Archived: The Coppice

The Coppice is a residential care home providing personal care to people with a learning disability or autism. The Coppice is registered to support up to seven people. At the time of the inspection there were six people living at the service. The Coppice is an adapted building set across two floors with gardens to the front and rear.

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

People were not always supported safely with their medication. Further improvements were required to ensure prescribed fluid thickening agents were used safely. Risks to people were not always assessed, reviewed and monitored in relation to the use of bed rails and fire safety.

People received support to eat a healthy and nutritious diet and had access to medical interventions when required. The layout of the home was spacious and accessible.

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.

Audits to monitor and improve the service had not always been completed and this had impacted on the service identifying areas for improvement. There was not always sufficient oversight from a manager at the service. Staff told us, following a recent change in the management team, a manager had been present at the home most days and that they were starting to see improvements.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence

The home was spacious and adapted to meeting people’s changing needs. People were supported to make their own decisions and included in the day to day running of the home. This included choosing menus, going shopping and accessing the community. People were able to access timely support from health and social care professionals.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

People were treated in a dignified manner and staff were aware of people’s support needs. Staff were observed talking to people in dignified and respectful way. Staff delivered personal care when people needed it and gained consent prior to providing any support.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

Staff told us there was a lack of leadership, but this had recently improved. Staff were caring and worked positively with people living at the home.

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 (23 November 2018).

Why we inspected

We received concerns in relation to infection control and staffing. We reviewed the information we held about the service. As a result, we undertook a focused inspection to review examine those risks in the key questions of safe, effective and well-led only. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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, effective and well-led sections of this full report. Following the inspection the manager provided confirmation that thickener was now in stock and that risk assessments are being updated.

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 Coppice 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 breaches in relation to the management of risks and medicines at this inspection.

Follow up

We will request an action plan from 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.

We found the following examples of good practice.

¿ All staff had received training in donning and doffing procedures associated with personal protective equipment (PPE). This was followed-up with observed practice by a member of the management team to ensure competency.

¿ Staff had completed a series of ‘role play’ exercises with people who used the service to run through the use of PPE and why this would be worn by staff. Evidence demonstrated this had been done in a light hearted and humorous way which people responded well to.

¿ The provider had introduced a new Covid-19 online App for staff to use on a daily basis. This tracked and recorded new and suspected cases, and provided a robust framework for staff to request PPE and share Covid-19 related information between services.

Further information is in the detailed findings below.

The Coppice is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at both during this inspection.

The service is registered with CQC to accommodate a maximum of seven people and at the time of this inspection the service was full.

We last inspected The Coppice in May 2017. At that time, we found breaches of legal requirements and the home was rated ‘Requires Improvement.’ We required the service to send us an action plan which sought to address the regulatory breaches and during this inspection we checked compliance against the action plan.

At this inspection, we found sufficient improvements had been made which meant the service was no longer in breach of regulations but areas of improvement were needed centred around 'well-led.'

We have also highlighted a recommendation for equality, diversity and human rights.

In our previous inspection report of May 2017, we noted the provider, FitzRoy Support, had started to make plans for The Coppice to close. At this inspection, we were told the provider was continuing to explore a variety of

different options for the service including alternative purchase, housing partnerships or rebuild on site. However, at this inspection we noted this issue continued to cause anxiety amongst relatives of people who used the service.’

There was a registered manager in post at the time of this inspection. A registered manager is a person who has registered with CQC 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 registered manager of The Coppice was also responsible for several other services across the Greater Manchester area. This meant they could only dedicate some of their time to maintaining oversight of the service delivered from The Coppice.

We reviewed systems for audit and quality assurance and were not assured the registered manager reviewed or analysed audits in a timely enough manner to identify themes or trends that would require remedial action.

Risks to people at the home were assessed and reviewed. We found risk assessments in place in the support files we reviewed around falls, moving and handling, infection control, oral health and other aspects of personal care.

We reviewed staffing levels and found there continued to be sufficient numbers of staff to meet people’s needs. The home also continued to benefit from a number of long serving members staff who knew people very well.

Systems and procedures which sought to protect people from abuse were robust; this included for safeguarding and whistleblowing.

Where accidents or untoward incidents occurred, these were appropriately recorded and investigated with preventative measures put in place to reduce the likelihood of a reoccurrence.

