Archived: The Coach House Residential 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.

The Coach House provides care and support to older people who require minimal assistance with their personal care. The home does not provide nursing care or on-duty night cover. This is clearly documented in people’s contracts. The contracts stated that people were not accommodated if, ‘The resident needs help moving or needs care between 22.30 and 07.30. All the accommodation is located on the ground floor and there is level access to the patio and garden area.

At our last inspection in July 2016 we rated the service good. At the inspection we found that the provider had not kept up to date with changes in legislation and good practice guidelines. We saw that documentation referred to outdated legislation. This was identified as an area that required improvement. At this inspection we saw that the required improvements had been made.

At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. The provider and her partner told us that they had not undertaken any training since the previous inspection in 2016. We did not assess that any harm had occurred as a result of this shortfall, but this is an area we identified as needing to improve.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained Good.

The service had a positive culture that was person-centred. There was an emphasis on individualised care. People were supported to have maximum choice and control of their lives and the provider supported them in the least restrictive way possible . People told us they did not wait when they needed assistance.

The provider was proud of the service and their work. They felt that the service provided a homely environment promoting people to remain as independent as possible for as long as possible. People were supported to maintain contact with their relatives. People received a varied and nutritious diet which was home cooked by the provider from fresh ingredients.

People had plans of care and risk assessments. Medicines were managed safely.

Further information is in the detailed findings below.

The registered provider managed the service. A registered provider, 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. Although everyone spoke highly of the provider they had not ensured they had kept up to date with changes in legislation and good practice guidelines. The provider was aware they needed to make amendments to their policies, procedures and documentation and whilst we did not assess any harm had occurred as a result of these shortfalls, this is an area of practice we identified as needing to improve.

Everyone told us they were happy with the care they were receiving. One person told us “It’s absolutely home from home”. A relative told us “I do believe she is very well looked after here. There’s nothing else I can say really they are absolutely wonderful. It is a marvellous place, I cannot fault anything, we were very lucky to get a place, there is a waiting list and that says it all”. Feedback the provider received about the service included the comment ‘My friend is extremely happy here, the staff are so friendly and caring and will do anything for you’.

People’s health and wellbeing was continually monitored and the provider regularly liaised with healthcare professionals for advice and guidance. One person told us “If I’m unwell they ring the doctor for me. They look after me so well, I can’t fault them”. Feedback the provider had received from a relative included ‘My relative has lived at The Coach House for nearly a year and it is the happiest and healthiest they have been in a number of years’.

People received medicines on time and records of people’s health and emotional wellbeing had been maintained. One person told us “They get my prescriptions for me and I always get my medicines on time in the morning and in the evening”.

Staff were responsive when people needed assistance. Comments we received from people included “There’s always someone here and they come quickly if I need any help”, and “There are no rules here. I can do what I want when I want. If I want a late breakfast I can have it. If I fancy a bath I just have to ask”. This person’s relative told us “It’s very personalised the care here. It’s all about what mum wants, that’s what makes it so special”.

Meal times were relaxed and sociable. People spoke highly of the quality of the food on offer which was homemade from fresh ingredients. One person told us “The food is beautiful and really, really nicely presented. Sometimes there are four or even five vegetables. A relative told us “One day mum was off her food and they went out and bought her lobster and salmon because that is what she fancied. There are not many places that would do that”.

People’s privacy and dignity was respected and upheld. Staff knocked on people’s doors and waited for a response before entering the room, and referred to people by their preferred term of address.

People felt safe. One person told us “Most definitely I feel safe and secure here”. A relative told us “We’ve stopped worrying now because we know she is safe here”.

People’s independence was promoted; they were supported to remain mobile and were encouraged to do as much as they could for themselves. People had opportunities for social engagement and stimulation. They were supported to maintain relationships with people that mattered to them. Visitors were made to feel welcome and people could invite their friends and relatives to spend time with them in the service and join them for meals.

People’s needs had been assessed and planned for. Plans took into account people’s preferences, likes and dislikes and were reviewed on a regular basis. Staff worked in accordance with the Mental Capacity Act (MCA) and associated legislation ensuring consent to care and treatment was obtained. People were supported to make their own decisions and arrangements were in place to ensure where people lacked the capacity to do so relevant legislation would be followed.

People were supported by sufficient numbers of suitably qualified and experienced staff, all of whom held a nationally recognised qualification in care. The recruitment and selection procedures in place ensured that appropriate checks were undertaken before staff began work. The provider knew what action to take if they suspected abuse had taken place and felt confident in raising concerns.

Risks to people were identified and managed appropriately and people had personal emergency evacuation plans in place in the event of an emergency. Accident and incidents had been recorded and action had been taken to reduce the risks of reoccurrence.

People, their visitors and staff had confidence in the leadership of the service. The provider was approachable open and transparent and had ensured there were processes in place to respond to complaints appropriately.

We considered all the evidence we had gathered under the outcome we inspected. We used the information to answer the five questions we always ask:

- Is the service safe?

