Prestwood Coach House is a ‘care home’. 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. Prestwood Coach House is registered to provider care for up to 40 people.

At this unannounced inspection which took place on the 23 and 24 October 2018 they were providing nursing and accommodation to 24 people.

Prestwood Coach House had a registered manager in place who was present throughout this inspection. 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.

Following our last inspection in April 2018 we published our report in May 2018. At that inspection we rated the key questions ‘Safe’ and ‘Well-led’ as inadequate and the remaining key questions ‘Effective’, ‘Caring’ and ‘Responsive’ as requires improvement. We rated Prestwood Coach House as ‘Inadequate’ overall.

As part of the inspection, published in May 2018, we identified eight breaches in the Health and Social Care act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, staffing, safeguarding people from abuse, consent, person centred care, complaints, governance and failure to make appropriate notifications.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the services that they provided to people to at least ‘Good.’ We received this action plan in June 2018.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At this inspection we found significant improvements had been made in all the areas previously identified. However, the provider had a proven history of non-compliance with the regulations and the improvements made need to be sustained over time.

However, owing to the history of non-compliance with the regulations we needed to assure ourselves that the improvements were sustainable over time. We recognised that the management team had introduced changes to quality monitoring systems, but owing to the short time period from their introduction we could not be assured that the improvements were embedded fully into practice. We will consider this further during future planned inspections.

People were safe from the risks of abuse and ill-treatment as staff knew how to recognise and respond to concerns. Any concerns raised with the management team were acted on appropriately. The provider followed safe recruitment procedures when employing new staff members. People received their medicines, as prescribed, with the assistance of staff who were competent to safely support them. Risks associated with people’s care and support were assessed and action taken to minimise the risk of harm. The provider followed effective infection prevention and control methods to minimise the risk of contractible illnesses.

People had access to additional healthcare services when they required them. People received support with their diet and hydration and had meals they found varied and enjoyable. Peoples individual rights were maintained by staff members who understood the law which informed their practice. People were asked for their consent for care and treatment and, if they couldn’t make such decisions, the staff team a

This comprehensive inspection visit took place on the 17 April 2018 and was unannounced

Prestwood Coach House 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. Prestwood Coach House is registered to accommodate 40 people in one building. Some of the people living in the home are living with dementia. At the time of our inspection 26 people were using the service. Prestwood Coach House accommodates people in one building and support is provided on two floors. There is a communal lounge and dining area, a conservatory and a garden area that people can access.

There is a registered manager in place. 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.

When we completed our previous inspection on 21 November 2017 we found risks were not always reviewed or managed in a safe way. There was not always enough staff available for people and they had to wait for support. Staff understood when people were at risk of harm and how to report this; however when safeguarding incidents had occurred we could not see how lessons had been learnt. Infection control procedures were in pace however they were not always followed. It was also unclear when people lacked capacity to make decisions for themselves and when needed decisions had not always been made in people’s best interest. People were unlawfully being restricted and this had not been considered. Referrals to partner agencies were not always made in a timely manner. Concerns were raised around the training and induction of agency staff. People did not always receive care in their preferred way. Care plans were not always reviewed to reflect people’s needs and when people had cultural needs these had not always been fully considered. People were not always sure how to make a complaint. Staff did not feel listened to and when needed that action was taken. People and relatives did not always know who the registered manager was. Quality checks did not always drive improvement within the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well led to at least good. We did not receive the action plan from the provider in the time frames we set. We again requested the action plan from the provider and this was sent to us.

At this inspection we found risks to people were not managed in a safe way. We saw that people were not transferred in a safe way and care plans and risks assessments were not always reflective of people’s current needs. When care plans were in place people were not always supported in line with these. When people were identified as at risk of harm staff did not always have the necessary information to offer the correct support. As all safeguarding’s had not been considered or reported appropriately we could not be assured people were protected from potential abuse.

Correct procedures were not always followed to ensure people had taken their medicines, meaning people were placed at increased risk of receiving the wrong medicines. We could not be assured there were enough staff available for people as they had to wait for support. Infection control procedures were in place however these were not followed to reduce the risk of cross infection.

Staff received training however we could not be assured people’s competency was assessed as they did not always demonstrate an understanding in key areas such as MCA. People were not supported to have maximum choice and control of

The inspection took place on 21 November 2017 and was unannounced. Prestwood Coach House is a care home that provided accommodation and personal care. It is registered to accommodate 40 people in one building. Some of the people living in the home are living with dementia. At the time of our inspection 31 people were using the service. Prestwood Coach House accommodates people in one building and support is provided on two floors. There is a communal lounge and dining area, a conservatory and a garden area that people can access.

The service had 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.

When we completed our previous inspection on 22 October 2015, the service was rated as good overall. We rated the well led domain as requires improvement as we found there was a lack of confidence that concerns raised would be dealt with and people did not always know who the registered manager was. Quality checks were in place but did not always bring about change.

At this inspection we found staff did not always feel listened to and when they raised concerns they felt action was not always taken. People did not always know how to complain and people did not know who the registered manager was. There were quality monitoring systems in place however they did not drive improvements within the service. The provider did not always notify us of significant events that had occurred within the home.

