Coppice Lodge

Coppice Lodge is a residential care home providing personal care for up to 64 people aged 65 and over in a single purpose-built building across four separate units. At the time of our inspection 56 people were using the service.

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

People were supported by caring staff who were trained to meet their needs and keep them safe. Systems were in place to manage any potential risks. The home was kept very clean and measures were in place to keep people safe from the risk of infection. Medicines were managed well, and people were supported to have them in their preferred way. There were some concerns around staffing, and people told us they sometimes had to wait for support.

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.

The home had a dedicated registered manager in post and a supportive and collaborative staff team. There was a robust auditing and quality assurance system in place to pick up on any areas for improvement. The home had close links with the local community and worked in partnership with other agencies to support people’s wellbeing.

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 24 April 2018).

Why we inspected

We had concerns in relation to the number of falls and serious injuries. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe sections of this full report.

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.

Follow up

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

We found the following examples of good practice.

The registered manager had registered for 'whole home testing' for staff and residents. Advice was sought from healthcare professionals when required for people who had tested positive. Family and friends of people who use the service were updated regularly and the service offered video and telephone calls to all people and their loved ones.

The service had implemented a robust system for all visitors including visiting professionals. Hand sanitising, a temperature check and personal protective equipment [PPE] was mandatory prior to entering the home. At the time of our inspection the home was closed for all but none essential visitors and visits for people who were receiving end of life care. The service had created a safe visiting space which included a designated entrance and booking system, this would be used when the home could safely allow visitors.

PPE was readily available, staff wore PPE in line with current best practice and it was disposed of appropriately. Enhanced training in infection prevention and control was provided and all staff completed this.

Thorough risk assessments were carried out to assess the impact of COVID-19 on people and staff. Actions were taken to mitigate risks to people when needed. The provider was very supportive of the registered manager and the well-being of the staff team. For example, transport was provided to those who would normally use public transport to minimise the risk of transmission of COVID-19.

The provider had systems in place to provide assurances surrounding the cleanliness of the home, action was taken when needed. Areas of the home that were touched more frequently such as light switches were cleaned multiple times throughout the day.

At our last inspection in January 2017, we found breaches of the legal regulations related to the safety of the home, consent and person centred care. We asked the provider to take action to make improvements to ensure the service was safe, to ensure people were consulted about their care and support and to make sure people received the support they needed. During this inspection we found the required improvements had been made and the home was compliant with the legal regulations.

There was a registered manager in post at the time of our inspection. 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.

People told us they felt safe in the home and there were systems and processes in place to minimise the risk of abuse. Staff had a good knowledge of safeguarding adults and referrals had been made to external agencies when required. Risks associated with people’s care and support were effectively assessed and managed. Staff had a good knowledge of measures in place to ensure people’s safety and equipment was used safely. Risks associated with the environment were identified and managed. Accidents and incidents were reviewed and analysed to try to prevent future incidents. Medicines were stored and managed safely and people received their medicines as prescribed. There were enough staff to provide care and support to people when they needed it, and safe recruitment practices were followed to ensure staff were suitable. The home was clean and hygienic and staff had a good understanding of the principles of infection control and prevention.

People were supported by staff who received training, supervision and support. Staff were knowledgeable and were provided with opportunities to further develop their skills. 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 practice. People had enough to and drink, mealtimes were positive sociable experiences and people were offered choices. Where people had risks associated with eating and drinking these were well managed. People had access to healthcare and their health needs were monitored and responded to. There were systems to share information between services to ensure care was person centred. The home was adapted to meet people’s needs and further improvements were planned to ensure people’s dementia related needs were accommodated.

People were overwhelmingly positive about the caring approach of staff. Staff treated people with warmth and affection and responded quickly to reduce any anxiety or distress. Staff treated people with respect and upheld their right to dignity. People’s right to privacy was promoted. People were enabled to have control over their lives and were supported to be as independent as possible. People had access to advocacy, if they required, to help them express their views. Staff understood what was important to people and how they communicated and they used this to provide a person centred service to people.

