Coastal Lodge

The provider had two designated units at the location in response to the Winter Plan for people discharged from hospital with a positive Covid-19 status. One of these units (Anchor) was operational at the time of our inspection.

People and staff had been placed at an increased risk of infection from Covid-19 due to three occasions where staff had worked in the main home after working in the designated setting. The provider had not informed CQC and other key stakeholders of this either before, during or after it happened. At our previous inspection of Anchor unit in November 2020 the provider informed us there would be a separate team of staff to work solely in the designated setting in line with the requirements of the scheme.

Contingency planning had not been sufficiently robust to avoid the decision to move staff between the Anchor unit and the main home. There were no formal risk assessments in place at the time to mitigate the risks of this; risk assessments were only produced after we requested them from the provider. We found no other concerns around IPC processes or practice.

There was a detailed pre-admission procedure for staff and people to follow.

The designated setting was visibly clean and hygienic. There was a detailed cleaning schedule. This included individual rooms and communal areas. When people left the unit, their room was left empty for 72 hours and decontaminated before any new admission to that room. Laundry from this designated unit was processed separately to laundry from other areas of the home.

There was a plentiful supply of personal protective equipment (PPE) with stock regularly monitored. Staff were observed wearing this appropriately.

The provider had a visiting protocol for people, relatives and staff to follow. Visits were by appointment only and were carefully managed to ensure they met the latest government guidance. All visitors were required to complete a health questionnaire and have their temperature checked. When this was completed satisfactorily, they were supplied with the required PPE.

The provider understood the potential impact of isolation on people’s wellbeing. In addition to facilitating visits and providing one to one activities, the provider had purchased tablet computers and mobile phones to facilitate contact between people and their family and friends. People also had the opportunity for socially distanced access to a designated, secure outside space. These initiatives helped maintain people’s mental and physical wellbeing.

We were not fully assured that this service met good infection prevention and control guidelines as a designated care setting and the provider is no longer operating as a designated setting as a result.

One of these units had already been set aside as a designated area of the home for up to 10 people in response to the Winter Plan for people discharged from hospital with a positive Covid-19 status. The provider had now set aside a further unit (Fisherman) for the same purpose. This additional unit can support up to 10 people.

We found the following examples of good practice

There was a detailed pre-admission procedure for staff and people to follow. A designated team of appropriately trained staff had been identified to work solely in the isolation unit to prevent cross infection. Staff had received the necessary training in infection prevention and control (IPC). The provider had carried out risk assessments for staff who had the potential to be at more risk of infection.

The unit was visibly clean and uncluttered. There were detailed cleaning schedules in place to ensure staff understood what areas they needed to focus on and the frequency of cleaning required to reduce risks. The cleaning schedules included individual rooms and communal areas. There was a 72-hour decontamination procedure in place for the management of clinical waste. Prominent signage around the unit acted as a reminder of good PPE practice and hand hygiene techniques.

A robust visiting protocol was in place for relatives and visiting professionals. Visitors were by appointment only with visits staggered to ensure ample time for thorough cleaning between appointments. All visitors were required to complete a health questionnaire and have their temperature taken and recorded. There was a plentiful supply of PPE for residents, visitors and staff.

People had individual risk assessments that included the risks from social isolation. The provider understood the impact this could have on people’s wellbeing. People were supported to settle in with a welcome pack and facilities were in place to keep them socially stimulated while isolating. They had purchased a separate telephone and tablet computer for people to stay in touch with friends and family. People were also supported to access a secure outside space.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

The provider had set aside one of these units as a designated area of the home in response to the Winter Plan for people discharged from hospital with a positive Covid-19 status. This part of the home can support up to 10 people.

We found the following examples of good practice

There was a detailed pre-admission procedure for staff and people to follow. A designated team of appropriately trained staff had been identified to work solely in the isolation unit to prevent cross infection. The home had liaised with local hospitals to ensure they understood the unit would support no more than one admission per day. This helped ensure safety was maintained and people had the appropriate support to settle in.

The unit was visibly clean and hygienic. There was a designated domestic staff member and a detailed cleaning schedule. This included individual rooms and communal areas. When people left the unit, their room was left empty for 72 hours and decontaminated before any new admission to that room. Laundry from this designated unit was done separately to laundry from other areas of the home.

