortfall.

At this inspection we found that the service was meeting Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Because of the significant improvements in people’s experiences the ‘Is the service Responsive?’ question has been reviewed and is now rated as ‘Good’.

The overall rating for Coral House remains as ‘Inadequate’. This is because the ‘Is the service safe?’, ‘Is the service effective?’, and ‘Is the service well led?’ questions were rated as Inadequate at the last inspection.

The provider has an action plan in place to address the shortfalls identified at the last inspection and we will undertake a comprehensive inspection to fully review Coral House at a later date.

People received care and support in a personalised way. Staff knew people well and understood their needs and the way they communicated. We found that people received the health, personal and social care support they needed.

There was an effective complaints procedure in place.

The service does not have a registered manager. The previous manager left in February 2015. Two managers had been appointed but had not been registered. From the end of December 2015 the regional manager was going to be based at Coral House until a new full time registered manager could be appointed. 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.

We inspected Coral House in February 2014 and did not identify any concerns. At this inspection we identified five breaches in the regulations and other areas for improvement.

Coral House is a care home for up to seven people with learning disabilities in Poole. The home comprises two separate houses next door to each other. They have separate entrances but access to the other houses can be gained through a locked side gate. At the time of the inspection five people lived in Coral House 1 and two people lived in Coral House 2.

Most people living at Coral House were able to tell us their experiences. Where people communicated differently and were not able to tell us their experiences, we saw that those people and the people we spoke with were smiling, happy and relaxed in the home.

Two people told us they did not feel safe at the home following a recent incident, whilst others told us they did feel safe. People had been given information supported by pictures about how they could report any allegations of abuse. People said they felt safe talking to staff about their worries and staff always acted on this information. However, we identified some delays in reporting some allegations of abuse to the local authority, CQC and or the police. This meant people were not fully protected and potentially placed people at risk of further abuse. This was a breach of the regulations.

Risks to some people’s safety were not consistently assessed and managed to minimise risks. Their needs were not reassessed when their circumstances changed and care plans were not updated or did not include all the information staff needed to be able to care for people. Staff did not always follow care plans that were in place for some people. These shortfalls were breaches of the regulations.

There were shortfalls in the records kept about people. This meant there was not an accurate record for each person including what they had eaten, drank, how they had spent their time or the personal care and support they had received. This meant staff did not have the information to be able to monitor people’s wellbeing and to know if they needed to take any action in response if people’s needs changed. These shortfalls were breaches of the regulations.

The home had not been well led following changes in managers. Following a review of the home by the provider and the local authority there was an improvement plan in place. People and staff were positive about the changes that had been made in a short period of time.

Medicines were managed safely. People received their medicines as prescribed by their GP.

People received care and support in a personalised way. Staff knew people well and understood their needs and the way they communicated. We found that most people received the health, personal and social care support they needed.

Staff were caring and treated people with dignity and respect. People and staff had good relationships. People had access to the local community and had individual activities provided.

Staff received an induction, core training and some specialist training so they had the skills and knowledge to meet people’s needs. Staff were recruited safely.

We spoke with five people who lived at Coral House, two visiting relatives, three staff and the manager. We observed staff supporting people in communal areas.

People we spoke with told us they were happy living at the home. One person said 'I like living here' and a relative said, 'X is much happier here now and it's put my mind at rest'. We observed a very relaxed atmosphere in the home with lots of laughter, conversation with staff and smiles from people living there. People freely approached staff and sought their company.

People experienced care and support that met their needs and protected their rights.

Medicines were managed, administered and stored safely.

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

Overall, there were systems in place to monitor and assess the quality and safety of the service. Not all of these systems had been fully implemented but there were action plans in place to address this.

We used a number of different methods to help us understand the experiences of people who used the service. This was because some of them had complex needs which meant they were unable to tell us about themselves.

We spoke with four people, three staff, the acting manager and the regional manager. We observed staff supporting people in communal areas.

People we spoke told us they were happy living at the home. One person said 'It's a good enough house to live in' and another said 'it's good here, I like (other person in house) we do lots of different things and I get on with the staff'.

People were involved in making decisions and their privacy and dignity was maintained.

People experienced care, treatment and support that met their needs.

We spoke with staff who understood what safeguarding was and what they would do if they suspected someone was being abused.

Staff told us they were well supported and trained. There were systems in place to monitor and assess the quality and safety of the service.