The Coach House is a ‘care home’ for 21 people, providing accommodation and services to older people. It is situated in a residential area of Garforth and is close to local amenities and public transport. People in care homes receive accommodation and nursing or personal care as a 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 had a registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

The service was last inspected on 6 October 2017. This was a focused inspection to check whether the provider had made improvements following an inspection on 23 February 2017. We found at the last inspection that the provider had made improvements but rated the service requires improvement until they could evidence a longer term track record of consistent good practice.

During this inspection we found that the service still remained requires improvement. We found a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) 2014 because the service was not doing all it could to keep people safe and was not effectively managing the application of prescribed creams. This is the third time that the service has been rated requires improvement.

Gaps in the recording of application of prescribed creams meant that the provider could not be sure that the creams had been applied as prescribed. Not all risks has had been identified or risk assessed against. However, risk assessments were in place for the majority of people.

Staff understood how to safeguard people from abuse; they had training in this area and were able to put this into practice. There was sufficient staff to ensure people were kept safe and the provider ensured that recruitment checks were in place. We felt that some recruitment checks could be more robust. We made a recommendation about safe recruitment practices.

People felt that the staff were caring and we observed people were treated with dignity and respect.

People’s care plans demonstrated a commitment to person centred care. People were supported to make their own decisions; this was encouraged and reflected in their care plans. Care plans demonstrated that the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) had been applied; however, this was sometimes inconsistent. We have made a recommendation about mental capacity and best interest decisions.

People’s nutrition and hydration needs were catered for. A choice of meals was available and drinks were made readily available throughout the day. Meal times were observed to be a pleasant experience.

Training was provided to meet the needs of people; this enabled staff to develop their knowledge to provide person centred care. Staff received regular supervision and appraisal and told us they felt supported in their roles.

People’s wider support needs were met through the provision of daily activities provided by an activity coordinator.

The service completed investigations into incidents and accidents. Investigations were thorough and comprehensive and lessons learned were reflected upon and recorded. This meant that the likelihood of future similar incidents was reduced.

The service was clean and infection control measures were in place.

There was a complaints procedure in place which allowed people to voice their concerns if they were unhappy with the service they received. All complaints were acknowledged and responded to within their set timescales.

There was a range of quality audits. Some concerns we identified during our inspection had not been picked up in the management audit

We carried out an unannounced comprehensive inspection of this service on 23 February 2017. At that inspection we found the provider had breached two regulations associated with the Health and Social Care Act 2008. Medicines practice was not safe and staff did not receive appropriate supervision and appraisal to ensure their competence was maintained.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 6 October 2017 to check they had followed their plan and to confirm they now met legal requirements. We found improvements had been made with regard to these breaches and the provider was now compliant with the regulations.

This report only covers our findings in relation to these topics and the management of the service. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for The Coach House Care Home on our website at www.cqc.org.uk

The Coach House Care Home is a service for 21 people, providing accommodation and services to older people; it is situated in a residential area of Garforth and is close to local amenities and public transport.

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 and associated Regulations about how the service is run.

People received their medicines as prescribed. Medicines were managed safely and in line with current regulations and guidance. Staff had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered and audited appropriately.

Staff had received appropriate supervision and appraisal which allowed them to fulfil their roles effectively and develop positive relationships with people who used the service. Staff understood their roles and responsibilities.

Quality assurance systems were in place to assess and monitor the service people received. There was a commitment to continuous improvements of the service. People we spoke with felt the registered manager was supportive and approachable and expressed confidence in them to address any concerns raised.

This was an unannounced inspection carried out on 23 February 2017. Our last inspection took place on 11 and 13 January 2016 when we gave an overall rating of the service as ‘Requires Improvement’. We found two breaches of the legal requirements in relation to the safe management of medicines and good governance. At this inspection we found ongoing concerns with the safe management of medicines.

The Coach House is a care home for 21 residents, providing accommodation and services to older people; it is situated in a residential area of Garforth and is close to local amenities and public transport. There were 17 people using the service when we visited.

Medicines were not managed safely as fridge temperatures showed medicines were not stored at the required temperatures. Gaps were seen in medication administration records and one person was given another person’s pain relief which was not their prescribed dosage. Medication audits had not identified the concerns found during our inspection. The issues we identified at our last inspection had not resulted in satisfactory improvements in the safe management of medicines. The registered manager completed audits covering infection control, beds and rooms which were more effective.