Staff continued to receive training and ongoing support that enabled them to fulfil their roles and to provide safe and effective care and support. Newly recruited staff continued to receive an induction and were expected to complete the Care Certificate.

Records we reviewed showed staff received regular supervision. Supervision meetings provide staff with an opportunity to speak in private about their training and support needs as well as being able to discuss any issues in relation to their work

People’s nutritional and hydration needs continued to be met. Food was freshly cooked each mealtime and people who used the service had input into menu planning and their personal preferences were factored into this.

People who used the service were supported to maintain good health and to access health care services. At the time of this inspection the service was updating and reviewing each person’s health action plan.

Without exception, people told us they considered staff at The Coppice to be caring. Staff also spoke with great pride about the people they supported and It was clear people were motivated to provide care and support that was kind and compassionate.

Through talking to staff and members of the management team, we were satisfied care and support was delivered in a were non-discriminatory way and the rights of people with a protected characteristic would be respected.

People's support plans were person-centred and contained key information which helped staff to get to know people well and to provide a responsive level of care. This included details about family relationships, significant life events, hobbies, personal preferences and likes and dislikes.

Staff spoke positively about their relationships with the local management team and were positive about the provider as an employer.

It is a legal requirement that providers display the rating they received at their last inspection, within the home and on their website if they have one. The rating of ‘Requires Improvement’ from our last inspection in May 2017 was not displayed conspicuously within the home. Checks completed before the inspection demonstrated the rating was displayed on the provider’s website. However, in respect of the failure to display a rating in the home, we are reviewing this matter outside the inspection framework.

The Coppice provides 24 hour care and accommodation supporting up to seven people whose primary needs relate to their physical or learning disability. The accommodation provided includes seven bedrooms that are located on both the ground and first floor. A chair lift provides access to the first floor for people who may have difficulty climbing stairs. At the time of our inspection there were six people living at the home.

The provider informed us that they planned to close the home in the near future, although there was no definite date set at the time of our inspection. This decision had been communicated to people living at the home, relatives and staff. The registered manager told us the provider was looking for a new property in the area, which would allow people using the service to continue living together if this is what they wanted to do.

We last inspected The Coppice in March 2016 when we rated the home requires improvement overall. At that time we found one breach of the regulations in relation to gaps in records relating to fire drills and fire alarm testing. We found improvements had been made in this area, but identified other breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to providing safe care, the cleanliness and maintenance of the premises, and having suitable systems in place to monitor the quality and safety of the service. You can see what actions we have told the provider to take at the end of the full version of the inspection report. We also made one recommendation, which was in relation to ensuring people are aware of the complaints policy and procedure.

We found shortfalls in the maintenance and cleanliness of the home. The conservatory attached to the home had leaked for an extended period of time, which had resulted in damp developing in this area. Around other areas of the home we saw stained carpets, torn wall-paper and mouldy sealant around a bath.

Staff were not always effectively recognising or managing risks to people’s health and wellbeing. For example, we saw medicines delivered from the pharmacy were not stored securely, and thickening agent, which presents a potential choking risk, was left unattended in the kitchen area for a short period. We also found some staff were not aware of the level of supervision one person required when eating to help reduce the risk of them choking. The registered manager took action to address this concern by asking staff to read and sign this person’s support guidance.

Staff were aware of their responsibilities in relation to safeguarding, and were aware how to raise any concerns internally, or externally if required. We saw the registered manager had followed-up any reported accidents or incidents appropriately, and these were also monitored by the provider.

Staff told us they received sufficient training to allow them to perform their jobs competently. Records showed staff had received training in a variety of topics including safeguarding, moving and handling, communication and positive behavioural support. New staff received a thorough induction, and we saw staff competence was checked by a manager. Staff received regular supervision, and they told us they felt supported in their roles.

Staff told us they would always ask for people’s consent before providing care or treatment. Information in people’s care files provided guidance to staff on how to support people to make their own decisions whenever possible.

People were encourage to be involved in planning a menu each week. We saw people were offered choices of meal, and alternative meals were provided to people based on their preferences and dietary requirements.