People received the support they required from staff who had a good knowledge of their needs, wishes and preferences. Care plans were detailed, thorough and clearly reflected people’s needs. People were given the opportunity to discuss their end of life wishes and were given compassionate support at the end of their lives. People were offered a wide range of opportunities for meaningful activity, both in the home and in the local community, this had a positive impact on their wellbeing. People’s diverse needs were recognised and accommodated. People were supported to raise issues and concerns and there were systems in place to respond to complaints.

The home was well led. The service had a homely and friendly atmosphere and people were consistently positive about the service provided. The management team were warm, open and approachable and had a positive impact on the quality of the service. People living at the home were able to express their views in relation to how the service was run and this was used to inform improvement. Staff felt supported, had a good understanding of their roles and were able to provide feedback and make suggestions for improvement. There were effective systems in place to monitor and improve the quality and safety for the home.

We carried out an unannounced comprehensive inspection of this service on 6, 7 and 12 October 2016. Breaches of legal requirements were found in relation to safeguarding people from abuse, consent, safe care and treatment, staffing and governance. We took action to ensure the necessary improvements were been made to make sure people received safe care and support.

The service had a registered manager in place at the time of our inspection. 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 conducted this inspection to follow up on the breaches identified in our October 2016 inspection and to look at the overall quality of the service.

Although some improvements had been made, risks in relation to people's care were still not always planned for appropriately to ensure that people received safe care and support. People were not consistently supported to mobilise safely.

Improvements had been made to ensure that people were safeguarded from abuse. People felt safe in the service and were supported by staff who knew how to recognise and respond to allegations of abuse.

Improvements had been made to the management and administration of medicines. People received their medicines as prescribed and medicines were stored and administered safely. Improvements had also been made to the deployment of staff and there were enough staff to provide care and support to people when they needed it.

We found that improvements had been made to staff training and supervision. Staff felt supported and received training to help them carry out their duties effectively and meet people’s needs. Safe recruitment procedures were followed.

Some improvements had been made in relation to supporting people who did not have capacity to make certain decisions, however people’s rights under the Mental Capacity Act 2005 were still not fully protected. Where people had capacity they were enabled to make decisions about their support and were asked for their consent by staff providing care.

People were treated with dignity and their right to privacy was respected. Staff supported people with care and compassion and had positive relationships with people who used the service. People were enabled to make choices about how they spent their day and had the opportunity to get involved in activities in the home.

People did not always receive the support they required as staff did not always follow guidance in care plans. Although some improvements had been made to care plans further improvements were needed. There was still a risk that people may receive inconsistent support as staff did not have access to accurate, up to date information about the support people required.

The provider did not have effective systems in place to monitor and review the day to day support provided by staff and this resulted in negative outcomes for people who used the service. Swift action was not always taken by senior staff to communicate and act upon known issues.

The management team were open, approachable and well respected by people who used the service, families and staff. People who used the service and staff were involved in giving their views on how the service was run. People and staff felt able to share ideas or concerns with the management.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, consent, person centred care and good governance.

We carried out an unannounced comprehensive inspection of this service on 15 June 2016. Breaches of legal requirements were found in relation to the safe care and treatment of people, safeguarding, consent to care and in relation to staff training and supervision. We asked the provider to make improvements in these areas. We asked the provider to develop an action plan to address the issues raised from our inspection which we received on 29 July 2016.

During the inspection on 15 June 2016 we also found a breach of legal requirements relating to good governance. We issued a warning notice against the provider and told them they must make improvements.

There was no registered manager for the service and there had not been one in place since 10 September 2015. A manager was in place and they had submitted an application to register with the CQC. 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 undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. 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.

Although people felt safe in the service, people were still not always protected from the risk of abuse and information of concern was not always acted upon or shared with the local authority. Risks in relation to people's care were still not planned for appropriately to ensure people received safe care and people's care records did not contain sufficient guidance for staff to minimise risks to people.

People did not always receive their medicines as prescribed and medicines were not always managed safely. Staff were not appropriately deployed in the service to provide effective care and support and this resulted in people receiving unsafe care.

