Inspection on 16/12/09 for Coach House

This inspection was carried out on 16th December 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Coach House 03/06/10

Coach House 28/01/09

Coach House 18/12/07

Coach House 09/01/07

Coach House 28/02/06

Coach House 03/01/06

Coach House 24/02/05

Coach House 20/08/04

Coach House 09/02/04

Similar services:

Claremont House

Sun Court Nursing Home

Bramley Avenue (73)

15 Bramble Close

Dolphin Court

Fen Road

Wakes Hall

165 Putnoe Lane

Extracts from inspection reports are licensed from CQC, this page was updated on 10/04/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Coach House 10 Woodwards Heights Off Ward Avenue Grays Essex RM17 5RR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michelle Love     Date: 1 5 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Coach House 10 Woodwards Heights Off Ward Avenue Grays Essex RM17 5RR 01375396041 01375393197 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.familymosaic.co.uk Family Mosaic Name of registered manager (if applicable) Type of registration: Number of places registered: care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 13 The registered person may provide the following category/ies of service only: Care home with Nursing Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical Disability Code PD Date of last inspection Brief description of the care home The Coach House is a registered home, providing nursing care for younger people with severe physical disabilities. The accommodation is a large, detached property of traditional construction on three floors. It is situated in a residential area of Grays and is fairly convenient for both rail and bus transport. The care provision is currently for thirteen service users requiring long-term care. The Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 13 2 8 0 1 2 0 0 9 Brief description of the care home home employs trained nurses and carers to support personal and nursing care. Activities for service users in the community are encouraged and staff support service users in pursuing activities according to assessed needs. The Service User Guide and Statement of Purpose are available and the residents and their representatives are provided with this information. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. The visit took place over two days by one inspector and lasted a total of 11 hours, with all key standards inspected. Additionally progress against previous requirements and recommendations from the last key inspection were also inspected. Prior to this inspection, the registered manager had submitted an Annual Quality Assurance Assessment (AQAA). This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. As part of the process a number of records relating to service users, support staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, service users and members of support staff were spoken with and their comments are used throughout the main text of the report. Prior to the Care Homes for Adults (18-65 years) Page 6 of 32 site visit, surveys for people who live at the home, staff, relatives and healthcare professionals were requested to be sent to the home for distribution. At the time of writing this report we had received 2 completed staff surveys and 1 survey from a healthcare professional. Where comments have been recorded these have been incorporated into the main body of the report. The Service Manager, adminstrator and other members of the staff team assisted the inspector on the day of the site visit. Feedback on the inspection findings were given to the Service Manager on the first day of inspection and to the administrator on the second day of inspection. The opportunity for discussion and/or clarification was given. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 8 of 32 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a formal assessment process in place however it was unclear that people who use the service are assessed and assured that their needs can be met. Evidence: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff and management team are able to meet the prospective persons needs. Admissions are not made to the home until a full needs assessment has been undertaken. In addition where appropriate, supplementary information is provided by the persons Placing Authority or Primary Care Trust. No changes have been made to the referral process since the last key inspection to the service. The Statement of Purpose confirms that referrals are initially taken from people who have a local connection with the Basildon and Thurrock area, however Family Mosaic will also actively seek referrals from other agencies. In addition The Coach House offers a respite service for those people with severe physical and neurological disorders, who would benefit from periodic short breaks. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: The care files for the two newest people admitted to The Coach House were requested. However we were unable to determine the quality of either persons pre admission assessment as they could not be located. The senior management team were given sufficient time to locate the documents and both the current and archived files were searched. From discussions with the homes Service Manager we were advised that a pre admission assessment was completed for each person. Neither person was able to confirm to us if they had been formally assessed by a representative of the organisation prior to admission. Out of 2 staff surveys returned to us, both recorded usually to being provided with up to date information about the needs of prospective people admitted to the home. In addition the Service Manager advised that the prospective person and/or their representative are given the opportunity to view the home, to meet staff and other service users and where appropriate to stay at The Coach House on a trial basis before a placement is agreed and finalised. A Statement of Purpose and Service Users Guide was readily available detailing the aims and objectives of the home and the services and facilities provided. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care needs of individual people are clearly recorded detailing their specific needs and how these are to be met by the home. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual people and to specify how these are to be met by staff who work in the home. As part of the care plan process a detailed Activities of Daily Living summary comprising of 14 elements were completed for each person. Each summary recorded a succinct outline of the persons specific needs in relation to Communication, Personal Hygiene, Elimination, Mobility, Tissue Viability, Eating and Drinking, Breathing, Pain, Sleeping, Mental Health, Expressing Sexuality, End of Life, Social Activities and Maintaining Safety. As part of this inspection the care files for 2 people were examined in full. Records showed that each person had a plan of care completed detailing their specific care needs and the actions and interventions required by care staff to ensure that all Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: aspects of their health, personal, emotional and social care needs are met. Each care plan was seen to be written in plain language and was easy to understand. Improvements had been made to ensure there was an appropriate indexing system in place within each care file and that all information held within the care file was pertinent. Improvements were noted since the last key inspection in January 2009 in relation to the quality of information recorded within each plan of care. Care plans examined were observed to be person centred and individualised and where risks were identified, a risk assessment was compiled detailing the specific risk and the measures to be taken by staff to ensure the persons safety and wellbeing. In addition to the above, specific assessments relating to manual handling, pressure area care and nutrition were completed. Records showed that where the persons needs had changed the care plan and/or risk assessment was updated to reflect the persons current care needs. The AQAA confirms that each service users support plan is reviewed every 3 months as a minimum. We also noted that an assessment to determine a persons ability to make decisions, choices and consent to medical treatment had been completed for one of the two people case tracked. The assessment concluded that despite the persons profound physical disabilities and the impact this has on their ability to communicate effectively the person was able to make decisions. On the first day of inspection people were observed to be assisted to get ready for their Christmas Lunch/Party. Interaction between support staff and service users was observed to be positive. Support staff were observed to uphold and maintain peoples privacy and dignity when providing personal care. Rapport between support staff and service users was observed to be good humoured and there was much laughter, happiness and excitement overheard. On the second day of inspection we spent time talking to support staff and it was evident from our discussions that staff understand the care, treatment and support needs of people who currently live at the home. We spoke with 3 service users and each one confirmed that they felt listened to and that they were provided with a good level of care by support staff. Comments included the staff are great, you get everything mate, nothing is too much trouble and staff are good. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further improvement is required to ensure the social care needs of people in the home are met. Evidence: The care files for two people, provided limited information as to their personal preferencs, likes and dislikes pertaining to their social care needs. On inspection of their social activity recording sheet this showed that they participate in a limited programme of both community based and in house activities. The Service Manager and support staff spoken with confirmed that they are looking at ways of improving how people spend their day and leisure time in the evenings and at weekends. One service user spoken with confirmed they find some days boring as there is little to do and staff are not always available to undertake social activities. They stated that there are film evenings and on occasions trips to the local theatre. As stated previously both the Statement of Purpose and Service Users Guide makes little Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: reference to the importance of engaging service users in appropriate leisure activities. The AQAA detailed under the heading of what we could do better promote community presence and participation by encouraging access to local amenities and groups. There is an open visiting policy at the home whereby visiting hours are not restricted. There was evidence to show that people living at the home are actively encouraged and supported to maintain friendships and relationships. Relatives spoken with confirmed they can visit the home at any time and are always made to feel welcome when they visit. Relatives visiting the home were observed to have a good relationship with staff and members of the management team. People spoken with who live at the home confirmed they are enabled to maintain friendships with others and to see members of their family when they choose. Evidence during both days of the site visit showed that service users rights are respected and where possible people are actively supported and enabled to retain as much independence as possible despite the physical challenges presented. People were observed to express a choice in the time they get up in the morning, the time they retire to bed, where they choose to spend their day, how they choose to spend their day and meal preference. People who live at the home are offered a varied menu according to their personal likes and dislikes. A menu record is recorded each day detailing individuals choices and actual food eaten. In general terms these were seen to be satisfactory however there were occasions when this was not completed and it was difficult to determine whether the diet was satisfactory. Where people require assistance and support from staff, this was provided with dignity and sensitivity. Staff spoken with demonstrated a good understanding and awareness of individuals specific dietary needs. We were advised that themed lunch-time meals are planned from