Notifications were not submitted to the Care Quality Commission (CQC) as required under the terms of the registered provider’s registration. We dealt with this outside the inspection process.

Supervisions and appraisals were not carried out in accordance with the registered provider’s policy. Staff had received an induction and were mostly up-to-date with their training programme. MCA and DoLS were managed satisfactorily. Staff knew to offer people choice and how to respond appropriately if a person refused care.

Recruitment was safely managed as relevant background checks had been carried out to ensure staff were suitable for working with vulnerable people. People felt safe and staff knew how to recognise and respond to signs of abuse. There were sufficient numbers of staff deployed in the service and feedback from people and staff confirmed this.

Staff and resident meetings took place and people were regularly asked for feedback regarding the service they received. People and relatives knew how to complain. Complaints were appropriately dealt with and responded to by the registered provider.

Risks to individuals were appropriately assessed, monitored and reviewed. Building maintenance and fire safety was appropriately managed as the necessary checks had been completed.

People were able to access a range of healthcare services. A visiting health professional spoke positively about the care provided by staff at The Coach House Care Home. People were happy with the food they received. Drinks were regularly provided throughout the day of our inspection. We observed a positive mealtime experience where people were well supported.

Feedback from people and relatives we spoke with confirmed staff provided good care. People’s privacy and dignity along with equality, diversity and human rights were respected by staff. Staff knew people’s care preferences and there were good natured interactions between people and staff.

Care plans contained sufficient information for staff to provide effective care. We saw these were updated on a regular basis and people and relatives were part of their reviews.

An activities coordinator was due to start of the end of February 2017. People received stimulation through a programme of activities with external entertainers and trips out also taking place.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still the registered manager on our register at the time of the inspection. A new home manager has been appointed and is going through the registration procedure. Information contained in this report was provided by the new manager.

The inspection helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

Is the service safe?

The provider acted in accordance with legal requirements where people did not have the capacity to consent. Staff had an awareness of the Mental Capacity Act and deprivation of liberty safeguards. Staff understood their obligations with respect to people's rights and choices when they appeared to lack mental capacity to make informed and appropriate decisions. The manager told us staff had received training around the Mental Capacity Act in 2012. The manager told us the home is in the process of reviewing their policies and procedures for consent and capacity.

Each person's care file had risk assessments which covered areas of potential risk such as pressure ulcers, falls and nutrition. When people were identified as being at risk, their plans showed the actions required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

Staff demonstrated good knowledge and awareness of their responsibilities for infection prevention and control and there was evidence staff had received relevant training. Two members of staff we spoke with during the inspection confirmed they had completed infection control training. We saw future infection control training had been arranged for 2014.

Staffing levels were assessed depending on people's need and occupancy levels. The staffing levels were then adjusted accordingly. They said where there was a shortfall, for example when staff were off sick or on leave, existing staff worked additional hours to make sure there was continuity in service

We spoke with three visitors and they told us they were pleased with the standard of care and facilities provided by the service. One person told us they were happy their relative was well cared for and were always made to feel welcome when they visited.

Is the service effective?

The home had a good working relationship with other healthcare professionals and always followed their guidance and advice. The input of other healthcare professionals involved in people's care and treatment was clearly recorded in their care plan.

People’s files contained pre-admission assessments, which showed that people's health, personal and social care needs were assessed before they moved into the home.

When people were identified as being at risk, their plans showed the actions required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

Is the service caring?

Visitors we spoke with told us they were very happy with the care provided and in their opinion people were well looked after. They described staff as friendly, patient and caring.

People who used the service told us they were happy with the staff at The Coach House and with the care they provided. One person said, “The staff are very good, lovely people." Another person told us, “The staff look after me well at all times.”

We found the care staff we spoke with demonstrated a good knowledge of people’s needs and were able to explain how individuals preferred their care and support to be delivered. We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

The provider’s quality assurance feedback from people who used the service, relatives and visitors, showed there was a high level of satisfaction. All felt the quality of care was excellent and the quality of staff was good. The registered provider had analysed the results and identified what they could improve and develop.

Is the service responsive?

People and their families were involved in discussions about their care and the risk factors associated with this. Individual choices and decisions were documented in the care plans and reviewed on a regular basis.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff we spoke with said there were effective systems to monitor quality and safety. They said managers were in regular contact and checked everything was in place. One member of staff said, “Everyone knows what they need to do. There is clear direction. " Another member of staff said, "Everyone works so well together. We are a good team and the place has a nice feeling.”

We spoke with three staff members, the registered provider and the registered manager.

