Inspection on 28/01/09 for Coach House

This inspection was carried out on 28th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 14 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 16/12/09

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 19/06/2009.

Inspecting for better lives 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, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michelle Love     Date: 2 8 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 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): Family Mosaic Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 13 Number of places (if applicable): Under 65 Over 65 0 physical disability Additional conditions: 13 Maximum number to be cared for shall not exceed 13. Personal and nursing care for people over 65 years of age is limited to 2 service users whose names are known to the CSCI. Personal and nursing care to be provided to up to 13 younger adults with physical disabilities. 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. Care Homes for Adults (18-65 years) Page 4 of 34 Brief description of the care home The 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 34 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 one day by one inspector and lasted a total of 8 hours, with all key standards inspected. Additionally, progress against previous requirements and recommendations from the last key inspection were also examined. Prior to this inspection, the manager had submitted an Annual Quality Assurance Assessment. 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 people living in the care home, Care Homes for Adults (18-65 years) Page 6 of 34 care staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to the site visit, surveys for residents, relatives, staff and healthcare professionals were forwarded to the home for distribution and for people to complete and return to us. Where surveys have been returned to us, comments have been incorporated into the main text of the report. The manager, deputy manager and other members of the staff team assisted the inspector on the day of inspection. Feedback on the inspection findings, were given as a summary to the manager/deputy manager. The opportunity for discussion and/or clarification was given. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 34 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 9 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current and prospective people are provided with sufficient information so they can make an informed decision as to whether or not The Coach House is the right choice for them. The care needs of individual people are assessed before they are offered a placement. Evidence: 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. The Coach House offers a respite service for those people with severe physical disabilities and neurological disorders, who would benefit from periodic short breaks. There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff team are able to meet the prospective service users needs. Admissions are not made to the home until a full assessment is undertaken. The pre admission assessment document was noted to be comprehensive and detailed and Care Homes for Adults (18-65 years) Page 10 of 34 Evidence: where appropriate additional information had been sought from other agencies. Prior to the inspection we were made aware that Thurrock Council undertook a contract compliance visit to The Coach House on 14/1/2009. The report provided to us details that pre admission arrangements were checked for 3 people, however out of these, documentation could only be found for 2 people. On inspection of 2 care files for those people newly admitted to the care home, evidence showed that pre admission assessments were completed by the management team of the home prior to the persons admission. Information recorded was observed to be detailed and informative and included information relating to the persons mobility, personal hygiene needs, respiratory needs, pressure area care, communication, sleep etc. In addition to the above key resident information/personal profile was also completed. There was clear evidence to show that where appropriate the pre admission assessment process had been undertaken with the service user and/or their representative. Where possible prospective service users are given the opportunity to visit the home on a trial basis. Staff surveys returned to us recorded that they were provided with sufficient information about the individual needs of people within the service. Two staff surveys recorded, On all handovers and supervision I am kept up to date. If I need to know anything I can approach my manager and On every shift we are told of any changes to our service users needs. A Statement of Purpose and Service Users Guide was readily available detailing the aims and objectives of the home and the services/facilities provided. Of 6 service user surveys returned to us, 5 confirmed that they were provided with sufficient information about The Coach House prior to their admission. Care Homes for Adults (18-65 years) Page 11 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in care planning and risk assessing means that people living within the care home cannot be assured that their needs will always be met or that their health and wellbeing will be maintained or proactively managed. Evidence: As part of this inspection the care files for 2 people were examined. Records showed that there is a formal care planning system in place to help staff identify the care needs of individual service users and to specify how these are to be met by care staff. In general terms the care plans were seen to be detailed and informative in some areas, recording service users physical, healthcare, emotional and social care needs. Some further development in care planning/risk assessing is required to ensure that the care needs of individual people are clearly recorded and staff have the most up to date information to ensure appropriate levels of care delivery. Prior to the inspection we were made aware that Thurrock Council undertook a contract compliance visit to Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: The Coach House on 14/1/2009. Evidence showed that care planning documentation was muddled, records took a long time to locate in some instances and of those care