Archived: Coghlan Lodges

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.

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 five people received 'personal care' in three of the nine 'supported living' settings.

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

The provider had taken action in response to our previous inspection but this was not effective. The lack of comprehensive and robust oversight by the provider meant shortfalls had been missed and action was not taken to prevent the service from falling below an acceptable standard. This meant people's quality of life suffered. We received mixed feedback from staff about senior management; some felt supported and others did not always feel listened to. The provider did not analyse or produce outcomes from information gathered from people using the service or staff to develop the service.

We have made a recommendation the provider develops systems which encourage and respond effectively to feedback from people, staff and other stakeholders.

People did not receive safe care and support. Fire risk assessments and safety measures were not adequate to reduce the risk of harm. People’s specific needs were not risk assessed effectively. The provider did not operate systems effectively to ensure safe staff were employed. People were not supported by sufficient numbers of staff. Infection control measures were not followed by staff and chemicals were not always stored safely.

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 other agencies to provide consistent, effective, timely care. People did not benefit from suitably trained staff to meet their needs.

We have made a recommendation that the provider updates care planning documentation to reference appropriate nutritional guidance and ensures information is provided to people about healthy food options.

The provider did not ensure people received care which consistently promoted their privacy, dignity or independence. People and their relatives were not always involved in decisions about their care. People told us they were satisfied with staff with comments such as, “Staff are alright, doing the best they can” and “Staff are generally caring and always pleasant.” We observed staff were caring in their interaction with people.

People were dissatisfied with the lack of personalised activities at the service and opportunities participate in the community. Information contained in people’s care plans was sometimes generic and did not respond to their individual needs. People's care plans included information about their communication needs but strategies to support people were not always fully developed. There was a complaints procedure and complaints were followed-up by the registered manager. The service explored with people their end of life preferences.

We have made a recommendation the registered manager seeks information from a reputable source about the Accessible Information Standards (AIS) to ensure people are given information in a way they can understand.

The service did not 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. For example, people felt they did not have enough opportunities to participate in the wider community. The provider could not evidence 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 18 December 2018) 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. We also found new concerns at this inspection.

Why we inspected

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, safe staff 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 six 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.

We met with the provider after the inspection to gain assurances that action was being taken to address the immediate risks to people. The provider submitted their action plan to us and kept us informed of progress made to reduce risk.

Our inspection site visits took place on 4 October, 5 October and 26 October 2018. The first day of our inspection was unannounced and the remaining two days were announced.

Coghlan Lodges is a ‘supported living’ service. The service provides ‘personal care’ to people living in a number of ‘supported living’ settings, so that they can live as independently as possible. Not everyone using Coghlan Lodges receives the regulated activity. We only inspect the service being received by people provided with ‘personal care’, which includes the prompting and supervision of tasks related to personal hygiene, eating and others. Where people do receive ‘personal care’ we also take into account any wider social care provided. At the time of our inspection, four people received ‘personal care’.

The provider is required to have a registered manager as part of their conditions of registration. 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. At the time of our inspection, there was a manager registered with us.

People were not safe from abuse. Systems in place did not always ensure that vulnerable adults were protected from foreseeable risks. Recruitment processes were inadequate and did not ensure that only fit and proper staff were employed by the service. An effective mechanism for determining safe staffing deployment was not in place. Staffing was based on people’s funded hours of care, and not their needs or dependency. Care risk assessments were completed, but were not always accurate and did not always contain sufficient information.

The governance of the service was unsatisfactory. Although a quality assurance tool was in place to log areas for improvement, issues were not always acted on promptly or sufficiently. When actions were marked off as complete, there were o further checks completed to ensure any changes put in place were suitable and sustained. The service did not always provide required information as required by the regulations. Record-keeping was inadequate, and the provider failed to comply with relevant legislative requirements for documentation.

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 and a rating of ‘inadequate’ remains 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 if they do not improve.

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.

There were a number of breaches of the regulations.

You can see what action we told the provider to take at the back of the full version of the report.

Coghlan Lodges Limited provides care and support to people living in 15 ‘supported living’ settings, so that they can live in their own homes as independently as possible. People’s care and housing are provided under separate contractual arrangements. The Care Quality Commission (CQC) does not regulate premises used for supported living. Not everyone using Coghlan Lodges Limited received a regulated activity; in this case, personal care. Personal care is where people are provided with help and tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of the inspection four people were in receipt of personal care and they lived in one of the 15 houses operated by Coghlan Lodges Limited. We visited the three houses where the four people lived who were in receipt of a regulated activity.

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 2008 and associated Regulations about how the service is run.

The last inspection was conducted on 2 and 3 November 2016. At that inspection, we found

a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took civil enforcement against the provider. We issued the provider a warning notice as the provider had not ensured robust systems were in place to manage risks to people, quality systems had been compromised and we found poor record keeping. There were two further breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the provider was not following the requirements under the Mental Capacity Act 2005 (MCA) and medicines administration was not safely managed.