We found that improvements had been made to recruitment procedures and safe practices were now followed. Although some improvements had been made to staff supervision we found that staff still did not always receive suitable training to help them carry out their duties effectively and meet people’s varying needs.

People who lacked the capacity to make certain decisions were still not always protected under the Mental Capacity Act 2005. People received support which was not assessed and planned for to ensure it was delivered in the least restrictive way. However when people had capacity they were supported to make decisions relating to their care and support.

People did not receive effective support with health conditions and were not consistently enabled to access healthcare services. In addition to this we found that people did not receive adequate support to eat and drink.

There was a continued lack of appropriate governance and leadership and this resulted in us finding ongoing breaches in regulation and negative outcomes for people who used the service. Improvements to the care planning systems planned by the provider had still not been made and this had a continued negative impact on the quality of care.

People who used the service and staff were offered opportunities to get involved in the running of the service and staff and people who used the service found the management team open and approachable.

We found multiple ongoing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, safeguarding services users against abuse and improper treatment, staffing, consent and good governance.

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.

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.

We carried out an unannounced comprehensive inspection of this service on 26 and 27 of November 2015. Breaches of legal requirements were found in relation to the care, treatment and safety of people, induction and training of staff, recruitment procedures, dignity and respect, person centred care. We also found breaches in the legal requirements relating to notifications a provider must make to CQC. We asked the provider to make improvements in these areas. We asked the provider to develop an action plan to address the issues raised from our inspection however we did not receive an action plan.

During the inspection on 26 and 27 of November 2015 also found a breach of legal requirements relating to staffing levels. We took enforcement action against the provider and told them they must make improvements. We inspected the service again on 28th April 2016, this was a focused inspection to follow up issues relating to staffing. In this inspection we found that the provider had made some of the required improvements to staffing levels.

There was no registered manager for the service and there had not been one in place since 10 September 2015. A new manager had recently been appointed and they informed us that they planned to register with CQC as manager of the service. 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 conducted this inspection to follow up on the other breaches identified in our November inspection and to look at the overall quality of the service.

Although people felt safe in the service, people were not always protected from the risk of abuse and information of concern was not always acted upon or shared with the local authority. Risks in relation to people's care were not always planned for appropriately to ensure people received safe care and support. Safe recruitment practices were not always followed.

Medicines were managed safely and there were enough staff to provide care and support. People were supported to eat and drink enough and had their healthcare needs met.

People were supported to make day to day decisions but there was a lack of understanding of supporting people who lacked the capacity to make specific decisions. People were supported by staff who had not received training and supervision.

People were treated with dignity and their right to privacy was respected. Staff supported people with care and compassion and had positive relationships with people using the service. People were supported to make choices about how they spent their day. People had the opportunity to get involved in activities in the home.

People’s care plans did not provide a detailed description of people’s individual needs and preferences and did not contain all the relevant information to enable staff to provide personalised support. People were not involved in the development of their care plans. The care plans developed by the provider did not enable the service to provide high quality care.

There was a lack of effective governance from the provider which put people at risk of receiving poor care. Quality assurance systems put in place by the provider were not always effective in identifying areas for development and action plans were not consistently developed or implemented. People and staff were not involved the development and running of the service.

The management team were approachable and proactive. People and staff felt able to share ideas or concerns with the management. People knew how to raise concerns and these were responded to appropriately.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to safe care and treatment, staff training, consent and good governance. You can see what action we told the provider to take at the back of the full version of the report.

We undertook this focused inspection to check whether or not the service now met legal requirements and to address the information of concern we had received. This report only covers our findings in relation to this requirement and what we found in relation to the concerns raised. 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.

Coppice Lodge is run by Ideal Care Homes (Number One) Ltd. The service is registered to provide accommodation for 64 older people who require personal care. There were 22 people living at the service on the day of our inspection. The service is split across two floors each with communal living spaces, there were 13 people living upstairs and nine people living downstairs.

There was no registered manager for the service. A representative of the provider informed us that they had appointed a manager who they planned to put forward for registration as manager of the service. 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.

