Archived: The Coach House Care Home

The Coach House Care Home is a residential care home providing accommodation and personal care for up to 21 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 16 people using the service. The service is in a residential area of Leeds city, in one building set out over 2 floors. The ground floor has a communal dining area and lounges.

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

There were inconsistences in people’s care records and quality assurance systems had not identified these. The provider had systems to review accidents, incidents and feedback about the service. However, there was little evidence how this was being used to improve the quality of the service.

Staff were clear about their roles and responsibilities and knew people well. We saw evidence of how the provider was working with other healthcare professionals to meet people’s needs. People and relatives felt communicated and consulted with.

There were inconsistencies in safe recruitment systems, we have recommended the provider consider current guidance on safe recruitment. Staffing levels were appropriate to meet people’s needs and people and their relatives consistently told us they felt safe. Medicines were managed safely and infection protection controls measures were good.

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.

Rating at last inspection and update

The last rating for this service was requires improvement (published 29 July 2019) and there was 1 breach of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. This is the sixth consecutive inspection the provider has been rated requires improvement.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 29 July 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

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.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Coach House Care Home on our website at www.cqc.org.uk

Enforcement and recommendations

We have identified breaches in relation to governance systems at this inspection and made a recommendation about safe recruitment.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Coach House provides personal care for a maximum of 21 older people, some of whom are living with dementia. At the time of our inspection there were 20 people living at the service.

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

Improvements had been made to medicines management; with clear records showing people received their medicines and topical creams as prescribed. There was a clear commitment from the management team to ensure effective and safe management of medicines.

There was a positive atmosphere in the service and staff worked well as a team. The service was clean and free from odours. Staff were wearing face masks and following COVID- 19 government guidance to minimise risks to people. The management team ensured staff were trained and supported in effective management and control of infection. Communication with people and their families had been seen as a key priority during the pandemic.

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

Rating at last inspection (and update) The last rating for this service was requires improvement (published 26 July 2019) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

This targeted inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on breaches of regulation or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Coach House on our website at www.cqc.org.uk.

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 coronavirus and other infection outbreaks effectively.

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.

The Coach House was providing personal care to 19 people aged 65 and over at the time of the inspection. The service can support up to 21 people some of whom were living with dementia.

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

People told us they liked living at the service Feedback from relatives and visiting professionals was very positive regarding the level of care and support people received.

People told us they received safe care. Ongoing issues were identified regarding people’s medication and this was in relation to people having their creams applied as per their GP’s instructions. The provider continued to recruit staff safely. Accidents and incidents had been reviewed and appropriate risk assessments had been carried out to keep people safe.

Staff received training to support them in their role.. Staff they felt supported by their managers and managers had an open-door policy and welcomed staff feedback. People were supported to have maximum choice and people told us they were involved in decisions regarding their care.

People were supported to maintain a healthy and balanced diet. They enjoyed their food and had access to snacks if they wished. People were quickly referred to other healthcare professionals to support their health and well-being.

All feedback was very positive regarding how staff and managers had worked to create an environment where people felt they could live both happily and safely. Staff supported people to maintain their independence as much as possible, and where support was provided, this was carried out in a way which maintained people’s dignity.

People were encouraged to participate in activities both internal and external to the home.

The provider welcomed feedback through various sources. They sent out regular questionnaires to gather people’s opinions, to further improve the level of care and support provided. In addition, the provider carried out a range a monthly quality checks.

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 (and update)

The last rating for this service was requires improvement (published 16 June 2018).

This is the fifth inspection where the provider has been rated as requires improvement. At our previous inspection, we identified one breach of regulation. At this inspection not enough improvement had been made and the provider was still in breach of regulation.

Why we inspected

This was a planned inspection based on the previous rating.

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

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.

The service had a registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

The service was last inspected on 6 October 2017. This was a focused inspection to check whether the provider had made improvements following an inspection on 23 February 2017. We found at the last inspection that the provider had made improvements but rated the service requires improvement until they could evidence a longer term track record of consistent good practice.

During this inspection we found that the service still remained requires improvement. We found a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) 2014 because the service was not doing all it could to keep people safe and was not effectively managing the application of prescribed creams. This is the third time that the service has been rated requires improvement.

Gaps in the recording of application of prescribed creams meant that the provider could not be sure that the creams had been applied as prescribed. Not all risks has had been identified or risk assessed against. However, risk assessments were in place for the majority of people.

