Coppice Lodge

Coppice Lodge is a care home providing care for up to eight younger people, living with learning disabilities or autistic spectrum disorder or mental health needs. There were six people living at the home at the time of the inspection.

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 service was a large home, bigger than most domestic style properties. It was registered for the support of up to 8 people. Six people were using the service. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.

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

The provider did not have a consistent manager at the home since our last inspection. Further time was needed for the provider to embed an open and honest culture within the staff group, so staff consistently felt confident to escalate concerns about people’s care. This would enable the provider could manage these promptly. Administration of people’s prescribed creams was not always safe.

A new manager had been appointed and advised us they were intending to apply to become the registered manager for Coppice Lodge. The provider had introduced new systems, staff structures and process so they could understand people’s experience of living at Coppice Lodge. These new arrangements will take time to embed and to provide assurances people are receiving good care.

People’s risks had now been identified and staff supported people to stay as safe as possible. There were enough staff to care for people and staff promptly supported people when they wanted assistance or reassurance.

The manager and provider planned further improvements to the care provided and the environment and checks on the quality of care. Compliments had been received from relatives and other health and social care professionals regarding the improvement in people’s care and the appearance of the home, since our last inspection. The manager understood their responsibilities and acted to inform CQC of important events at the home. Staff felt supported and their suggestions were listened to.

The provider, manager and staff had driven through improvements in the way people’s needs were assessed. People were assisted to achieve the best health and well-being possible, through planned health checks. People were supported to have enough to eat and drink, based on their choice. 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 supported this. Staff had commenced training to meet the needs of the people they cared for and were supported in their roles.

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.

People approached the new staff team supporting them with confidence, when they wanted any assistance. The provider and manager had driven through improvements in people’s environment, which had further enhanced how people’s rights to dignity and independence was promoted. Further improvements were planned to meet people’s needs and increase their well-being and safety. Staff involved people in decisions about their care and listened to their choices.

Care plans and risk assessments reflected people’s histories and preferences, and people’s care was planned in consultation with their relatives, with input from other specialist health and social care professionals. People’s care plans were reviewed as their needs changed.

People had opportunities to do things which they enjoyed, and their communication needs were considered when their care was planned. People’s wishes at the end of their life were being established, and plans created based on their preferences and needs.

Systems were in place to manage any complaints, and to take learning from these.

Rating at last inspection and update

The last comprehensive rating for this service was Inadequate (published 5 March 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also undertook a focused inspection (published 22 May 2019), in response to concerns about the management of people’s risk of choking. The inspection did not lead to a change in ratings.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 5 March 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected: This was a planned inspection based on the rating at the last inspection. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme, to ensure all improvements made are embedded. If any concerning information is received, we may inspect sooner.

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

The service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with a learning disabilities and autism using the service can live as ordinary a life as any citizen.

People’s experience of using this service:

¿ Staff had not always detailed the full description of the food and drinks provided to safely meet people’s needs.

¿ The management team were continuing to develop their quality checks, so they could be assured people with specific eating and drinking needs had these met effectively and safely.

¿ People were supported by staff who understood how to prepare and serve people their food and drinks so people could safely and comfortably enjoy these.

¿ People’s care and risk plans guided staff in providing safe and consistent support to people when eating and, external professionals had been consulted.

¿ People received their medicine in a way which met their individual swallowing needs.

¿ The management of the home had changed since the last comprehensive inspection. The manager showed commitment and enthusiasm to implement the changes needed to improve staff practices so risks to people from choking were consistently managed and mitigated.

Rating at last inspection: At the last comprehensive inspection undertaken on 16 January 2019 the rating was Inadequate and the report was published on 5 March 2019. At this inspection the rating has not changed because our focus was on people who required care and support from staff to meet their swallowing needs and, mitigate the risks of choking.

Why we inspected: We undertook this focused inspection because we had received information of concern in relation to people who required staff to support them in reducing the risks of choking. As a result, the team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led, specifically linked to people with swallowing needs. This report only covers our findings in relation to this and therefore, the ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Coppice Lodge on our website at www.cqc.org.uk.

Enforcement: At the previous comprehensive inspection we identified five breaches of regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. We issued an urgent Notice of Decision to impose conditions on registration and restriction on admissions into the home. We found the service was inadequate overall, and in the key questions safe, effective and well-led. The inspection identified five breaches of regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. 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.

Follow up: We will continue to monitor the service through the information we receive until we return, as part of the inspection programme. If any concerning information is received, we may inspect sooner.

Coppice Lodge is a ‘care home’. 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.

Coppice Lodge accommodates eight people with a learning disability in one adapted building which is over two floors. There were seven people living in the home when we completed our inspection visit.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. 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. Registering the Right Support CQC policy

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. The registered manager, while still active on the register, left the company in April 2018. The manager who we met on inspection had worked in the home for three weeks prior to our arrival.

At this inspection we found the service was inadequate overall, and in the key questions safe, effective and well-led. The inspection identified five breaches of regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. 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.

Where risks to people's health were identified people had not been adequately assessed or reviewed to understand if the support in place was adequate. Staff were not provided with clear and accurate guidance as care records were not readily available, incomplete and historic to ensure people risks of harm were being managed and mitigated in the right way. This exposed people to potential harm of unsafe care and treatment. There were sufficient staff to keep people safe. People's as required medication was not always managed in a safe way; as staff did not have clear guidance on how and when this should be given.

People had not had proper assessments of their care. People, their relatives and professionals had not been involved in the planning of the care to ensure this was consistently being delivered in the right way. The provider could not be assured that they had not followed the principles of The Mental Capacity Act 2005 (MCA) and could not demonstrate that care and support was being offered in people's best interests. Staff did not recognise when they were restricting people. Where applications had been made to Deprivation of Liberty Safeguards (DoLS) these were not available to the manager to understand who had them and how care was to be provided in a legalised way.

Staff were not supported by the provider to keep their skills and knowledge up to date. The provider did not have checks in place to demonstrate staff were competent in their roles.

The provider could not demonstrate that people always had access to routine appointments such as dentist and optician, and their annual health care checks were out of date. We found that people had access to healthcare professionals when they became unwell or had an accident. Where healthcare professionals did visit, communication about changes in care was not consistently shared with staff.

The provider had not promoted people's dignity and privacy. Aspects of the environment, and an institutionalised culture within the service compromised people's dignity.

Most staff knew people well and understood their likes and dislikes and how to meet their interests. People did were supported to maintain their interests and hobbies, however plans for the day and developing future plans had not taken place to give people structure. The provider did not meet the requirements of The Accessible Information Standard. This aims to make sure that people who have a disability or sensory loss get information that they can access and understand, and any communication support that they need.

People and staff felt the manager was supportive. The provider did not have effective systems in place to ensure the service was delivering good quality care.