Following the inspection in November 2016, the provider submitted an action plan dated 7 January 2017 which set out the actions they planned to take to address the breaches. The current inspection provided an opportunity to assess whether the warning notice had been met and the action plan had been successfully completed. At this inspection we found the provider had effective systems in place to monitor and mitigate the risks relating the health, safety and welfare of people, people’s medicine was safely administered and they were following the principles of the MCA.

People and their families told us they felt safe with the staff from Coghlan Lodges Limited and had no concerns about their safety in their home.

We saw where the provider looked after people’s money on their behalf; systems were in place to manage people’s finances safely.

Staff understood their responsibilities in relation to safeguarding people. Staff received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the authorities where concerns were identified. People received their medicine as prescribed.

People benefitted from caring relationships with the staff. Relatives said, “Definitely good relationships with staff” and “All (people) are very happy at this house”. People and their relatives were involved in their care and people’s independence was actively promoted. Relatives and staff told us people’s dignity was promoted.

Where risks to people had been identified, risk assessments were in place and action had been taken to manage these risks. Staff sought people’s consent and involved them in their care where possible.

People, relatives and staff told us there were sufficient staff to meet people’s needs. This was confirmed on the day of the inspection as we observed staff numbers were adequate to meet people’s needs. The service had safe recruitment procedures and conducted background checks to ensure staff were suitable to undertake their care role.

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. The service was operating within the principles of the Mental Capacity Act 2005(MCA).

Relatives and people who were able to, told us people had enough to eat and drink. People were involved in planning their meal choice and their preferences were respected. Staff promoted healthy food options for people they looked after.

Relatives told us they were confident they would be listened to and action would be taken if they raised a concern. The service had systems to assess the quality of the service provided. Improvements and learning needs were identified and action was taken to make improvements which promoted people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.

Staff spoke positively about the support they received from the registered manager and all of the team at the service. Staff supervision and other meetings were scheduled as were annual appraisals. People, their relatives and staff told us all of the management team were approachable and there was a good level of communication within the service.

Relatives and people told us the staff at Coghlan Lodges Limited were very friendly, responsive and the service was very well managed. Comments received included, “Very pleased with his care”; “All the staff get on with [name]." The service sought people’s views and opinions and acted on them.

The management team's ethos was echoed by staff and embedded within the culture of the service. One staff member said, “The management are good, they listen and there are leadership opportunities for me here”.

We have made one recommendation about the Information Access Standard.

Coghlan Lodges provides personal care and support to people living in ten supported living schemes. At the last inspection on 5 August 2015, we asked the provider to take action to make improvements in their management of medication, increasing people’s independence, notifying the CQC of important events and to improve their quality auditing arrangements. There were two breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. At this inspection we found some improvements had been made but further actions were needed to ensure the provider met the regulations.

At the time of the inspection nine of the schemes were occupied and 47 people were in receipt of a service.

There had been no registered manager in post for a period of over 12 months. We were informed there had been a delay in obtaining the necessary information to enable the person to register with the Care Quality Commission (CQC). At the time of inspection an application had been submitted, however this was rejected due to supporting evidence being out of date. 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’s medication was not managed safely. There were a number of recording errors on people’s MAR charts, changes to specific medicines were not recorded and some staff had not followed guidance to keep people safe from risks when they missed their medicines. The provider was also failing to follow national pharmaceutical guidelines.

People’s medicines were stored safely and in most cases people received their medicines when required.

People and their families told us they felt people were safe. Staff understood their responsibilities in relation to safeguarding adults. Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified.

People benefitted from caring relationships with the staff. We saw positive interactions where staff respected people’s privacy and promoted their dignity. Relatives told us they were involved in people’s care and people’s independence was actively promoted. However, people who used the service were not always involved in their care reviews.

There were sufficient staff to meet people’s needs. Staff rotas confirmed planned staffing levels were maintained. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

Staff understood the Mental Capacity Act 2005 (MCA) but the provider had not applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves. The operations manager was knowledgeable about the MCA and how to ensure the rights of people who lacked capacity were protected. However, MCA assessments were not in place for people. Where people lacked capacity to make decisions the registered manager was not acting within the principles of the Mental Capacity Act (2005).

People had enough to eat and drink. People could choose what to eat and drink and their preferences were respected. Where people had specific nutritional needs, staff were aware of, and ensured these needs were met.

Relatives and professionals told us they were confident they would be listened to and action would be taken if they raised a concern. The service had systems to assess the quality of the service provided. Learning needs were identified but actions were not always taken to make improvements to promote people’s safety and quality of life. Systems were not always in place that ensured people were protected against the risks of unsafe or inappropriate care.

Staff spoke positively about the support they received from the manager. Staff supervision and other meetings were scheduled as were annual appraisals. Staff told us the registered manager and area manager were approachable and there was a good level of communication within the service.

People told us the service was friendly, responsive and well managed. People knew the registered manager and staff and spoke positively about them. The service sought people’s views and opinions and acted upon them.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.