Staff understood how to safeguard people from abuse; they had training in this area and were able to put this into practice. There was sufficient staff to ensure people were kept safe and the provider ensured that recruitment checks were in place. We felt that some recruitment checks could be more robust. We made a recommendation about safe recruitment practices.

People felt that the staff were caring and we observed people were treated with dignity and respect.

People’s care plans demonstrated a commitment to person centred care. People were supported to make their own decisions; this was encouraged and reflected in their care plans. Care plans demonstrated that the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) had been applied; however, this was sometimes inconsistent. We have made a recommendation about mental capacity and best interest decisions.

People’s nutrition and hydration needs were catered for. A choice of meals was available and drinks were made readily available throughout the day. Meal times were observed to be a pleasant experience.

Training was provided to meet the needs of people; this enabled staff to develop their knowledge to provide person centred care. Staff received regular supervision and appraisal and told us they felt supported in their roles.

People’s wider support needs were met through the provision of daily activities provided by an activity coordinator.

The service completed investigations into incidents and accidents. Investigations were thorough and comprehensive and lessons learned were reflected upon and recorded. This meant that the likelihood of future similar incidents was reduced.

The service was clean and infection control measures were in place.

There was a complaints procedure in place which allowed people to voice their concerns if they were unhappy with the service they received. All complaints were acknowledged and responded to within their set timescales.

There was a range of quality audits. Some concerns we identified during our inspection had not been picked up in the management audits. Concerns that had been identified still required action to be taken to address them.

All of the people we spoke with told us they felt the service was well-led and that they felt listened to and could approach management with concerns. Staff told us they enjoyed working at the service and enjoyed their jobs.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 6 October 2017 to check they had followed their plan and to confirm they now met legal requirements. We found improvements had been made with regard to these breaches and the provider was now compliant with the regulations.

This report only covers our findings in relation to these topics and the management of the service. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for The Coach House Care Home on our website at www.cqc.org.uk

The Coach House Care Home is a service for 21 people, providing accommodation and services to older people; it is situated in a residential area of Garforth and is close to local amenities and public transport.

There was 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 and associated Regulations about how the service is run.

People received their medicines as prescribed. Medicines were managed safely and in line with current regulations and guidance. Staff had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered and audited appropriately.

Staff had received appropriate supervision and appraisal which allowed them to fulfil their roles effectively and develop positive relationships with people who used the service. Staff understood their roles and responsibilities.

Quality assurance systems were in place to assess and monitor the service people received. There was a commitment to continuous improvements of the service. People we spoke with felt the registered manager was supportive and approachable and expressed confidence in them to address any concerns raised.

The Coach House is a care home for 21 residents, providing accommodation and services to older people; it is situated in a residential area of Garforth and is close to local amenities and public transport. There were 17 people using the service when we visited.

Medicines were not managed safely as fridge temperatures showed medicines were not stored at the required temperatures. Gaps were seen in medication administration records and one person was given another person’s pain relief which was not their prescribed dosage. Medication audits had not identified the concerns found during our inspection. The issues we identified at our last inspection had not resulted in satisfactory improvements in the safe management of medicines. The registered manager completed audits covering infection control, beds and rooms which were more effective.

Notifications were not submitted to the Care Quality Commission (CQC) as required under the terms of the registered provider’s registration. We dealt with this outside the inspection process.

Supervisions and appraisals were not carried out in accordance with the registered provider’s policy. Staff had received an induction and were mostly up-to-date with their training programme. MCA and DoLS were managed satisfactorily. Staff knew to offer people choice and how to respond appropriately if a person refused care.

Recruitment was safely managed as relevant background checks had been carried out to ensure staff were suitable for working with vulnerable people. People felt safe and staff knew how to recognise and respond to signs of abuse. There were sufficient numbers of staff deployed in the service and feedback from people and staff confirmed this.

Staff and resident meetings took place and people were regularly asked for feedback regarding the service they received. People and relatives knew how to complain. Complaints were appropriately dealt with and responded to by the registered provider.

Risks to individuals were appropriately assessed, monitored and reviewed. Building maintenance and fire safety was appropriately managed as the necessary checks had been completed.

People were able to access a range of healthcare services. A visiting health professional spoke positively about the care provided by staff at The Coach House Care Home. People were happy with the food they received. Drinks were regularly provided throughout the day of our inspection. We observed a positive mealtime experience where people were well supported.

Feedback from people and relatives we spoke with confirmed staff provided good care. People’s privacy and dignity along with equality, diversity and human rights were respected by staff. Staff knew people’s care preferences and there were good natured interactions between people and staff.

