This comprehensive inspection took place on the 7 and 9 August 2018. The first day was unannounced. The Koppers provides accommodation and personal care. Any nursing needs are met through community nursing services. The service can accommodate up to 24 people in a detached three storey building in the village of Kilmington near Axminster. People had access to the first two floors with the use of a stair lift. There is a large lounge/dining room, quiet lounge and a conservatory for people to sit privately or with others. There is an accessible courtyard and gardens for people to use. There were 21 people living at the home at the time of the inspection. One of these was staying at the service for a period of respite (planned or emergency temporary care provided to people who require short term support).

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

We had previously carried out a comprehensive inspection in October 2016 and rated the service as Good in all domains. We returned in June 2017 and carried out an unannounced focused inspection because of concerns we had received about the safe running of the service. We looked at the key questions; ‘Is the service safe?’ is the service effective?’ and ‘Is the service well led?’ This was to ensure people were safe, staff were supported and had the skills to support people and systems were effective to ensure the safe running of the service.

At this focused inspection we found the provider in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 Registration Regulations 2009. This was because they did not have systems or processes established and operating effectively to assess, monitor and improve the quality and safety of the services provided. The provider has legal obligations to submit statutory notifications when certain events, such as a death or injury to a person occurred. These had not always been submitted. This meant CQC changed the rating for the service to Requires Improvement for the safe and well led question and overall from Good to Requires Improvement. Following the inspection we were sent an action plan which set out the actions the provider was going to take. At this inspection we found the provider had made the improvements and were no longer in breach of these regulations.

The service had a new registered manager who was registered with CQC in October 2017. 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. People, relatives and staff said the new registered manager had made a lot of improvements at the home.

The directors were very active at the service and visited at least twice a week. They met with people and staff and completed a director’s audit. The provider and registered manager had implemented a number of quality monitoring systems to review and monitor the service. These included regular audits where any areas of concern were addressed. The registered manager had reviewed all of the provider’s policies and procedures to ensure they were up to date and reflected current guidelines. They were instrumental in the implementation of the new computerised system which they used amongst other things to undertake audits, supervisions and reviews. They had worked with staff to improve the team work at the home and a lot of new staff had been recruited. The registered manager recognised there was still more to do. They said, “There are still areas where we need to

We carried out an unannounced comprehensive inspection of this service on 6 October 2016. The service was rated as Good. After that inspection, we received concerns in relation to the safety of people living at the service, staffing levels, the culture within the service, medicines errors in relation to the administration of anticoagulant medicines (a medicine used to keep their blood at the required consistency) and the safety of the premises. As a result, we undertook this focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Koppers on our website at www.cqc.org.uk.

The Koppers is a care home for older people who do not require nursing. There are 19 bedrooms, 14 of which are single and five rooms can be shared. There was capacity for 24 residents. At the time of the inspection, there were 21 people living at the service.

There was a registered manager in post although they made us aware at the inspection that they had handed their notice in to the provider the previous day and would be submitting their application to deregister with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

At this inspection, we found some of the concerns which had been raised with us were unfounded, in relation to medicines errors, staffing levels but other concerns remained. For example, whilst risks to individuals had been well assessed, this was not reflected in the care plans to guide staff on how to manage concerns. Environmental checks had been delegated to another member of staff because the maintenance person had been on sick leave for several weeks. There had been no additional time allowed for this and there were several gaps in the records. Some safety repairs had not been undertaken. For example, fire strips to reduce airflow in the case of a fire had been reported missing on three bedroom doors but they had not been replaced. We were made aware after the inspection that these have been replaced.

CQC had received concerns in relation to an alleged abuse taking place at the service which had not been reported to the local authority safeguarding team as required. CQC had also not been notified. The registered manager confirmed they were aware of their responsibility to notify CQC but owing to the high level needs of another person at the home they had forgotten to make the appropriate referrals. However, they had investigated the concern and had taken action.

