About the service: The Coach House is a care home without nursing for up to five people with a learning disability, an autistic spectrum condition or a mental health condition. People who use the service may have additional needs and present behaviours which can be perceived as challenging.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

People’s experience of using this service:

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The principles and values of Registering the Right Support and other best practice guidance were seen to be met in the following ways:

People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Staff understood how to communicate with people effectively to ascertain and respect their wishes.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were protected from abuse and discrimination.

The service did met the characteristics of ‘Good’ in all areas.

Rating at last inspection: at the last inspection the service was rated Good (report published in July 2016)

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about this service until we return for a further inspection as required by our re-inspection programme. If we receive any information of concern we may inspect sooner.

This inspection was unannounced and carried out on the 27 and 28 July2016. The Coach House is a residential care home providing individualised support for people with a learning disability. At the time of the inspection four people were using the service.

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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment.

People were receiving effective care and support. Staff received training which was relevant to their role. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and where required the Deprivation of Liberty Safeguards (DoLS).

Staff told us there was an open culture and the environment was an enjoyable place to work. Staff were extremely passionate about their job roles and felt integral to the process of providing effective care to people. Family members said the management team were approachable.

The service was caring. We observed staff supporting people in a caring and patient way. Staff knew the people they supported well and were able to describe what they like to do and how they like to be supported. People were supported sensitively with an emphasis on promoting their rights to privacy, dignity, choice and independence. People were supported to undertake meaningful activities, which reflected their interests.

The service was responsive to people’s needs. Care plans were person centred to provide consistent, high quality care and support. Daily records were detailed and recorded every hour throughout the day.

The service was well led. Quality assurance checks and audits were occurring regularly and identified actions to improve the service. Staff, relatives and other professionals spoke positively about the registered manager.

We spoke with one person and observed the support provided to two people within the home. We also spoke with two relatives and two professionals. One person told us they were happy and “liked the food and staff”. One relative had no concerns and felt the person “was getting more time from staff and was getting out more now”. Another relative queried whether staff could do more to engage their relative.

One professional that we spoke with felt that staff were “managing well with someone with complex needs”. Another professional had some concerns about the ability of staff to effectively support people with complex needs.

We found that care plans had been reviewed and contained appropriate information about each person. Inconsistencies had been resolved following the last inspection. The goals set in support plans were, however, vague and progress was not being tracked over time.

At our last inspection, we had concerns about the cleaning and maintenance of the premises. A contractor had now been commissioned to undertake the remedial work needed. Cleaning had improved and was being monitored.

Staff training had improved since our last inspection. There were fewer gaps in the training summary record. Training around epilepsy was still needed and training needs were being monitored through supervision meetings and appraisals. All staff had now received safeguarding training and were familiar with protocols.

This inspection took place on 8 and 9 December 2014 2014 and was unannounced.

The Coach House is a care home providing accommodation and personal care for five adults with a learning disability or an autistic spectrum condition. There were five people living at the home when we visited. Some people were new to the service whilst others had been there for a number of years. The people living at the home had a range of support needs. Some people could not communicate verbally and needed help with personal care and moving about. Other people were physically able but needed support when they became confused or anxious. Staff support was provided at the home at all times and most people required the support of one or more staff away from the home.

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.

The service had experienced an increase in the frequency and intensity of incidents amongst people living in the home over a 12 month period. This resulted in people being harmed and being at risk of harm. Staff had worked hard to minimise the impact of these incidents on people but people had continued to be affected. As a result, we found some breaches of our regulations; people were not being adequately safeguarded from harm and action was not taken quickly enough to minimise the risk of harm to people.

We found other breaches of our regulations. People’s rights under the Mental Capacity Act 2005 were not being consistently met. We found some problems relating to infection control, maintenance of the premises and the management of medicines that put people at risk. We had not received some relevant notifications from the service. Services tell us about important events relating to the service they provide using a notification. You can see what action we told the provider to take at the back of the full version of this report.

People using the service, local authority commissioners and a learning disability nurse told us they were generally happy with the care provided. The registered manager led by example to provide a service which was tailored to each person’s individual needs and preferences.

Staff spoke passionately about supporting people to the best of their ability. People were being supported by staff who knew them well and respected their individuality. People were being encouraged to work towards their personal goals and to find activities of specific interest to them.

Staff felt well supported and had the training they needed to provide personalised support to each person. They were now meeting with their line manager to discuss problems and we could see action was taken when concerns were raised. When things did not go well, staff generally reviewed the situation and learned for the future.