Archived: Coolhaze

Coolhaze is a residential care home providing personal care and accommodation for up to three people. Coolhaze provides care for people with a learning disability and associated conditions such as autism. Accommodation is arranged over three floors with each person having their own self-contained flats. At the time of the inspection three people were living at the home.

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

Not everyone living at Coolhaze was able to share their views with us. One person told us they felt safe at the service and trusted the staff: they said the service was “really good”. Another person we met looked happy and relaxed in staff’s company.

We found improvements were required in how the safety and quality of the service is assessed, monitored and improved. Care records were not always fully accurate, and the safety checks and maintenance of the equipment and grounds was insufficient to ensure people and staff were safe. The provider’s quality assurance and governance systems had not been effectively implemented and improvements were made only after the commencement of the local authority’s safeguarding investigation.

We also found people were not always provided with care and support that was person-centred. We made a recommendation to improve how people are supported to develop their skills and engage in activities meaningful to them.

Medicines were being managed safely, after action had been taken following a medicine error.

We received positive feedback from four staff: all reported feeling well supported by the registered manager, and they said they enjoyed working at Coolhaze.

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 (report published 16 July 2018)

Why we inspected

We received concerns in relation to people’s safety and well-being. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach of regulation in relation to managing risks to people’s health, safety and welfare, as well as with the implementation of effective governance systems at this inspection.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Coolhaze provides care and accommodation for up to three people. At the time of the inspection two people were living at the home. Coolhaze provides care for people with a learning disability and associated conditions such as autism.

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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service did not have a registered manager in post. However a manager was in post and has started the process of registration with 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.

Following the inspection of March 2017 and August 2017 we had rated the service as requires improvement overall. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, caring, responsive and well led to at least good.

At this inspection we found the service was now rated Good overall. However, the rating for Well led remained Requires Improvement.

Why the service is rated Good.

During the last comprehensive inspection in March 2017 we found the areas of caring, responsive and well led required improvement with breaches of Regulation.

At that time the design and delivery of care was not in all cases person centred and did not demonstrate people's needs were met appropriately. People’s privacy and independence was not in all cases respected and promoted and people were not always protected by effective governance to help ensure the quality of the service was maintained. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of caring, responsive and well led to at least good.

We went back to the service in August 2017 and carried out a focussed inspection after the provider had informed us about concerns relating to the conduct of staff and an incident of medicines missing at the service. At that inspection we found the areas of safe and well led required improvement. We found the provider did not have sufficient systems in place to identify where quality and/or safety were being compromised and to respond appropriately and without delay. Also people were not always protected by the safe management of medicines. Medicines audits were not robust and had failed to identify discrepancies in the amount of medicines stored in the home. People were also not fully protected by staff who fully understood how to escalate concerns about abuse outside of the organisation. We asked the provider for a report and they sent a report telling us what actions they would take to put this right.

At the inspection in August 2017 we found although improvements were underway on the breaches found in March 2017, they were not at the time of that inspection, August 2017, completed. Therefore, it was not possible to see if the improvements and actions taken would be sustained and continue to improve the quality of the service.

At this inspection, we found that the provider had followed their action plans and that steps had been taken to ensure improvements had been met or nearly met.

We met and spoke to both people during our visit. However people who lived at Coolhaze had some communication difficulties due to their learning disability and associated conditions, such as autism. Therefore they were not able to tell us verbally about their experience of living there. We spent short periods of time with people seeing how they spent their day and observing the interactions between people and the staff supporting them.

Staff had completed safeguarding training and further updates were arranged. Staff had a good knowledge of what constituted abuse and how to report any concerns. Staff understood what action they would take to protect people against harm and were confident any incidents or allegations would be fully investigated. Staff confirmed they would have no hesitation reporting any issues to the management or to the local authority.

People’s risks were documented, monitored and managed well to ensure they remained safe. People lived full and active lives and were supported to access local areas and activities. Activities reflected people’s interests and individual hobbies.

People lived in an environment that was clean and hygienic. Parts of the environment had been refurbished to a high standard taking into account people’s needs.

All significant events and incidences were documented and analysed. The evaluation and analysis of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff. Feedback to assess the quality of the service provided was sought from other agencies and the staff team.

People had sufficient staff to meet their needs. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people.

People’s medicines were now managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received appropriate training and understood the importance of safe administration and management of medicines.

People continued to receive care from staff who had the skills and knowledge required to effectively support them. New staff who did not have formal qualifications or previous experience of care completed the Care Certificate (a nationally recognised training course for staff new to care). Staff said the Care Certificate training looked at and discussed the Equality and Diversity policy of the company.