Risks to people were not always managed in a safe way and assessments were not always reviewed to reflect people’s current needs. There were not always enough staff available for people and they had to wait for support. The provider did not assess people’s dependency levels within the home to ensure there were enough staff available. Referrals to health professionals were not always made in a timely manner. When professionals had made recommendation these were not always followed placing some people at risk. Infection control procedures were not always effectively implemented within the home, increasing the risk of cross infection for people.

Care plans and risk assessments were not always reviewed to reflect people’s current needs. People preferences or cultural needs had not always been fully considered. When people lacked capacity to consent this was often unclear and we could not see how decisions were made in peoples best interests. People were being unlawfully restricted as authorisation for DoLS had not been considered. There was lack of understanding from both staff and the registered manager with regards to this. Therefore people are not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice.

People were happy with the staff and people were treated in a kind and caring way. People were encouraged to be independent and make choices about their day. People enjoyed the food and were offered a choice. They also had the opportunity to participate in activities they enjoyed. People were supported to attend health appointments when needed. Medicines were managed in a safe way. Advanced decisions had been considered for people and end of life care had been anticipated by the provider.

Staff understood when people were at harm and to report safeguarding concerns. The provider had a system in place to ensure staffs suitability to work with the service. The provider sought feedback from people and relatives. When formal complaints and been made the provider had responded to these in line with their procedures and people were happy with the outcome. The provider ensured there was enough pro

We carried out this inspection to review the care of people who used the service.

We spoke with seven people who lived at the Coach House. All were complimentary of the staff and the care they received. People told us that staff were polite and respected their privacy and independence. They told us that staff were available to deliver personal care and offer support when needed. One person said: “I am encouraged to be as independent as possible, but the staff are always around to help”.

The staff we spoke with were knowledgeable about the care needs of the people living at the home. People at the home were supported with health care needs and received consultations from their general practitioner and other health professionals when required. People told us they received their medication in a timely manner.

There was a policy in place to ensure people living at the home and their family could formally raise any concerns or complaints. The policy ensured that all complaints were investigated and responded to.

Complete Link Ltd. had two registered locations on the same site. Both have the same registered manager who informed us that both locations were managed together with the same management team. We visited Prestwood House on 15 October 2012 and have used the information collected and reported during this visit in relation to the quality monitoring and staffing requirements of the service to reach our judgement.

During our inspection we observed that staff were polite and attentive, supporting people where appropriate. Plans of care for people were available. We spoke with nursing staff and care staff about the care provided at the home. Staff were knowledgeable about the care requirements for people.

We asked staff about their understanding of safeguarding (protecting vulnerable adults). Staff we asked told us how they would raise any concerns they may have. All said they were able to speak with senior staff or management.

The home had an induction programme to ensure all new staff employed at the home were supported within their role. Staff told us they had training provided and had one to one meetings with the manager.

There was a process for the on going quality monitoring of the service provided at Prestwood House and Prestwood Coach House. The current systems were being reviewed and updated to ensure the organisation continued to gather feedback on the quality of the service it provided.

During the course of the inspection comments were received from people using the service, and from people visiting at the time. People who were able to share their experiences of living at Prestwood Coach House were positive about the care they receive. People also told us that they enjoy their meals, and that their bedrooms are comfortable and warm.

People told us of the open atmosphere in the home, that they were treated with respect, and that visitors were made to feel welcome. They told us of a relaxed and open relationship with the care staff, especially regarding the friendliness of the staff, and the good standards of care, “My overall opinion is extremely positive, the staff are consistently really good”, ”We came with dad last week, and we have not been disappointed, an excellent home and great staff”.

They told us that they find the home clean and fresh, and were complimentary of the quality and presentation of their living areas, "Having been here for a few years I have been impressed with the continual attention to detail". People said they enjoy their meals, and that their bedrooms are comfortable and warm.

We inspected this service on 22 October 2015. This was an unannounced inspection. Our last inspection took place in November 2013 and we found no concerns in the areas we looked at.

The service was registered to provide accommodation for nursing and personal care for up to 40 people some whom may be living with dementia or physical disabilities. At the time of our inspection there were 29 people living in the home.

The service had 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.

There was a lack of confidence that any concerns raised would be dealt with by the provider. There were procedures in place to support people to whistleblow; however staff felt unsure if their concerns would be listened to and dealt with. People did not always know who the registered manager was and it was felt that leadership was lacking. Quality monitoring checks were completed by the provider but we did not see any evidence they brought about change.

People told us they felt safe and staff demonstrated they knew how to recognise and report potential abuse. Staff had received training and used this information to keep people safe. The provider had procedures in place to appropriately report concerns. We saw there were enough staff to meet people’s needs. There were adequate checks in place to ensure the staff that worked at the service were suitable.

Medicines were managed in a safe way. We found effective systems were in place to store, administer and record medicines to ensure people were protected from the risks associated with them. When people self-administered medicines they were supported to do so safely.

Staff sought people’s consent before they provided support and care. Staff understood how to support people if they were unable to make certain decisions about their care. In these circumstances the legal requirement of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed.

People could access sufficient amount of food and drinks and when people had specialist diets they were catered for. People’s health and wellbeing was monitored and they had access to healthcare professionals as required.

People were involved in the assessment and reviewing of their care and staff supported people to be as independent as possible. Staff received training which helped to support people. People were supported to maintain relationships with friends and family and we saw friends and family visited the service. People were treated with kindness and their privacy and dignity was promoted by staff. People were able to make choices about their day and participated in pastimes and hobbies they liked.