The Olde Coach House

The Olde Coach House is a residential care home that provides support and accommodation for up to 41 people, some of whom may be living with dementia. On the day of the inspection there were 38 people living at the home. The service is run across two buildings, one of which is across the street and has been recently renovated.

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

Governance systems were not always robust and did not identify gaps in recruitment records or inconsistencies in care plans. Audit systems relating to medicines were not effective in identifying issues we found with medicines. Personal Protective Equipment (PPE) was not always disposed of correctly which meant people were at a greater risk of infection. Oxygen cylinders were not stored correctly.

We have recommended the provider seeks advice regarding best practice guidance for medicines and updates their practice accordingly.

The provider had failed to notify the CQC about safeguarding concerns they had raised with the local authority. We recommend the provider seeks advice and reviews their policy and practice relating to notifiable events to the CQC.

People were safe and received person centred care. People we spoke with were happy at the service. People, and their relatives, spoke highly of the staff.

There were enough staff to meet people’s needs. Staff demonstrated knowledge relating to safeguarding when to raise concerns. Staff told us they felt confident raising concerns with the manager and felt supported in their role. Staff told us they felt valued.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 (16 November 2017).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about restricting visits. A decision was made for us to inspect and examine those risks.

We inspected and found we needed further reassurances regarding infection control, fire safety and visiting, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We have found evidence that the provider needs to make improvements. Please see the well led sections of this full report. 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 The Olde Coach House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to good governance and oversight at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had invested in staff and technology, to ensure safe visiting processes which followed government guidance were in place. Visitor protocols were in place to ensure anyone entering the service received a lateral flow coronavirus test prior to entry, was temperature tested and provided with personal protective equipment (PPE) to remain safe during their visit.

People were supported to maintain important relationships with their families and friends. This included phone and video calls and window visits. The provider had discussed visits with people and their families to ensure appropriate contact was maintained.

Social distancing was maintained, and people were admitted to the service safely. Isolation processes were implemented for people new to the service and if people displayed symptoms of COVID-19 or received a positive test result. Staff and people using the service were regularly tested for COVID-19.

Staff were trained in the use of personal protective equipment (PPE) and used PPE appropriately. The provider regularly completed ‘spot checks’ to ensure staff had the relevant skills and knowledge for hand washing and PPE use.

The service was clean and tidy. Extra cleaning was regularly completed and focused on frequently touched areas to help reduce the risk of infection.

At the last inspection, the service was rated Good and at this inspection we found the service remained Good.

People told us they were happy living at the home and that they felt safe. Risks were appropriately managed.

Medicine had been managed safely for the majority of people. However, we found some minor anomalies in the records that were addressed on the day, after our discussion with the registered manager.

Fire safety and evacuation procedures were in place and systems to record accidents and incidents. We noted that on one occasion we felt staff should have sought medical attention in a more timely manner. We discussed this with the registered manager and they advised that they would discuss with the appropriate staff member. This appeared to be an isolated incident.

Staff were aware of people’s individual support needs and this enabled

them to provide person-centred care. Many activities were provided in the home to give people the opportunity for meaningful occupation.

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.

Staff received induction training when they were new in post and on-going training that was considered to be essential by the home.

People told us they enjoyed the meals provided by the home and we saw that people’s nutritional needs were met.

Quality assurance systems were robust and identified shortfalls in the service that were acted upon. People told us both the home and the home care service were well managed.

People had various opportunities to give feedback about the service they received. They felt their concerns and complaints were listened to.

Further information is in the detailed findings below.

We found that people's records included some evidence that they had given their consent, for example with the handling of their medication. The manager told us how they were developing record keeping in this area.

People were supported though a computerised system of care planning which recorded assessments of needs and daily records. Staff were knowledgeable on how to support people and had received training, for example in dementia care needs.

We saw that mealtimes were unrushed and relaxed with people receiving support to have their nutritional needs met.

Systems were in place to support people with their medication needs, these had recently been reviewed and updated.

There was a quality assurance system in the home which included audits of different areas of care by the manager to help ensure that people's needs were met.

We saw that people's records included their likes and dislikes with staff being able to give us good examples of the choices people had each day.

People were supported in having their needs met through a computerised care planning system which covered a variety of areas. People had access to other health professionals to ensure that their needs were met. A visiting professional told us that they felt the home met people's needs.

Staff were aware of and had received training in the safeguarding of vulnerable people and there were systems in place to support people with their finances.

Staff were effectively recruited and received some training. However a number of training courses required completing to ensure that the continued to have their needs met.

There was a complaints system within the home and although not on display people who lived in the home and their relatives were aware of how to complain and felt able to raise any issues.