- Is the service effective?

- Is the service caring?

- Is the service responsive?

- Is the service well-led?

This is a summary of what we found '

Is the service safe?

People told us that they felt their rights and dignity were respected. People were happy with the service's medication practices. People told us they 'Felt safe' and had no concerns regarding the service. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told that no applications had needed to be submitted.

Is the service effective?

During our visit all interactions we saw between the staff and the people who lived at the service were respectful. People told us that they were happy with the care they received and their needs had been met. It was clear from speaking with staff that they had a good understanding of the people's care and support needs. People told us that, 'It's very good here'.

Is the service caring?

People told us that they liked the staff. Comments included, 'They are very kind' and, 'They look after me well'.

Is the service responsive?

At our last inspection of the home on 10 April 2014 a compliance action was set. This was because medicines were not handled, administered or stored safely. At this inspection we found that action had been taken and the compliance action had been met.

Is the service well-led?

People were very happy with the care and support they received. People told us they felt they were listened to. People told us they could raise concerns or make suggestions to the staff if necessary. They told us they had confidence in the staff and, 'Have no complaints.'

We found that accommodation for people who used the service was in a discrete area within the wider home. We saw that the bedrooms were all en-suite with patio doors on to the garden and there was a lounge and dining area. The accommodation was bright and had a comfortable, homely feel. We observed that people who used the service and staff interacted in a relaxed and friendly manner. We observed that the owner, member of staff and people ate together and that the service had a warm and friendly atmosphere.

We considered our inspection findings to answer questions we always ask: 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 what we observed during the inspection, what people who used the service told us, the staff that supported them and from the records we saw.

Is the service safe?

We saw that people's needs were assessed and care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Care records contained information on people's backgrounds, needs and information for staff on how to meet them, their preferred routines and risk assessments.

We found that medicines were kept in a locked cupboard but that the keys were not kept in a safe way and presented a potential risk of misappropriation. We found that some medicines that required storage in a fridge to ensure they were in a suitable state were not stored safely as the temperature of the fridge was not checked. The fridge was not locked and was in an area accessible to people who used the service and visitors which meant there was a risk of misuse. In one person's record we looked at we saw that prescribed medicine was not given to the person on a regular basis as indicated on the person's Medication Administration Record (MAR) chart. A compliance action has been set in relation to the management of medicines and the provider must tell us how they plan to improve.

We found that the majority of care given to people was delivered by the provider. We noted that the provider and member of staff had undertaken training in key areas such as safeguarding and administration of medicines. We observed the care that was delivered was appropriate and of a good standard. People confirmed they were happy with the care provided. One person told us, 'We are well looked after'.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told that no applications have needed to be submitted.

Is the service caring?

People were treated with respect and dignity by the staff. People told us they were very happy with the care and support provided and that their care needs were met. One person told us, "They are very nice, we are treated very well'. We saw that staff were attentive and showed patience and encouragement when supporting people. One person told us, "I am so pleased they don't rush me. They let me take my time so I can do as much for myself as possible'. Another person told us, 'They are wonderful'.

Is the service responsive?

We found that people's needs were assessed and records confirmed that people's preferences, interests and needs had been recorded.Care and support was provided in accordance with people's wishes. People told us they had been supported to maintain relationships with their friends and relatives.

People told us that they felt able to raise any concerns with the provider and that they would be responded to. People told us they could not think of any ways in which the service could be improved.

Is the service well led?

The provider and member of staff told us that as they lived at the home they were assessing and monitoring the service on a regular basis and any issues were resolved instantly. We observed that the environment was of a clean and high standard.

The provider told us that they use feedback given to an external website to monitor the quality of the service.

We found that appropriate records relating to peoples care needs were kept.

The majority of day to day care was provided by the manager of the home, supported by one other member of care staff. A further staff member provided domestic support to people living at the home. The manager also provides 24 hour support to the service.

During our visit we observed interactions between the manager and people who used the service. We found these interactions to be positive, sensitive and friendly. Everyone that we spoke with told us they were satisfied with the care and support they received.

Despite people expressing satisfaction with the care provided we found that staff were not supported to deliver care and treatment safely, and to an appropriate standard. This included staff not receiving training in areas specific to people's needs.

We found that records were not accurately kept in relation to care and treatment received.

We also found that there were no effective systems to regularly assess and monitor the quality of service that people received.

We found people choices were taken in account in the way they were cared for at the home. People told us they chose when to get out of bed.

We found people needs were not assessed and care was not delivered in a way intended to ensure people's safety and welfare. We reviewed the care records and found there were no plans to deal with people with complex needs.

The provider told us they listened to people and made changes to accommodate the requests people made.

We found the one out of the three staff working at the home was trained in safeguarding and there were no identified future training scheduled for staff to attend. We found no evidence that supervision and appraisals were carried.

The provider told us they monitored and assessed the quality of the service they offered by reviewing incidents and monitoring complaints received. We found serious incidents which involved people who lived at the home were not reported to the Care Quality Commission.