Improvements had been made to staffing levels at Coppice Lodge and further improvements were planned. We saw that most shifts were fully staffed to the level determined by the acting manager. However, we found that staff were not always effectively deployed and people told us that there were still not enough staff at times.

Medicines were not consistently stored and administered safely. Risks relating to the management of infection control were not always appropriately managed. There was no one responsible for ensuring infection control processes were adhered to.

Risks to people's health were not always assessed or planned for to ensure people received safe and appropriate care. There was no system for analysing and learning from incidents and accidents such as falls. This put people at risk of receiving unsafe care.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to safe care and treatment at the service. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with five people who had used the service and asked if they were happy with the care and support they received. One person said, “I am happy, the staff are nice and they respond fairly quickly when I ask for help. I get the care I need, although there is nothing much to do.” Another person said, “I like it here it is very good. Everything is fine I have no grumbles.”

Improvements had been made to the information contained in people's care plans and the completion of on-going records. However we saw that care plans sometimes contained contradictory information.

Staff generally interacted kindly with people and responded to people's immediate needs in a timely manner. However, there were occasions where staff did not interact with people appropriately.

The inspection team who carried out this inspection consisted of two adult social care inspectors. During the inspection we worked to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People's medication was stored, administered and recorded appropriately.

There weren't enough suitably qualified, skilled and experienced staff employed to be able to meet people's needs. The home was using agency staff at the time of our inspection to cover for shortfalls when the manager was unable to fill the shifts on the rota. We saw that there were times when staff struggled to be able to meet people's needs in a timely manner.

Appropriate records were not always maintained in relation to the care and support that was provided to people using the service.

Is the service effective?

We found that appropriate procedures were in place that were effectively utilised in order to obtain people's consent. Where a person did not have the capacity to provide consent an appropriate assessment of their capacity had been carried out.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. The manager was aware of the procedure to follow to make such an application.

People's care plans did not always provide staff with adequate guidance in how to meet their needs. Daily care records were not always fully completed so we could not be sure that people had been provided with the care they required.

Is the service caring?

We spent periods of time throughout the day observing the care and support that was provided to people in communal areas. We saw that some staff had a good understanding of people’s needs and provided support in a kind and considerate manner.

We spoke with six people who were using the service and asked if they were happy with the care and support they received. One person said, “Yes it’s alright on the whole, nothing to complain about.” Another person indicated that they were not satisfied with their care.

Is the service responsive?

During our inspection we observed that staff did not always respond to people's needs in a timely manner because staff had not responded appropriately when a call bell was pressed.

We saw that records of complaints did not always indicate how the complaint had been responded to. We did not see evidence of how complaints were used to bring about an improvement in the quality of the service, for example a review of any patterns emerging in the complaints received.

Is the service well-led?

The auditing system that was being used was not effective in identifying all issues and ensuring improvements to the care provided to people were made.

There were regular meetings for staff and people using the service and we saw that people were able to give their views about the service at these meetings. The people and staff we spoke with told us they felt they could approach the manager.

We saw that staff were taking appropriate steps to ensure medication was safely administered to people during our inspection. There were some inconsistencies in the way staff were completing records relating to medication.

There were enough staff to meet people's needs. Staff responded in a timely manner to requests for assistance and we observed staff spending time talking with people and providing activities. Staff received appropriate induction when they first started working at the service. Staff were provided with a wide range of training courses and on-going support and supervision.

We spoke with six people who were using the service to ask if they were aware of the different ways in which they could provide feedback about the quality of service they received. Some people told us they had recently completed a survey about the quality of food. People were also aware of meetings that were held for people using the service. One person said, “There are meetings for us to talk about the home. It’s good to see they take the time to listen to us.”

We looked at the medication administration records (MARs) for eight people who were using the service. We found inconsistencies in the way medication was being recorded.

We saw that there were not always sufficient numbers of staff available to meet people's needs in a timely manner. Staff had not all received the training and support required to carry out their role safely and to an appropriate standard. People using the service and staff were asked for their opinion about the quality of the service being provided. Systems were in place to audit the quality of the service but these were not fully effective.