There was a long-standing staff team who knew the people living at the home well. Staff were able to tell us about peoples likes, dislikes and support needs. There was one vacancy on the staff team, and any unallocated shifts were covered either by agency staff or the regular staff team working additional hours.

People living at The Coppice either accessed day services or received additional support from staff to carry out other activities during the week. One person’s relatives felt staff did not follow their care plan in meeting their needs in relation to activities. We found there was limited interaction from staff when people returned home as staff were required to complete other domestic duties. However, the interaction we did observe was respectful and staff communicated effectively with the people they were providing support to.

Relatives we spoke with told us they found staff were kind and caring. Staff were aware of the importance of supporting people to retain their independence and build skills, and were able to provide examples of instances where they had done this.

Care plans were personalised and contained information on people’s preferences, support needs and strengths. However, we found care plans hard to follow due to the volume of information they contained, which was not always up to date or relevant. We saw the service was in the process of introducing new care plans.

People told us they would be confident to make a complaint if required. However, one relative was not sure whether their concerns had been handled as a formal complaint. We made a recommendation that the provider ensures all relevant persons are aware of the complaints procedure.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was also responsible for the management of a supported living service run by the same provider. She was supported in the management of The Coppice by a full-time deputy manager.

There were systems and checks in place to help ensure the safety and quality of the service was monitored and improved. However, these had not always been effective in identifying, or ensuring actions were taken in relation to required improvements. The provider completed a quality audit, which the registered manager told us was completed quarterly. However, the last quality audit that could be located had been completed over one year previously.

The provider had not always taken effective action to address areas where it was known there were shortfalls, such as in relation to the leaking conservatory and worn carpets.

Staff told us they were confident to approach the registered manager or deputy manager if they had any concerns or required any support. They told us they felt valued for the work they did.

The Coppice is a small service providing accommodation and support with personal care to a maximum of seven people with a learning disability. At the time of our inspection, six people were living at the service.

The service had a registered manager. 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 felt safe and were supported by the care staff and registered manager. However, not all safety checks had been completed, meaning people could have been at risk from harm.

Staff sought consent from people before providing care or support. The ability of people to make decisions was assessed in line with legal requirements to ensure their liberty was not restricted unlawfully. Decisions were taken in the best interests of people when necessary. However, we had not been informed where two people had a Deprivation of Liberty Safeguarding authorisation in place.

Risk assessments were not always up to date. Care plans were written with the person whenever possible and people were supported to be involved in identifying their support needs. Care plans included people’s likes and preferences and reflected any changes to the person’s needs.

Medicines were mostly administered as prescribed; when errors occurred, appropriate actions had been taken. All medicines were stored safely.

People were well cared for and there were enough staff to support them effectively. The staff were knowledgeable about the complex needs of the people and knew how to spot signs of abuse. There were robust recruitment checks in place prior to staff commencing work.

Staff had completed training appropriate to their role. Staff were observed as being kind and caring, and treated people with dignity and respect. They spoke to people with respect. There was an open, trusting relationship between the people and staff, which showed that staff and managers knew people well.

People were supported to be part of the local community and were able to attend activities both within the home, as well as in the local community. They made choices about how they spent their time and where they went each day.

We saw where people and their relatives had been asked for feedback about the service they received and any concerns were addressed promptly. Staff worked well as a team and said the manager provided support and guidance as they needed it. There was an open and transparent culture which was promoted amongst the staff team.

Staff felt the service was well-led and they were supported in their roles. Procedures were in place to learn from any incidents and there were clear actions recorded.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

Prior to our inspection we had been made aware of some concerns in relation to medication management, and in particular, medication errors. We looked at the systems in place to ensure people received their medication safely.

There were seven people living at The Coppice on the day of our inspection. Due to the complex health care needs of people living at the home we were only able to speak with one person who used the service. Comments from this person included; 'I have lived here for two years now and I like it. I like going to the day centre, reading and going shopping. The staff look after us well and we have a laugh and a joke. I get my tablets each day and staff come with me to any appointments'.

We looked at personnel files to ensure staff had been recruited safely and we found appropriate checks had been made, and relevant documentation obtained such as CRB's and references from previous employers.

We looked at the systems in place to both monitor the quality of service provision and deal with complaints effectively. We found there were several methods in place such as regular auditing, staff meetings and the use of a complaints log and policy and procedure.