People were given the choice of meals, snacks and drinks they enjoyed while maintaining a healthy diet. People had input as much as they were able to in preparing some meals and drinks.

People were engaged in different activities during our visit and enjoyed the company of the staff. People were busy; however there was a calm and relaxed atmosphere within the service. The provider and staff understood their role with regards to ensuring people’s human and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by the registered manager. They knew how to make sure people, who did not have the mental capacity to make decisions for themselves, had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.

People were treated with kindness and compassion by the staff who valued them. The staff had built strong relationships with people. People's privacy was now respected. People or their representatives, were involved in decisions about the care and support people received.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were upheld and consent to care was sought. Care plans were person centred and included full details on how people’s needs were to be met, taking into account people’s preferences and wishes. Information held included people’s previous history and any cultural, religious and spiritual needs.

People’s care records were detailed and personalised to meet individual needs. Staff understood people’s needs and responded when needed. People were not all able to be fully involved with their support plans, therefore family members or advocates supported staff to complete and review people’s support plans. People’s preferences were sought and respected.

The service was responsive to people's individual needs and provided personalised care and support. People who required assistance with their communication needs had these individually assessed and met. People were able to make choices about their day to day lives. The provider had a complaints policy in place and the deputy manager confirmed any complaints received would be fully investigated and responded to.

People’s end of life wishes were documented. People were supported to maintain good health through regular access to health and social care professionals, such as speech and language therapy.

The service was mostly well led. There was a manager in place however they were not yet registered with the commission.

People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff and professionals said the management team were approachable. Staff said the management team were involved in the day to day running of the service.

The manager and provider had monitoring systems which enabled them to identify good practices and areas of improvement.

People lived in a service which had been designed and adapted to meet their needs. The service was monitored by the management team to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service.

The manager and provider had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

Coolhaze provides care and accommodation for up to three people. At the time of the inspection two people were living at the home. Coolhaze provides care for people with a learning disability and associated conditions such as autism.

We carried out an unannounced comprehensive inspection of this service on 14 & 15 March 2017. Since that inspection the provider had informed us about concerns relating to the conduct of staff and an incident of medicines missing at the service. In response to this we undertook a focused inspection to look into those concerns, and to see if people were safe. We also reviewed concerns from the last inspection relating to the management of the service. We found some improvements had been made. However, it was too early to know if these improvements would be sustained. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Coolhaze) on our website at www.cqc.org.uk.

The provider had an action plan in place to address issues raised at the last inspection. The quality lead for the organisation had responsibility for ensuring these improvements were actioned within the agreed timescales. Following recent concerns the provider had increased their visits to the service and reviewed quality auditing processes to help ensure people remained safe and appropriately supported.

We looked at medicines to make sure they were managed safely. Regular monthly medicines audits were undertaken by the manager and senior staff. The provider also completed audits of the service, which included medicines. However these audits had failed to identify medicines missing from the service. Actions had been taken by the provider and manager to prevent this from happening again, and to make sure that any discrepancies in stock levels would be identified and addressed in a timely manner. At the time of the inspection these improvements were underway, but not in all cases fully completed. When they have been fully implemented they should help to pick up any problems in a more timely way.

Medicines were stored safely and securely. Some were kept in locked cupboards in people’s flats, and a new medicines cupboard had been fitted in the office to store medicines waiting to be used the following month. All medicines in the home were given by staff who had received regular and updated training.

At the time of the inspection a new manager was in post and was responsible for overseeing the day to day running of the service. The manager was in the process of registering with the Care Quality Commission. 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.

.Staff undertook training in how to safeguard people from abuse and had a good understanding of the different types of abuse that could occur. However, not all staff understood how to escalate concerns outside of the organisation. This could mean that people would not be fully protected from the risks of abuse. This was raised with the acting manager at the time of the inspection and they told us they would speak to all staff to ensure they had the information they needed to safeguard and protect people.

Staff were employed in sufficient numbers to keep people safe. Any concerns relating to staff were dealt with appropriately by the provider to help ensure people using the service were kept safe. Staff had a good understanding of people’s needs and how to support their daily routines.

Staff understood and managed risk appropriately in relation to people’s care and the environment.

The acting manager had previous experience of supporting people with complex needs and demonstrated a commitment to developing and improving the service. Staff said they had been well supported by the new manager. They said although there had been further changes in management they felt confident the new manager had a good understanding of the service and needs of people being supported. The acting manager was being supported in their new role by senior staff within the organisation.

