The Coach House

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.

This was the service’s first inspection since being newly registered on 14 December 2017.

The inspection was completed on 25 October 2018 and was unannounced. At the time of this inspection there were 13 people receiving a service.

The service had 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.

Suitable arrangements were in place to keep people safe. Policies and procedures were followed by staff to safeguard people and staff understood these measures. Risks to people were identified and managed to prevent people from receiving unsafe care and support. The service was appropriately staffed to meet the needs of the people using the service. People received their medication as prescribed and in a safe way. Recruitment procedures were followed to ensure the right staff were employed. People were protected by the providers arrangements for the prevention and control of infection and suitable arrangements were in place for learning and when things go wrong.

Staff had a thorough induction to carry out their role and responsibilities effectively. Staff had the right competencies and skills to meet people’s needs and received regular training opportunities. Suitable arrangements were in place for staff to receive regular formal supervision. People’s nutritional and hydration needs were met, including having their cultural requirements and preferences met. People received appropriate healthcare support as and when needed from a variety of professional services. The service worked together with other organisations to ensure people received coordinated care and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People were treated with care, kindness, dignity and respect. People received a good level of care and support that met their needs and preferences. Staff had a good knowledge and understanding of people’s specific care and support needs and how they wished to be cared for.

Care plans were in place to reflect how people would like to receive their care and support, and covered all aspects of a person's individual circumstances. Social activities were available for people to enjoy and experience both ‘in house’ and within the local community. Information about how to make a complaint was available and people’s representatives told us they were confident to raise issues or concerns.

Suitable arrangements were in place to assess and monitor the quality of the service provided. There was a positive culture within the service that was person-centred, open and inclusive. The service sought people’s and others views about the quality of the service provided.

Further information is in the detailed findings below.