This inspection took place on 15 August 2018 and was unannounced. At our previous inspection in August 2016 we rated the service as Good.Coppice Lea 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. The service can accommodate up to 53 older people. Care is provided across two floors in a converted Victorian house near the village of Bletchingley. At the time of our inspection there were 44 people using the service the majority of whom were living with dementia.
There was 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.
A number of key staff had left the home since our last inspection. This had an impact on the registered manager, the staff team and their ability to consistently provide a good standard of care and support to people. We found areas that required improvement across all five of the key questions that we ask during an inspection (Is the service safe, effective, caring responsive and well led?). We have identified nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of the full report.
The provider had identified that the service was struggling to provide a good level of care in June 2018. They had begun to act to make improvements, such as supplying additional management support.
People were not always supported to stay safe at Coppice Lea. Risks to people’s health and safety had not always been identified or appropriately managed by staff. Staffing levels and their deployment around the building meant that there were times when there were not enough of them to give a safe level of care.
People received their medicines when they needed them, however we identified improvements were needed in how ‘as required’ medicines (such as pain relief medicines) are managed.
Staff recruitment processes ensured appropriate checks were carried out on prospective staff to ensure they were safe to work at the home. Staff understood their responsibilities around protecting people from abuse.
People’s rights under the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were not always met. Issues identified included assessments of people’s capacity; if the person could not make a decision for themselves who had legal authority to make decisions for them; and updating Deprivation of Liberty Safeguard (DoLS) authorisations when restrictions were no longer required.
Staff did not always have the knowledge and skills to ensure ensuring people received a good standard of care. Examples were seen where staff did not follow written guidance, or where they did not follow best practice, such as when using wheelchairs to move people. This also impacted the support people received with eating and drinking, and where health care professionals had given guidance and advice. For example, people at risk of pressure sores were seen to be in the same position throughout the inspection, when guidance stated they should be turned at regular intervals.
The provider had not ensured that the home environment had kept up to date with best practice around supporting people living with dementia. The provider had a dementia specialist, however they had not been effectively utilised to review the home and implement changes to meet people’s needs.
People were overall positive about the staff that supported them, however we identified a number of areas where improvements were needed. Staff did not always show respect to people, for example going into rooms without knocking. Many staff were ‘task focussed’ having little interaction with people while they supported them. Staff were also unaware of people’s preferences with regards to some of the protected characteristics of the Equalities Act. A person told us they did not feel comfortable identifying their preferences to staff, as they were uncertain how this would be received and if they would be supported.
Peoples care and support plans were found to contain out of date information, or information was missing. There were a number of agency staff used so there was a risk that people’s current needs and preferences would not be known.
Complaints were not always fully resolved to the satisfaction of the people who made them. Actions proposed by management to address the concerns were not always followed by staff.
People had access to a range of activities, which included clubs and trips out. However, those people that stayed in bed had less access to them, and told us they often felt bored and lonely.
People received care and support at the end of their lives that met their needs and preferences.
The providers quality assurance process had been slow to identify that the staff team were failing to provide care and support that met people’s needs. However, the provider had now begun to make improvements around the home.
Although we identified a number of areas where the staff and provider needed to make improvements, we did also see some good care and support being given. People were positive about the staff, and felt safe living at the home. They liked the food, even though they had to wait a long time for it sometimes.