Concerns had also been raised with CQC about the culture at the service and the openness of the registered manager. The registered manager made us aware at the start of our visit that she had resigned from her position and was in discussion with the directors regarding a potential new role within the service. The registered manager said they had recognised that, owing to personal circumstances, they found the role too demanding to fulfil as they felt they should like to do. Since the inspection site visit the local authority safeguarding team have been working with the provider and registered manager in relation to another safeguarding concern which has been raised with them.

Staff had not always received formal regular supervisions and support with their performance and future development. There was a clear system for induction, mandatory training and supervision at the service. However, some deadlines for initial training had not been met and formal supervisions had not taken place. The registered manager was aware of these shortfalls but said she worked alongside staff so they could speak with her at any time. Ne

This inspection took place on October 17 and 19, 2016 and was unannounced.

We last inspected the service in July 2014. At that inspection, we found the provider was meeting all of the regulations we inspected. There were no breaches of legal requirements at this previous inspection.

The Koppers is a residential care home for older people. It is registered to provide accommodation for up to 24 people who require help with personal care. There are 14 single rooms and five shared rooms. The service specialises in the care of older people but does not provide nursing care. At the time of the inspection there were 22 people living at the home.

There was a registered manager who was responsible for the service. She was registered on 19 May 2015. 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.

In December 2015 four new directors took over the service with a clear vision for how to improve the service. They have embarked on a programme of renovation of the building and a comprehensive review of existing systems, including quality assurance and training. The registered manager has the autonomy to plan, organise and manage training. A new staffing structure was put in place which created progression from care assistant to senior carer to deputy manager. There were now two deputy managers in addition to the registered manager. New shift patterns have been created in order to incorporate more flexible timings to start and end of shift. This enabled wider recruitment to take place. There was a positive culture of teamwork in the home, with directors and the registered manager being very "hands on".

People visiting the service commented on the significant improvements to training, staff morale, and fabric of the building. One person commented, "I would say this place is massively better since the new owners arrived."

Staff understood their responsibility for safeguarding and people living at the service said they felt safe. A programme of induction, training, supervision and appraisal was in place. Staff were able to describe what they had learned and how this had improved their practice. However, better staff awareness and understanding of the requirements of the Mental Capacity Act 2005 was needed.

The registered manager planned to seek additional specialist guidance and training in this area. By the time this report was written she had already implemented additional training for new staff.

People living at the service were cared for by cheerful staff who were sensitive to individual needs. An effective care planning system ensured that each person had the support they required. Staff were seen to work well together as a team, offering mutual support. The Koppers received universally positive comments from family members. "I visited other homes before placing (name) in Koppers. None came close in terms of compassionate care as far as I could tell."

Two visitors commented on how much their relative’s health had improved since moving to the service. Healthcare needs were closely monitored as part of their care.

Five bedrooms were shared and had the potential to compromise people's privacy and dignity and adverse comments were made about this by relatives. However, people had given their consent to sharing and screens were used to maintain privacy of individuals. Staff were aware of how to maintain people’s privacy and dignity when providing support for them in shared rooms.

Whilst there was a range of generic activities organised to suit people in groups, some people were seen to spend most of their time alone. There was a programme of individual activities to stimulate and engage those with more advanced dementia to help avoid social isolat

The inspection was carried out by an adult social care inspector. The focus of the inspection was to answer five key questions: is the service safe, effective, caring responsive and well led?

As part of the inspection we spoke with eight people who lived at the home, four relatives, six care staff, one domestic staff, the deputy manager and registered manager who was also the provider. We also reviewed records relating to the management of the home which included, five care plans, daily care and clinical records and six staff files.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found that people were cared for in a safe, clean and hygienic environment. A relative told us that they, "had never encountered an unpleasant odour in the home". There were sufficient staff on duty to meet the needs of people living at the home, with both the deputy manager and registered manager available every day.

