The Coach House SBDP1 Limited

Updated 29 June 2019

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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

Three inspectors (one of whom specialised in medicines), one assistant inspector and two experts by experience carried out this inspection. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type:

The Coach House is a residential home that is registered to provide accommodation and personal care to a maximum of 66 people. At the time of our inspection, 64 people were living there. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

This inspection was unannounced.

What we did:

We reviewed information we had received about the service since the last inspection. This included details about incidents the provider must notify us about and we sought feedback from the local authority and professionals who work with the service. We assessed the information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection, we spoke with 12 people who used the service, four relatives, and four visiting healthcare professionals to ask about their experience of the care provided. We carried out observations of people receiving support and spoke with the registered manager, deputy manager, care co-ordinator, and six care and catering staff who worked at the service.

We looked at seven care records in relation to people who used the service. We reviewed medicine administration records for 12 people. We also observed medicines administration. We looked at four staff files as well as records relating to the management of the service, recruitment, policies and systems for monitoring quality.

Updated 29 June 2019

About the service:

The Coach House is a residential care home that is registered to provide accommodation and personal care to a maximum of 66 people. At the time of our inspection, 64 people were living there, some of whom were living with dementia.

People’s experience of using this service:

People told us and we observed that staff were kind and caring in their interactions with them. Staff knew people well and used effective techniques to reassure people when they became distressed.

Auditing processes needed to be more robust and detailed to enable the service to identify where improvement was needed.

Further improvements were needed to ensure risk assessments and care plans were accurate and sufficiently detailed.

Staffing levels were observed to be adequate and staff were available to people when they needed assistance. However, given some of the feedback we received, we have made a recommendation that the service monitors staffing levels to ensure they remain adequate.

People’s end of life wishes were not always documented fully so staff knew how to deliver care effectively, and we have made a recommendation about this.

Improvements were needed to ensure the service was adhering to the principles of the Mental Capacity Act 2005. Best interests decisions were not always in place where people lacked capacity to consent to their care.

Medicines were being managed safely at the home. However, we have made a recommendation that the provider takes steps to ensure sufficient and detailed information is available for staff to refer to about how people have their medicines given to them.

Recruitment procedures were not sufficiently robust to ensure staff were suitable for the role.

Staff understood the need to keep people safe from abuse and what was required to do this. Some staff however had not received safeguarding training whilst working in the service.

We observed staff to be skilled when supporting people with complex physical and emotional needs. However, training for many staff was either overdue or had not been completed. The registered manager was addressing this and had booked relevant training sessions throughout 2019.

Health care professionals were involved in people’s care and referrals were made promptly.

We have made a recommendation that the provider reviews best practice guidance to ensure that the building is designed and decorated in a way that supports people living with dementia.

Rating at last inspection:

At the last inspection the service was rated ‘Good’ (Report published 13 December 2016).

Why we inspected:

We inspected this service in line with our inspection schedule for services currently rated ‘Good’.

Enforcement: Action we told the provider to take is outlined at the back of the report.

Follow up: We will continue to monitor the service through the information we receive. We have also requested an action plan from the provider to monitor that improvements will be made promptly.

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