The Coach House

Updated 24 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by 1 inspector.

Service and service type

The Coach House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Coach House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the Local Authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with 3 people who use the service about their experience of The Coach House. We spoke with the registered and deputy manager. We reviewed a range of records. This included 5 people’s medication administration records. We looked at 5 staff files in relation to the service’s recruitment practices, including evidence of their induction, training and supervision. A variety of records relating to the management of the service, quality assurance information was viewed.

Following the inspection, we reviewed 4 people’s care plans, risk assessments and daily care records. We also viewed additional information requested by us from the registered manager. We contacted 6 members of staff, asking them to contact us so we could speak to them about their experience of working at The Coach House. We also contacted 4 people’s relatives about their experience of the service. The response from staff was poor as we were only able to speak with 2 members of staff. We spoke with 3 people’s relatives.

Updated 24 February 2023

About the service

The Coach House is a residential care home providing accommodation, personal and nursing care for up to 13 people in one adapted building. The service provides support to people who have a neurological condition which has been acquired through a life changing event or diagnosis. At the time of our inspection there were 11 people using the service across 3 separate floors.

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

Although not all risks for people were identified and recorded in relation to their care and support needs, staff demonstrated a good understanding and knowledge of these to ensure people's safety and wellbeing. The service’s fire arrangements were not safe. The provider was non-compliant with the requirements of the Regulatory Reform [Fire Safety] Order 2005 following a visit by Essex County Fire and Rescue Service in December 2022. The latter was brought to the provider's attention and actions were in progress to address this.

Safeguarding procedures were not always being followed and internal investigations initiated to ensure lessons were learned. We have made a recommendation about safeguarding. Not all relatives spoken with felt there were enough staff available to meet their family care and support needs. Medication practices ensured people received their medication as they should. Staff had received medication training, but had not had their competency assessed. We have made a recommendation about this aspect of medicines management.

The quality assurance and governance arrangements in place were not as effective as they should be to identify shortfalls within the service. Effective auditing arrangements were not in place and improvements were required. Not all staff felt supported and valued. People and their relatives had been given the opportunity to provide feedback about the service through the completion of a satisfaction questionnaire. However, the outcome of the satisfaction questionnaires was not yet known.

People and those acting on their behalf, told us they or their family member was safe and they had no concerns relating to their safety. Interactions between staff and people using the service were relaxed and comfortable. Staff were observed to have a very good rapport with the people they supported, including having a good understanding of their specialist communication needs and how they liked to be supported.

Robust arrangements were in place relating to the provider’s recruitment practices. 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.

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 December 2018]

Why we inspected

This inspection was prompted by a review of the information we held about this service and prompted in part due to concerns received about the care of people using the service who had specific complex healthcare needs. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to risk management, quality assurance and governance arrangements at this inspection.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.