Care plans contained sufficient information for staff to provide effective care. We saw these were updated on a regular basis and people and relatives were part of their reviews.

An activities coordinator was due to start of the end of February 2017. People received stimulation through a programme of activities with external entertainers and trips out also taking place.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.

The inspection helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

Is the service safe?

The provider acted in accordance with legal requirements where people did not have the capacity to consent. Staff had an awareness of the Mental Capacity Act and deprivation of liberty safeguards. Staff understood their obligations with respect to people's rights and choices when they appeared to lack mental capacity to make informed and appropriate decisions. The manager told us staff had received training around the Mental Capacity Act in 2012. The manager told us the home is in the process of reviewing their policies and procedures for consent and capacity.

Each person's care file had risk assessments which covered areas of potential risk such as pressure ulcers, falls and nutrition. When people were identified as being at risk, their plans showed the actions required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

Staff demonstrated good knowledge and awareness of their responsibilities for infection prevention and control and there was evidence staff had received relevant training. Two members of staff we spoke with during the inspection confirmed they had completed infection control training. We saw future infection control training had been arranged for 2014.

Staffing levels were assessed depending on people's need and occupancy levels. The staffing levels were then adjusted accordingly. They said where there was a shortfall, for example when staff were off sick or on leave, existing staff worked additional hours to make sure there was continuity in service

We spoke with three visitors and they told us they were pleased with the standard of care and facilities provided by the service. One person told us they were happy their relative was well cared for and were always made to feel welcome when they visited.

Is the service effective?

The home had a good working relationship with other healthcare professionals and always followed their guidance and advice. The input of other healthcare professionals involved in people's care and treatment was clearly recorded in their care plan.

People's files contained pre-admission assessments, which showed that people's health, personal and social care needs were assessed before they moved into the home.

When people were identified as being at risk, their plans showed the actions required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

Is the service caring?

Visitors we spoke with told us they were very happy with the care provided and in their opinion people were well looked after. They described staff as friendly, patient and caring.

People who used the service told us they were happy with the staff at The Coach House and with the care they provided. One person said, 'The staff are very good, lovely people." Another person told us, 'The staff look after me well at all times.'

We found the care staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered. We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

The provider's quality assurance feedback from people who used the service, relatives and visitors, showed there was a high level of satisfaction. All felt the quality of care was excellent and the quality of staff was good. The registered provider had analysed the results and identified what they could improve and develop.

Is the service responsive?

People and their families were involved in discussions about their care and the risk factors associated with this. Individual choices and decisions were documented in the care plans and reviewed on a regular basis.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff we spoke with said there were effective systems to monitor quality and safety. They said managers were in regular contact and checked everything was in place. One member of staff said, 'Everyone knows what they need to do. There is clear direction. " Another member of staff said, "Everyone works so well together. We are a good team and the place has a nice feeling.'

We looked at care plans and saw that they contained information about peoples' preferences and social histories.

We saw how staff maintained people's privacy and dignity, and maintained confidentiality when speaking to people and other staff.

During the inspection our expert by experience spoke with the relatives of two people and comments included;

'I am very happy with the care she [mother] receives here. I work in Leeds and I can pop in whenever I want to see her. I am always made welcome.'

'Mum can be quite difficult and she gets angry because of her dementia. The staff are always calm and kind and help her through things.'

'I would recommend it here ' 100 percent.'

We contacted a further two relatives by telephone following our inspection. When asked for any other comments about the service these included:

'If ever there's a problem or issue they involve me, even with the small things.'

'Everything is excellent.'

We found the communal living areas within the Coach House to be clean however, some of the communal bathrooms and toilets were in need of updating.

Personal Protective Equipment (PPE) was not readily available in all areas.

'Staff are friendly, caring and kind'

'Nothing's too much trouble'

'Honestly never seen anything that would give me any cause for concern'

'I haven't got even one grumble about living here'

Everyone we spoke with told us their dignity and privacy was respected. We observed staff being respectful, caring and providing good standards of care. Care plans reviewed had a full assessment carried out prior to or on admission. People who used the service said they were happy living at the home and would not hesitate to raise concerns. Staff we spoke with said they had received safeguarding training and were clear of the action to take if they suspected abuse or if an allegation was made. Staff files reviewed showed effective recruitment, selection processes and evidence of staff attending training. Staff rotas showed good staffing levels, well organised to support people throughout the day and night. We looked at the provider's complaint policy and procedure and saw people's complaints were fully investigated and resolved, where possible to their satisfaction.