We found that the care support and treatment was individually tailored to people's care needs and took account of people's choice and preferences. People were treated with dignity and respect by the staff which meant that people felt at ease and safe in their home. There were systems, policies and procedures in place which ensured risks to people were reduced and that the service was safe. We saw from records examined that risk assessments had been undertaken which ensured people’s safety and which were regularly reviewed. People were given choice and remained in control of decisions about their care and lives.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications have needed to be submitted and there were policies and procedures in place should this have been needed.

People at the home benefitted from the close communication and cooperation between staff, relatives and professionals who worked together collaboratively to protect individuals from suspicion or allegation of abuse.

Is the service effective?

From observation and from speaking with people and visitors, we were aware that people were happy in their environment. People were smiling and relaxed. People engaged with each other and staff in appreciative ways. People were well supported and staff knew the people they cared for well. Staff told us they worked as a team and we observed how staff communicated with each other to make sure no one was kept waiting and everyone received the appropriate care and support.

From speaking with staff it was clear they understood each person’s individual care and support needs. We observed gentle encouragement and positive interactions between staff and people. A relative told us they were, "very impressed" with the care provided and said, "everyone is so calm and happy. The staff keep an eye on everything and they don’t miss a thing".

Is the service caring?

People were supported by kind and attentive staff. We noted how staff encouraged people to do as much as possible for themselves and constantly reassured people in their care which meant that no one was left alone or isolated. Staff were intuitive and alert to people’s needs. No one was hurried or rushed and there was a feeling of calmness and wellbeing throughout the home. Staff took time to talk with people and we observed warm, sensitive and friendly interactions between people and staff.

Is the service responsive?

People’s health and care needs had been assessed prior to their arrival at the home. We looked at five care plans and saw that records were well organised, were up to date and accurate. Records confirmed people’s preferences, interests and diverse needs which ensured care and support provided met individual need.

We observed staff that were attentive and anticipated people’s changing needs and responded without delay. Visitors were welcomed at the home at any time. A relative we spoke with told us that any issue however small was always, "rectified straight away". Another visitor said, "I am so relieved that Mum is here, everything was so difficult before, but she settled very quickly through the staff’s response and understanding".

Is the service well-led?

There were formal and informal systems and mechanisms in place to monitor the quality of the service provided. People, their relatives, outside professionals and the staff were asked for their feedback on the service. Suggestions and ideas for improvement to the service were welcomed and acted on.

One of the relatives we spoke with told us they visited the home very regularly and "never with any notice". They said, "I’ve not got one bad thing to say about the place, there are no pretences here. Every single time there is a problem it gets sorted out immediately".

Clear management structures and lines of accountability were in place. Staff were clear about their roles and responsibilities and had a good understanding of the ethos and values of the home and to quality processes in place.

The home benefitted from the experience and active involvement of the provider who provided continuity and consistency to the service delivered. People experienced effective leadership of the service, together with a stable staff team. We found there was a strong commitment from the provider alongside other staff to the continuous improvement of the service.

At the time of this inspection there were 23 people with varying levels of dementia living there. Some had limited communication skills while others were able to tell us about their experience of life in the home. We spoke with the provider (who is also the registered manager), three members of staff, four people who lived in the home, four relatives, and also three people who regularly visited the home. We looked at the care records of four people who lived in the home.

People we spoke with and their relatives told us they were completely satisfied with the care provided by the staff. Comments included “They are always very kind,” and “The care is extremely good. I am very, very grateful to them.”

Each person’s nutritional needs had been assessed and monitored regularly. People told us they enjoyed the meals. Comments included “The food is wonderful.” Individual nutritional needs, likes and dislikes were catered for.

We saw that people had been consulted and involved in drawing up and agreeing their care plans. People told us the staff knew how to meet their needs. A relative told us “The staff are very competent and knowledgeable. They understand dementia.”

We saw evidence that safe recruitment procedures had been followed before new staff began working in the home.

Effective systems were followed to assess and monitor the quality of service that people received. People’s views were sought and acted upon.