The inspection took place on 9 and 10 November 2016 and was unannounced.

The Coach House provides residential care for up to 66 people, some of whom may be living with dementia or have mental health needs. The home is divided into three separate units, The Coach House, Chapel View and The Willow. At the time of this inspection there were 64 people living within the home, 38 in The Willow, 22 in The Coach House and 4 in Chapel View.

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.

At our last inspection in January 2015, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to person centred care and medicines administration and management. At this inspection, carried out in November 2016, we found that the provider had made sufficient progress to no longer be in breach of the regulations.

The service had processes in place to ensure that only those suitable to work in the home were employed. New staff received an induction that prepared them for their role. The provider encouraged staff training and development and this was delivered in a variety of forms. The training the staff received was relevant to their role.

People benefited from receiving care and support from positive staff who told us they were happy working at The Coach House. Staff received support from their managers and colleagues and worked well as a team. Staff morale was good and staff told us that they felt valued by the management team and provider. We saw that staff clearly understood their roles, the responsibilities that came with that and demonstrated accountability.

Everyone we spoke with said there were enough staff to meet people’s individual needs. Staff told us that they had time to spend with people engaging on a one to one basis. During our visit we saw that people’s needs were met promptly and efficiently.

Care and support was delivered in a respectful and courteous manner and staff understood the importance of empowering the people they cared for. People had choice in how they spent their day and staff respected these decisions. People’s dignity was maintained and staff were discreet when assisting people. Staff adapted their language to suit the needs of each individual.

People’s independence was promoted at every stage of the care and support delivery. Staff understood the need to maintain people’s privacy and confidentiality and respected this.

The provider had processes in place to help protect people from the risk of abuse. Staff were knowledgeable in safeguarding procedures and could tell us how they managed this. Staff knew how and where to report any concerns they may have both inside their organisation and externally.

The individual risks to people had been identified, assessed, appropriately managed and regularly reviewed. These demonstrated people’s changing needs. Although not all risks associated with the building and working practices had been recorded, the risks had been mitigated by regular maintenance checks. Accidents and incidents had been recorded and analysed to identify any trends or contributing factors in order to help mitigate future risk.

Medicines management and administration followed good practice and people received their medicines as the prescriber intended. Staff had access to supporting information that assisted in the safe handling and administration of medicines.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. DoLS applications had been appropriately submitted for some people who used the service and these were indiv

This inspection was unannounced and took place on 7 January 2015. The inspection was carried out by two inspectors.

The service provides care and accommodation for up to 66 older people who require dementia care or who have mental illness. On the day of this inspection there were a total of 65 people using the service. The service is divided into three units, The Coach House, The Willows and Chapel View.

This service is required to have 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.

Some people who had pressure ulcers were not always receiving the care necessary to protect them from further skin damage or to promote the healing of existing wounds. You can see what action we have told the provider to take at the back of the full version of this report.

We found that some people were having their medicines crushed although the service had not consulted a pharmacist to confirm it was safe to do so. You can see what action we have told the provider to take at the back of the full version of this report.

People at the service were under surveillance by staff that accessed CCTV equipment.

The registered manager had a sound understanding about the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards and how they impacted on the way people were cared for. Everyone living at the home had been assessed to protect their rights.

Staff were kind, caring and compassionate. People were supported by staff with the necessary skills and experience. Staff received training that was relevant to their role but we observed that they did not always put this into practice.

People were supported to eat well and healthily, but choices and options available were not always communicated to people in a way that involved them in making a choice.

People, relatives and professionals were complimentary about the care provided. The care was person-centred and delivered by staff who understood people’s complex needs.

People and their relatives found the management team approachable and always ready to assist them.

Quality monitoring of the care provided was completed. Audits were in place but the medicines audit failed to identify the issues at this inspection.

When we carried out this inspection visit on the 22 January 2014 we observed people who lived at The Coach House being treated with respect and courtesy. We observed that staff worked with people in a quiet but encouraging manner.

The Coach House was very vibrant during the visit. There was a group sing-along taking place using musical instruments and there was lots of laughter and smiling faces. We saw staff participating in an effort to encourage communication and movement.

We saw that care and support offered to people was tailored to their individual needs. Risk assessments were ongoing and actions taken to minimise or remove the risks. Care plans, needs assessments and behaviour charts were reviewed monthly or earlier if required to ensure they reflected people’s current needs. We also noted that interventions by health or social care professionals were recorded and followed through. We saw evidence of support provided by GP's, district nurses, social workers and other therapies.

We saw a good selection of menu options and choices with vegetarian options available. The home was clean and tidy and good hygiene practices were promoted. There was cleaning going on throughout the visit to minimise the risk of infection.

During our inspection visit we spoke with seven people who used the service.

We saw people taking part in activities with staff. Everyone we spoke with told us or indicated to us that they were satisfied with the care and support they received.

We observed lunch being served and watched how people were treated. Overall, we saw that people were given plenty of time to sit and eat their meal comfortably, being offered appropriate cutlery or being assisted by staff to eat their meal within a homely environment.

We saw how staff supported people to leave the table and escorted them back to their room, lounge or where they wished to go. One person told us "I really enjoy my meals here, the cook makes really nice homemade dinners and we get plenty of vegetables with it". Another person said "The staff are very kind to me and help me have a bath. They take me into the garden so I can get some fresh air and it’s lovely to sit outside".

One visitor told us they were completely satisfied that their relative was 'very well looked after’ and said the staff worked to ‘high standards’ at the home'.

We saw that staff treated people with respect and dignity when attending to them by communicating at eye level and waiting for a response before doing anything else. Staff spoke to people frequently and did not leave people alone for long periods of time. We saw that staff engaged people by offering them something to do, for example, we saw one person taking part in housework.

Two people in each of the three units were spoken with We also spoke with two visitors and three members of staff.

The comments ranged from how staff looks after people to staff confirming they are well supported by the manager.

In Chapel View three people were seen in the lounge with staff members preparing lunch and one assisting a GP, having their consultation in private.

Two people said 'they were happy with the small number that lived there and knew the staff very well'.

In The Coach House several people were seen helping with household tasks, and staff were sitting with a small group of people discussing topics of interest.

In Willow unit the activities coordinator had another group of people reminiscing and singing. Several people were walking around the building and some were in the garden.

Two people said 'we can go out into the garden, although it’s chilly today, it’s nice to get some fresh air'.

I regularly go to the local post office so I can buy my paper and magazines'.

All the comments received were positive and people appeared happy and content living at the home. Several visitors were seen, either taking their relatives out, or just having a coffee with them. Parts of the environment were noisy at times, staff were observed to reassure those with diversion tactics to try to alleviate there anxieties.

Overall, the staff appeared sensitive to people with dementia and treated them with respect and dignity.