January 2010 e.g. Scottish Burns Night, Greek, Indian etc Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in some aspects of medication practices and procedures means that people living at The Coach House cannot be assured that their healthcare needs will be maintained or proactively managed. Evidence: Of those care files case tracked, records showed that service users have access to a range of healthcare professionals and services as and when required. These include GP, Community Psychiatric Nurse, Physiotherapist, Social Worker and Dietician. There was evidence to show there is an audit trail detailing healthcare interventions provided and outcomes. The care file for one person showed in recent months that the persons nutritional needs had deteriorated significantly however there was evidence that appropriate action had been taken by the management team of the home to ensure the persons comfort and wellbeing and where appropriate healthcare professional advice and interventions had been sought. Practices and procedures for the safe storage, handling and recording of medication were examined as part of this inspection. It remains of concern that some aspects of medication practices and procedures are poor. A sample of eight peoples medication Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: records were examined on the first day of inspection. These showed no record of some medicines having been given to people when they were due as the entries on the MAR (Medication Administration Record) record had been left blank and not signed by staff. A discrepancy for one persons medication between what was recorded on the MAR record and the instructions printed from the pharmacy on the bottle of medication were observed. It was unclear as to which instruction was correct as a copy of the prescription could not be located at the time of the site visit. We examined the records for people who are prescribed Controlled Drug medication and found that the stock balance and record keeping was in good order providing a clear audit trail. However in the Controlled Drug cupboard, other items other than Controlled Drug medication were stored there. The Service Manager was advised that this is not in line with regulatory requirements. Medication that requires cold storage was stored in the homes dedicated fridge however some medication was noted to be out of date and past its expiry date. The fridge temperatures where medication is stored were examined for a 3 month period. Records showed these were not recorded each day and on some occasions the fridge temperature was noted to not be within the recommended guidelines. This means there is potential risk for medication to deteriorate and/or lose its effectiveness. There was no evidence to show this had been picked up by staff and the actions taken to address this. As part of good practice procedures not all bottles and packets of medication were observed to be signed and dated when opened. Following the last key inspection to the service in January 2009 where concerns were raised in relation to some aspects of the homes medication practices and procedures, an improvement plan was forwarded to us by the manager as to the steps taken to address the identified shortfalls and deficits. The improvement plan confirmed that additional training had been delivered to staff to ensure that records were completed accurately and medication audits conducted to ensure compliance with statutory requirements and the homes own policy. The dates for compliance were March and April 2009. It was clear from this inspection that any improvements made had not been sustained and/or maintained. A sample of medication audits for 2009 were examined. These showed that the homes own audits had picked up issues which were similiar in nature to the above findings. An audit from Boots Pharmacy in March 2009 raised 9 action points. As a result of the above findings we forwarded a Serious Concern Letter to the Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: organisation detailing the areas of concern. Following the site visit on the first day of inspection an email was forwarded to us by the Service Manager detailing the actions taken to address the shortfalls. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are able to express their concerns and are protected from abuse. Evidence: Information relating to how people can make a complaint or raise concerns was observed to be displayed at The Coach House. This is also detailed within the homes Service Users Guide however the address of the Care Quality Commission is inaccurate and it continues to make reference to the previous regulatory authority, Commission for Social Care Inspection. Further consideration is required to ensure that service users and other interested parties are aware of the Local Authorities contact details, to whom they can raise any concerns or complaints. We observed during the first day of inspection that the complaints book was located in the main entrance hall/reception area of the home. This was seen to be inappropriate as it does not preserve peoples anonymity and some of the information recorded could be of a sensitive nature. This was discussed with the Service Manager and we were advised by them that following the site visit the complaints book was relocated. On inspection of the homes complaints log, records showed that since the last key inspection to the service there had been 2 complaints. These related to the homes referral/pre admission process and a service user being unhappy about the length of Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: time it took for staff to answer their call alarm facility and staffs attitude. A record of the specific complaint, investigation and outcome was recorded for each of the complaints. The outcome was that both complaints were upheld and the complainant was happy with the actions taken by the management team of the home. However following discussion with a service user on the first day of inspection we were made aware that they had recently made a complaint to the manager. They advised that the manager had taken notes of the discussion however no record of this could be found. The AQAA details that there is an open-door approach in the home for service users and their families to make their concerns known. Appropriate safeguarding policies and procedures are in place. The Service Manager confirmed that since the last key inspection to the service there have been no safeguarding referrals. Staff spoken with demonstrated an understanding and awareness of safeguarding procedures and stated that should an issue arise, information would be passed to the person in charge. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in a safe, well maintained and comfortable environment which meets their needs. Evidence: A partial tour of the premises was undertaken on the second day of inspection. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home environment continues to be maintained, decorated and furnished to a good standard and is both homely, comfortable and modern. Furnishings and fittings were domestic in nature and were of a good quality and in keeping with the environment. There is sufficient communal space and this refers specifically to 1 large lounge/dining area with a kitchenette and 1 dining room on the ground floor and a sensory room on the second floor. There are sufficient bathing and communal toileting facilities available which enable immediate access and these are fitted with appropriate aids and adaptations. On the day of the site visit the premises were seen to be clean, tidy and odour free and no health and safety issues were noted. People spoken with continue to be happy with their personal space. A random sample of individual peoples bedrooms were inspected and these were seen to be personalised and individualised to suit peoples personalities and individual tastes. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: The AQAA details that in the last 12 months all areas of the home have been redecorated and refurbished. A modern respite suite with wet room facilities has been newly created on the second floor. In addition a large LCD television has been purchased for the lounge on the ground floor. The Service Manager advised that the garden re-development project remains ongoing with new garden furniture and plants purchased. A random sample of maintenance records and certificates were examined in relation to fire drill records, emergency lighting, fire alarms, fire equipment and fire risk assessments. Records showed that regular fire drills are conducted, the homes emergency lighting and fire alarms are tested each week to ensure they remain fully operational, the homes fire extinguishers were serviced in November 2009. The gas safety certificate was observed to remain in date however the electrical safety certificate dated January 2006 recorded a further inspection was required after an interval of not more than 1 year. There was no evidence to show that this had been undertaken. An email from the Service Manager following the first days site visit advised us that the latter was being reviewed by the organisations Housing Officer and Health and Safety Representative. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained and in sufficient numbers to support the people who use the service. Evidence: We were advised by the Service Manager that the staffing levels at the home are 1 RGN and 6 support staff between 07.30 a.m. and 15.00 p.m., 1 RGN and 3 support staff between 13.30 p.m. and 21.00 p.m. and 1 RGN and 2 support staff between 20.45 p.m. and 07.45 a.m. each day. An additional person is employed between 09.00 a.m. and 16.30 p.m. each day as a member of support staff/activities. In addition to the above ancillary staff are employed for laundry, housekeeping, domestic and cook. The managers hours are supernumerary to the above however at the time of the site visit we had been made aware that the manager had tendered their resignation. Appropriate on call arrangements are in place for staff to contact for advice. We were advised that Family Mosaic have a pool of bank staff they can deploy to the home to cover staff shortages. In addition the organisation use 3 external agencies to cover staff sickness and annual leave. On inspection of 4 weeks staff rosters these showed that staffing levels as detailed above are being maintained. We checked the staff roster on the day of the site visit and this reflected accurately the staff on duty. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: The recruitment files for 2 people newly employed since the previous key inspection to the home were examined. Records showed that recruitment procedures within the home are generally sound however some gaps were highlighted. These relate specifically to the Annex 4 proforma for one person who had transferred from another care home within the organisation to The Coach House did not detail the specific types of proof of identification held on file for this person, the employment history for one person was not fully explored and the reason for leaving an employer not recorded for one person. No record of induction was available for either person. We also requested the profile and record of induction for an agency member of staff. The profile for this person was readily available and this confirmed their employment history, records of training, confirmation that a Criminal Record Bureau (CRB) check had been attained and evidence of their NMC (Nursing and Midwifery Council) membership. Initially their record of induction could not be located however this was found by the Service Manager shortly prior to the inspectors departure from the home. We examined the training records for 5 members of staff (including the 2 newly appointed members of staff case tracked). Records showed that the newly appointed member of staff had received training relating to Gastrostomy Competence, Basic First Aid, SOVA, Breakaway and Safe Escape Techniques and Fire Awareness however there was no evidence to show that they had received manual handling training. For the remaining 4 members of staff records showed that since the last key inspection to the home, staff had received training relating to the Administration of Rectal Diazepam, Assistive Technology Assessment Programme, Manual Handling updates, Nutrition Study Day, Palliative Care and Therapeutic Activities. The AQAA confirms that out of 19 members of support staff, 9 have attained an NVQ qualification. On inspection of a random sample of 5 member of staffs supervision records, these showed that staff are not receiving regular formal supervision in line with the recommendations as detailed by the National Minimum Standards for Younger Adults. The staff recruitment files for two people recorded them as having commenced employment at The Coach House in June and August 2009. No record of supervision was available for either person. In addition shortfalls were identified within the remaining 3 files examined. Following the site visit we received an email from the homes Service Manager and they confirmed that a supervision matrix has been newly devised and implemented to ensure that staff receive regular formal supervision. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general terms the home is well run and provides positive outcomes for people. Evidence: We were advised on the first day of inspection by the homes Service Manager that the registered manager had tendered their resignation on 25th November 2009. They advised in the interim that an RGN from within the existing staff team had been given the acting up role of managing the home on a day-to-day basis. In addition we were advised that the Service Manager would increase their presence in the home so as to support the interim manager and the Housing Officer would visit the home 3-4 times a week. We spoke with several members of staff and two service users. People spoke openly about difficulties relating to the previous manager of the home. This referred specifically to people expressing concern about the negative impact the previous manager had on the home, resulting in low staff morale and staff feeling they did not have any clear direction or leadership. Residents spoken with discussed their unhappiness with the previous manager and stated it was the worst Id known it and Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: Its heaven now the atmosphere was really terrible. Evidence showed that on a day-to-day basis the home is generally well run and provides positive outcomes for the people who live at The Coach House. Relatives spoken with confirmed they had confidence in the organisation to ensure good care practices were adopted at the home and that there were positive outcomes for people who live in the home. It is evident from this inspection that while there are many positives and outcomes for people are generally good, further development is still required in relation to some aspects of medication practices and procedures, ensuring that people in the home have their social care needs met, ensuring that all people newly recruited to the home receive an induction and staff supervision. All sections of the AQAA were completed and the document returned to us when requested. Information recorded was informative, detailing the changes that have been made and where they still need to make improvements. There is a quality assurance system in place and records showed that questionnaires were provided to residents and their representatives and staff in June 2009. Recommendations to address issues raised by the satisfaction survey included enhancing communication with service users, developing services around in house and community based activities for service users, reviewing service users support plans every 3-6 months and provide service users with information (service user meetings, planned activities, medical information, access to housing officer). In addition to the above monthly Regulation 26 visits and reports are completed by a representative of the organisation. Records showed over the past 4 months that issues relating to more activities for service users and concerns about the managers management style were recorded. There was also evidence to show that staff and service user meetings are held at the home. Corporate health and safety policies and procedures were readily available. A list of health and safety policies which can be found in the home were listed within the AQAA forwarded to us. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 13 16 All people are given the opportunity to engage in appropriate in house and community based activities. Previous timescale of 31/3/09 not met. So that people feel valued and do not become bored. 01/04/2010 2 20 13 People must be protected 15/01/2010 from harm by having their medication administered safely and in accordance with the prescribers instructions. Previous timescale of 23/3/09 not met. This will ensure peoples health and safety and that they get their medication. 3 20 13 When medication is not administered to residents, records clearly record this, the rationale why they are not and any action taken to address the above. Previous timescale of 23/3/09 not met. This will ensure that staff have all necessary and up to date information. 15/01/2010 Care Homes for Adults (18-65 years) Page 28 of 32 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 4 36 18 Ensure that staff, receive regular supervision. Previous timescale of 23/3/09 not met. This will ensure that staff, feel supported and able to carry out their role. 01/03/2010 Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 Ensure there is evidence to demonstrate that the needs of the prospective person are assessed prior to admission. So as to ensure the service can meet the needs of the individual person. 01/03/2010 2 20 13 Medication must not be stored or used past its expiry date. So as to ensure that medication remains effective and people are not placed at risk of harm. 15/01/2010 3 20 13 Where medication requires cold storage, this must be within recommended guidelines and the temperature recorded each day. This will ensure that medication remains effective. 15/01/2010 Care Homes for Adults (18-65 years) Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 34 18 All newly appointed staff (including agency staff) receive an induction. So that newly appointed staff can effectively undertake their role. 01/03/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 Ensure all packets and bottles of medication when opened are signed and dated. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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