Staff meetings were held as well as daily handovers to help ensure staff had the information they needed to fulfil their role. Formal staff supervision sessions took place and the acting manager said these were going to be developed to include agency staff so that all staff had the opportunity to discuss their role, development and any concerns.

We found a breach of the regulations. You can see at the end of the full report on our website what action we have told the provider to take.

Coolhaze provides care and accommodation for up to three people. At the time of the inspection two people were living at the home. Coolhaze provides care for people with a learning disability and associated conditions such as autism.

The inspection was prompted in part by notification of an incident involving a person using the service. Other organisations are looking at this incident. During this inspection we looked at risks and if people were safe.

The service had 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. At the time of the inspection the registered manager also had responsibility for another home, which was located within close proximity of Coolhaze. A deputy manager was also in post at Coolhaze to assist with management tasks.

The inspection in 2015 raised concerns about inconsistencies in management. At this inspection we found the inconsistency in management had still not improved. At this inspection there was a registered manager who had been in post for seven months, however, they were soon to leave. Prior to the current manager and since our last inspection there had been two different acting managers overseeing the service.

Staff said these frequent changes in management had been confusing and unsettling. Comments included, “We just get to know one manager and how they work then they leave, it must affect the people living here and the quality of care”. Staff said admissions of new people needed to be overseen by a consistent and skilled management team, “People have been admitted by one manager and then they leave, a new manager has to pick up where one left off”. Staff said they did not feel this was a safe way of admitting people who could have very complex care needs.

Although the regional manager who had only been in post a month prior to the inspection said they had recognised that Coolhaze required consistent, skilled management this had not been recognised and appropriately addressed by the provider as part of their quality monitoring of the service.

The service was not always responsive to people’s individual and specific needs. Some parts of the environment did not meet people’s needs and did not promote their privacy and independence. One person used a wheelchair in the home, however, the environment had not been adapted sufficiently to promote the development of skills and independence. The layout of the person’s flat meant they could not always undertake personal care tasks independently or in private.

We saw risk assessments and risk management plans were in place. These assessments included detail of any potential or predictable risks and how these should be managed and minimised. Risk assessments related to the environment and people’s particular needs and lifestyle choices. We saw following a serious incident risk assessment and management plans had been reviewed and updated to help ensure people were safe. These reviews and changes had been agreed in liaison with other relevant agencies, including the specialist learning disability team.

People living at Coolhaze had complex care needs and required a high level of support with daily care needs inside and outside the home. Staffing levels had been agreed with the funding local authority and documented as part of a person’s plan of care. We saw staffing levels and how people were supported was discussed and reviewed regularly. Staffing levels had been increased when required to ensure they remained appropriate and safe.

The provider had clear and effective recruitment procedures in place and carried out checks of all staff working in the home to ensure they were appropriate to work with vulnerable people. People were protected by staff who knew how to recognise and report possible signs of abuse. Staff said reported signs of abuse or poor practice would be taken seriously by the registered manager and provider.

People had their medicines managed safely, and received their medicines in a way they chose and preferred. People were supported to maintain good health and when required had access to a range of healthcare services.

All staff, including those employed by an agency undertook a thorough induction when they first started work in the home. Training was on-going and relevant to the service and needs of people being supported. Staff said they felt the training was appropriate to their role and said they felt well supported by management and their colleagues.

Staff spoke positively and with compassion about the people they supported. We spoke with an agency member of staff who was working with one person on a temporary basis. They were able to tell us in detail about the person being supported and focused on the positive aspects of the person’s life such as their lively personality, interests and hobbies.

Management and staff understood their role with regards to the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards. Applications had been made and advice sought when necessary. When people were unable to consent to their care or support, or were unable to make decisions, discussions took place with relatives, other agencies and staff in the home to help ensure decisions were made in their best interest.

Where possible people were supported to make choices about their daily routines and lifestyle. We saw people making choices about what they wanted to wear, what they wanted to eat and how they wanted to spend their day. People had the opportunity to partake in activities they enjoyed and to maintain relationships that mattered to them.

The registered manager undertook regular checks of the environment as well as completing a range of quality audits, covering medicines management, staff training and health and safety.

We found 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.

Below is a summary of what we found. The summary describes what staff and other agencies told us, what we observed and the records we looked at.

Is the service safe?

We saw that support plans were individualised and included information about people's preferences and choices. We observed the care being provided and saw that staff had a good understanding of people's needs and communication methods. Staff were able to use their skills to support people promptly and to prevent behaviours escalating in a way that may be unsafe or distressing for people who used the service.

