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 resp

Coppice Lea is registered to provide accommodation and nursing care for up to 53 people, some of whom have dementia. Accommodation is arranged over three floors accessible by a passenger lift. There were 50 people living here at the time of our inspection.

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.

People told us they were happy living here. One person said, “‘I have no complaints whatsoever. If I have a worry then they listen to me.” Staff were happy in their work and proud of the job they do.

People were safe at Coppice Lea because there were sufficient numbers of staff who were appropriately trained to meet the needs of the people who live here. One person said, “I feel very safe because the staff are nice.” Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. In the event of an emergency people were protected because there were clear procedures in place to evacuate the building. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency.

Staff recruitment procedures were safe to ensure staff were suitable to support people in the home. The provider had carried out appropriate recruitment checks before staff commenced employment.

Staff received a comprehensive induction and ongoing training, tailored to the needs of the people they supported. Staff received regular support in the form of annual appraisals and formal supervision to ensure they gave a good standard of safe care and support.

Staff managed the medicines in a safe way and were trained in the safe administration of medicines. People received their medicines when they needed them.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had enough to eat and drink, and received support from staff where a need had been identified. People’s individual dietary requirements where met.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. People’s health was seen to improve due to the care and support staff gave.

The staff were kind and caring and treated people with dignity and respect. Good interactions were seen throughout the day of our inspection, such as staff talking with people and showing interest in what they were doing. The staff knew the people they cared for as individuals.

People received the care and support as detailed in their care plans. Care plans were based around the individual preferences of people as well as their medical needs. People and relatives were involved in reviews of care to ensure it was of a good standard and meeting the person’s needs.

People had access to a wide range of activities that met their needs. Activities were available seven days a week, and initiative programmes had been introduced to help improve people’s physical and mental health.

People knew how to make a complaint. When complaints had been received these had been dealt with quickly and to the satisfaction of the person who made the complaint. Staff knew how t

People experienced care, treatment and support that met their needs and protected their rights.

We saw people were treated with respect by staff who were caring and professional in their manner.

People told us they liked living in the home. They said staff were kind and understood their needs. "Nothing is too much trouble for them". "They always come when I ring the call bell and make me feel at ease."

A relative of a person who lived in the home told us they were always made to feel welcome and chose the home because of the caring atmosphere and the standard of cleanliness.

We looked at care plans which were well maintained. We saw that people had been included in the development of their care plans which were reviewed and updated accordingly.

We observed lunch being served during our visit. People told us they enjoyed the food provided and said there was always a choice. One person said " It is difficult to please everyone but the chef does a pretty good job".

Staff told us they liked working at Coppice Lea and felt well supported by the management structure in place. We observed the home was well managed, and the manager operated an open door policy. This was supported by staff, visitors and people who used the service who all confirmed that the manager was always available to listen, and support them.

We saw systems were in place to monitor quality assurance that ensured people's safety and welfare were protected.

This inspection took place on 22 and 24 April 2015 and was unannounced on both days.

Coppice Lea provides accommodation and nursing care for up to 53 people, some of whom have dementia. At the time of our visit 40 people lived here. Rooms are arranged over three floors and there is a passenger lift.

One person told us, “It’s a nice place to live, I love it here.” When asked what the best thing about Coppice Lea was, a relative said, “Everything. They have taken the worry away of my family member not being able to look after herself.”

At the time of our visit there was no 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 peripatetic manager was in place and a permanent manager had been recruited. They were expected to start in July 2015, at which point they would register with the Care Quality Commission.

There were enough staff to meet the needs of the people that live here, however we identified that the deployment of staff around this large building should be reviewed. The provider was recruiting more permanent staff to try to minimise the use of agency.

Before people received care and support their consent was obtained. Where people did not have the capacity to understand a decision the provider and staff had followed the requirements of the Mental Capacity Act (2005). However we did note that some capacity assessments needed to be reviewed.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards to ensure the person’s rights were protected.

People were safe at Coppice Lea. Staff had worked with people to identify risks of harm and plans had been put into place to minimise those risks. Staff had a good knowledge of their responsibilities for keeping people safe.

People had enough to eat and drink and they received their medicines when they needed them.

People were supported by staff that had been given appropriate training to meet their needs. Staff supported people to maintain good health, and people had access to healthcare professionals when they needed them.

The staff were kind and caring and treated people with dignity and respect. People had been involved in their care planning and had access to activities that interested them.

People knew how to make a complaint and feedback from people was used to improve the service.

The management team had identified shortfalls in the service earlier in the year and were taking positive action to improve the service. People and relatives told us that the service was getting better and was being well managed.