The provider had a clear visiting protocol for people, relatives and staff to follow. Visits were by appointment only and were carefully managed to ensure they met the latest government guidance. All visitors were required to complete a health questionnaire and have their temperature checked. When this was completed satisfactorily, they were supplied with the required Personal Protective Equipment (PPE).

The provider had recognised the potential impact of isolation on people’s wellbeing. In addition to facilitating visits and providing 1:1 activities, the provider had purchased tablet computers and mobile phones to facilitate contact between people and their family and friends. People also had the opportunity for socially distanced access to a designated, secure outside space. These initiatives helped maintain people’s mental and physical wellbeing.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

This comprehensive inspection took place on 18 and 19 June 2018. The first day was unannounced. This was our first inspection of the service since it registered with CQC after moving to the current premises. The service was previously known as Broadwaters and was located elsewhere in Bournemouth.

Coastal Lodge is a ‘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.

Coastal Lodge is purpose built. It specialises in providing short term rehabilitation and reablement to people, as a step down from hospital following an admission, or as a step up from the community with a view to forestalling a hospital admission. Health care professionals who worked for the local NHS community care trust were based on site, working closely with staff from day to day.

Coastal Lodge has four separate units, each with their own communal facilities such as dining areas. When we inspected, only two of these units were in use, accommodating up to 20 people out of a maximum 40. There were 19 or 20 people using the service during the inspection, as people were admitted and discharged over the two days.

The registered manager had left the service at the end of the week before the inspection and had yet to apply to cancel their registration. A deputy manager had been seconded to manage the service, and was receiving support from the operations manager responsible for the service. 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 treated people with kindness and compassion, respecting their privacy and dignity. They knew and respected the people they were supporting, and people felt valued by the staff.

People were protected from neglect and abuse. There were processes in place to ensure people did not experience discrimination in relation to their care and support.

The service and its staff had excellent links with health and social care professionals. They had found innovative and efficient ways to deliver joined-up care and support to people, and continued to look for ways in which this could be developed further.

People’s return home or move on to other services was planned from the start of their admission to Coastal Lodge. People were central to this process, care plans fully reflecting their individual circumstances and preferences. People were actively encouraged to express their views and be involved in decisions about their care and support.

People had personalised care that was responsive to their needs. Staff promoted people’s independence, which was central to their rehabilitation and reablement.

People got the support they needed to manage their health.

Medicines were managed safely and stored securely.

People were supported to eat and drink enough to obtain a balanced diet. People’s dietary needs were respected. Meals looked appetising and people spoke positively about the food.

Communication needs and sensory impairments were flagged in people’s care plans. People got the support they needed to communicate.

People were encouraged and supported to avoid social isolation, although staff respected their preferences to spend time alone.

People were supported to take part in activities that were enjoyable and meaningful to them, if they so wished.

Staff worked in line with the requirements of the Mental Capacity Act 2005. The manager understood the requirements of the Deprivation of Liberty Safeguards.

Risks were assessed and managed in the least restrictive way possible.

People were protected from the spread of infection.

There were sufficient staff on duty to keep people safe and provide the care they needed. Staff had the training and supervision they needed to perform their roles effectively.

Robust recruitment processes helped ensure that only suitable staff began working at the service. These included obtaining references and a Disclosure and Barring Service (DBS) check before candidates started working with people.

The premises were well maintained, clean and smelt fresh throughout.

The decoration and adaptation of the premises met people’s individual needs. Decoration was fresh and bright, contributing to a homely atmosphere.

The service had a positive, open, inclusive, person-centred culture. It encouraged open communication with people, their family and friends, staff and other stakeholders. Staff were supported to question practice and raise concerns if necessary.

The service provided clear information for people about how to make a complaint.

Lessons were learned and improvements made when things went wrong.

Managers were aware of what the service was like from day to day.

The provider had quality assurance processes were in place to monitor and improve the quality of the service. These included audits, and feedback forms when people left the service.

The service sought to develop links with stakeholders and the local community. A recent garden party had provided an opportunity for people, their friends and families, past users of the service and other professionals to meet each other and the senior staff team.