Risk assessments were detailed and ensured that people could develop their skills and independence whilst remaining safe and protected. Staff had a good understanding of issues relating to abuse and training regarding the safeguarding and protection of vulnerable adults was regularly updated.

Sufficient staffing levels were in place to meet people's assessed needs and staff said they felt well supported by their colleagues and management.

Records confirmed that when a person lacked capacity to make decisions, the service had acted appropriately to ensure their best interests and rights were taken into account and protected. A representative from the specialist Learning Disability service in Plymouth said ' The staff understand about how they may restrict people and how this could impact on people's rights and freedom'.

Is the service effective?

The staff we spoke to were knowledgeable about the people they cared for and were well supported in their roles. People's care plans were individualised and considered all aspects of their health and social care.

One staff member said 'I think the support plan is a true reflection of that person's needs and provides staff with the right information they need'. The service monitored people's health needs and liaised appropriately and promptly with healthcare professionals when required.

Is the service caring?

We observed that people were happy and relaxed within their environment. We saw that people looked to the staff to support them when they wanted help and staff responded promptly and in a way that the individual trusted and recognised. Staff we spoke to were passionate about their role within the home and expressed a clear wish to do their very best for the people they supported. Staff showed a genuine fondness for people they cared for, whilst recognising the need to enable people to develop and move on when required.

We spoke to a representative from the specialist learning disability services in Plymouth who said 'The staff know people very well and are always very caring and kind'.

All the staff we spoke to said that despite an unsettled period within the home due to changes in management they still felt well supported by their colleagues and the organisation.

Is the service responsive?

Support plans were based on people's individual health and social care needs. The service liaised regularly with external agencies and updated support plans to reflect any new guidelines or changes in need. Staffing levels were organised to meet the needs of individuals and these were reviewed regularly to ensure they remained appropriate and safe.

We saw that the service considered people's short term goals and long term needs and wishes. Arrangements were in place to support one person in relation to their future living arrangements and staff were aware of how this person may need to be supported during this period of change.

We saw that the service closely monitored people's health needs and responded promptly and appropriately to any changes or concerns.

Is the service well led?

At the time of the inspection the Registered Manager was absent from the service. The provider had made the Care Quality Commission (CQC) aware of this situation and the arrangements in place to manage the service during this time.

During the inspection we were able to meet the acting manager as well as the Regional Manager for the organisation who was also working in the service providing support to the management and staff team.

Staff told us that they understood their roles and responsibilities and felt confident to seek advice from colleagues and management.

The Regional Manager said that he had been spending regular time in the home supporting the acting manager and reviewing records relating to the service. He said that visits to the home had increased following the last inspection to ensure that the concerns and areas of non- compliance were fully addressed.

We saw that a range of audits had been carried out in the home to assess and monitor the quality of the service. This had included a recent audit of people's personal finances, medication and safeguarding. We saw that any recommendations made to improve systems within the service had been completed, such as updated safeguarding training and more robust procedures for checking and recording people's personal finances.

We saw that staff encouraged people to make daily decisions, such as what they wanted to eat, what they preferred to wear and activities they wanted to be involved in during the day. When people did not have the ability to make decisions the service involved others so that decisions were made in people's best interests.

Staff we spoke to had a good understanding of people's needs and we observed staff supporting people in a dignified and appropriate manner.

We saw that the needs of one person were not being fully met due to the behaviours and support arrangements of other people using the service.

Staff we spoke to had a good understanding of issues relating to abuse and understood what they needed to do if they thought anyone using the service had suffered abuse or was at risk of abuse occurring.

Improvements had been made to the environment since the last inspection, and we found the service to be clean and well maintained throughout.

Some of the records within the service were out of date. The way records were organised did not in all cases provide clear and up to date information about people's needs.

We saw that staff spoke to people respectfully, and ensured that their privacy and dignity was maintained. Staff had a good understanding of each person's communication methods and used this knowledge to encourage people to make choices about their care and lifestyle. Staff had access to the information they needed to meet people's needs.

Concerns were raised about the use of locks on doors within parts of the home. Records did not demonstrate that correct procedures had been followed to ensure that people's rights, freedom and liberty were protected.

The environment had been organised in a way that ensured that people's individual care needs could be met. However, some parts of the home were not well maintained and did not provide a homely, stimulating environment for the person to live in.

Sufficient staffing levels were in place to meet people's assessed needs and staff undertook training relevant to their role and the needs of people they supported.

Systems were in place to regularly review the quality of the service. We were told about and saw examples of further improvements being made to the way the provider checked and monitored the quality of the service provided.