Archived: Coghlan Lodges

Updated 12 February 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was completed by two inspectors.

Service and service type

At the time of our inspection the service provided care and support to people living in eight ‘supported living’ settings, so that they can live as independently as possible. Since our inspection the number of supported living settings has reduced to six. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service did not have a manager registered with the Care Quality Commission at the time of our inspection. The previous registered manager deregistered in November 2019. A new manager was in post and applied to register after our inspection.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 16 November 2019 and ended on 22 December 2019. We visited the office location on 16 and 18 November 2019. We received information of concern about complaints on the 10 January 2020, which we followed-up with the provider and have included as part of the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

Some people being supported had complex needs and were therefore unable to provide us with feedback. We used observations of care to help to understand the experience of people. We wanted to check that the way staff spoke and interacted with people had a positive effect on their wellbeing. We spoke with one relative, six care workers, the manager, the area manager, the finance manager and the business development manager. We received feedback from four safeguarding local authorities, three quality monitoring teams and three social workers.

We reviewed parts of four people's care records including care plans, risk assessments and medicines administration records. We looked at six staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including staff rotas and policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, staff rotas, care planning documentation and a number of management records. We received email questionnaire responses from four staff. We spoke with another professional who was involved in one person’s care and support.

Updated 12 February 2020

About the service

Coghlan Lodges is a 'supported living' service. The service provides 'personal care' to people living in nine 'supported living' settings, so that they can live as independently as possible. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

At the time of our inspection, the service provided support to four people who received 'personal care' in three of the nine locations.

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

People did not receive safe care and support. People’s specific needs were not risk assessed effectively. The provider did not operate systems effectively to ensure staff were recruited safely. People were not supported by sufficient numbers of staff. Infection control measures were not followed by staff. Safeguarding concerns were not always reported to the local authority.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People’s needs were not always assessed or delivered in line with current guidance. Staff did not co-ordinate effectively with each other or agencies to provide consistent, effective, timely care. People did not benefit from suitably trained staff to meet their needs.

The provider did not ensure people received care which consistently promoted their privacy, dignity or independence. People and relevant others were not always involved in decisions about their care.

The provider did not respond appropriately to complaints. The complaints log did not show outcomes or actions taken in response to complaints. The service did not always provide personalised care; people’s end of life preferences were not recorded in the event of sudden death.

Provider oversight and governance systems were not adequate or effective to assess, monitor and improve the quality of all areas of the service provided. The management structure did not provide sufficient oversight of services to ensure safety. Risks to people were not always identified or responded to by the provider to protect people from harm.

The service didn’t always consistently apply 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 did not fully reflect the principles and values of Registering the Right Support for the following reasons; limited inclusion and lack of choice and control. The provider could not show us how people were included in decisions about their care or how the service was run.

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 inadequate (published 29 August 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. At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulations and remains inadequate.

This service has been rated inadequate for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, injuries sustained through falls and the provider’s management of risk. A decision was made for us to inspect and examine those risks. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

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

Enforcement

At this inspection we have identified breaches in relation to, person-centred care, dignity and respect, need for consent, safe care and treatment, safeguarding people from abuse and improper treatment, good governance, staffing levels, suitable staff, responses to complaints, duty of candour and informing the Commission of incidents.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.