We looked at care plans and saw that they contained information about peoples’ preferences and social histories.

We saw how staff maintained people's privacy and dignity, and maintained confidentiality when speaking to people and other staff.

During the inspection our expert by experience spoke with the relatives of two people and comments included;

“I am very happy with the care she [mother] receives here. I work in Leeds and I can pop in whenever I want to see her. I am always made welcome.”

“Mum can be quite difficult and she gets angry because of her dementia. The staff are always calm and kind and help her through things.”

“I would recommend it here – 100 percent.”

We contacted a further two relatives by telephone following our inspection. When asked for any other comments about the service these included:

“If ever there’s a problem or issue they involve me, even with the small things.”

“Everything is excellent.”

We found the communal living areas within the Coach House to be clean however, some of the communal bathrooms and toilets were in need of updating.

Personal Protective Equipment (PPE) was not readily available in all areas.

The Coach House accommodated 21 residents, 2 rooms en-suite, 19 bedrooms had wash basins. 3 toilets upstairs and 5 downstairs, 2 baths and 1 wet room. We spoke with 5 people who used the service and 4 relatives, to gain their views about their experience of the service provided. All the people we spoke with were positive about the service, comments included:

“Staff are friendly, caring and kind”

“Nothing’s too much trouble”

“Honestly never seen anything that would give me any cause for concern”

“I haven’t got even one grumble about living here”

Everyone we spoke with told us their dignity and privacy was respected. We observed staff being respectful, caring and providing good standards of care. Care plans reviewed had a full assessment carried out prior to or on admission. People who used the service said they were happy living at the home and would not hesitate to raise concerns. Staff we spoke with said they had received safeguarding training and were clear of the action to take if they suspected abuse or if an allegation was made. Staff files reviewed showed effective recruitment, selection processes and evidence of staff attending training. Staff rotas showed good staffing levels, well organised to support people throughout the day and night. We looked at the provider's complaint policy and procedure and saw people's complaints were fully investigated and resolved, where possible to their satisfaction.

People we spoke with said they enjoyed living at the home and were very satisfied with their care. Comments included:

“Very happy here, the girls are lovely.”

“We are attended to promptly, day or night.”

“Very satisfied with my care, they can’t do enough for you.”

“They do things just as I like them.”

A number of people who use the service and their visitors also said they were ‘always being asked if everything was alright for them.’

Visitors told us good systems are in place to make sure people get the right care to meet their needs. They were very complimentary of the staff and said people received a good service.

A healthcare professional told us that people received ‘excellent’ care and the home were very prompt in attending to people’s health needs. They said, “I have every confidence in them.”

People said they liked the staff. They were comfortable with staff and had a good rapport with them. They appeared to get on well. People said they had enough staff to support them. Most people said that staff responded promptly when they pressed their buzzers. They did however say that they sometimes had to wait for short periods of time if staff were busy with others, especially at night.

People said they had enough to do and enjoyed the activity at the home. They said they enjoyed the bingo, games and musical entertainers who come in to the home.

This inspection took place on 11 and 13 January 2016. The first day was unannounced and the second day was arranged because we wanted to make sure the registered manager was available. At the last inspection in April 2014 we found the provider was meeting the regulations we looked at.

The Coach House Care Home provides accommodation and personal care for up to 21 older people. 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.

During the inspection there was a very pleasant and friendly atmosphere. People were happy living at the home and felt well cared for. People told us staff were caring. They enjoyed a range of social activities and had good experiences at mealtimes. They were supported to make decisions and received consistent, person centred care and support. Staff knew people well and understood their needs and preferences. People received good support that ensured their health care needs were met.

People told us they felt safe. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. People were comfortable in their surroundings, which were in the main well maintained. Some issues with the environment had been identified and remedial work was planned but action was not always taken promptly. Medicines were not always managed consistently and safely. Some people were not given their medicines as directed by the prescriber, for example, before food, and medicines were not stored appropriately.

Staff were skilled and experienced to meet people’s needs because they received appropriate training and support. There were enough staff to keep people safe and meet their needs. Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service.

The registered manager promoted high standards of care and was well respected. They worked alongside everyone so understood what happened in the service. People had no concerns about their care but were informed how to make a complaint if they were unhappy with the service they received.

People were encouraged to share their views and ideas to improve the service. The processes and systems for monitoring the service were not always effective. Some areas of improvement had been identified to help mitigate risk but these were not always actioned.

We found the home was in breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.