files sampled, information was not up to date. The care file for one person recorded them as having some weight loss. This was confirmed by their weight chart which showed a weight loss of 4KG over several months. While we acknowledge there was a risk assessment in place, this only made reference to the person being at risk of choking and requiring food to be cut up. No reference was made with regards to the person losing weight and there was no evidence to show how this was being proactively managed. The nutritional screening tool dated 10/6/2008 recorded the implementation of fluid balance charts, however recording was inconsistent. This was not an isolated case as the other care file examined also recorded the person as having lost over 10KG in weight in under 6 months, however there was no evidence as to how this was being managed and no risk assessment. The same persons pre admission assessment recorded them as being at medium to high risk of developing pressure sores and that they should be nursed on a pressure relieving mattress. It was of concern that their care plan pertaining to pressure area care was not compiled until 23 days after their admission. Additionally their care plan made reference to them suffering with depression and mood swings. No information was recorded as to how this specifically manifests, the impact this has on the persons ability to undertake activities of daily living, or how this is being managed by the management/staff team of the home. No risk assessment was devised for the above, yet associated documentation viewed recorded several occasions whereby the person exhibited inappropriate actions. Little information was recorded detailing staffs interventions to deal with the above. This was not an isolated case as the other care file examined also recorded the person as being both verbally and physically aggressive on occasions. While we acknowledge there was a plan of care, no risk assessment was devised, detailing the nature of the risk and steps to be taken to minimise the risk so as to safeguard the service user and others. Healthcare records for January 2009 showed that the local Mental Health Team had been requested to undertake a reassessment of the service users care needs and a Community Psychiatric Nurse was providing input, however associated documentation showed that the service users inappropriate behaviours had been prevalent for some considerable time. On inspection of staff meeting minutes for October 2008, records showed that the above issues had been highlighted by the management team of the home. The minutes recorded, some care plans are out of date and team members are requested to update these. It was of concern that despite the above instruction, this had not been carried on those care files sampled. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: Both the manager and deputy manager advised us that end of life strategies have as yet to be incorporated into individual peoples care files. Interaction between support staff and service users was observed to be both respectful and with dignity. It was evident that some staff are knowledgeable about individual service users complex needs and that they have a good rapport. Of 6 service user surveys returned to us, 5 recorded positively that they felt staff listened to them and acted on what they said. However 4 out of 6 surveys recorded usually to the question, are the staff available when you need them and 1 survey recorded sometimes. The majority of service users recorded they usually received the care and support they required. One survey recorded, I am advised that I need to drink plenty of fluids but not always staff are available to provide this. Care Homes for Adults (18-65 years) Page 14 of 34 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. The social care needs of people are generally met, however shortfalls were identified. Evidence: On inspection of 2 care files there was limited information recorded detailing the social care needs of service users. Where information was recorded, this showed that service users had participated in theatre visits, shopping to Lakeside, a visit to Romford dogs, drive to Southend and the cinema. Mixed comments were recorded within service users surveys received and these included, would like more activities organised and depending on the definition of activity, activities are arranged. Outdoor activities are sometimes arranged but not on a regular basis. Both the Statement of Purpose and Service Users Guide makes little reference to the importance of appropriate stimulation and activities for the people within The Coach House and there is no planned/structured programme of activities currently in place. The home has access to Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: a mini bus, to be used solely for the purpose of service users. We were advised that 2 therapy assistants are employed within the home and are experienced in dealing with neurological conditions and work closely with the community physiotherapist. There is an open visiting policy at the care home, whereby visitors can see their member of family and/or friend at any reasonable time. There was evidence to show that people living at the care home are actively encouraged and supported to maintain friendships and relationships. On inspection of the menu, this showed that service users receive a varied diet according to their dietary needs. Observation of the lunchtime meal evidenced that where people require assistance, this is provided with dignity and sensitivity. Staff spoken with demonstrated a good understanding and awareness of individuals dietary needs. Care Homes for Adults (18-65 years) Page 16 of 34 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 poor medication practices and procedures means that people living at the care home cannot be assured that their needs will always be met or that their health and wellbeing will be maintained or proactively managed. Evidence: Of those care plans sampled as part of this site visit, records showed that service users have access to a range of healthcare professionals and services. These include GP, Community Psychiatric Nurse, Physiotherapist, Social Worker, Practice Nurse etc. Records within individual care files showed that peoples healthcare needs are recorded, however the outcome of the appointment and/or follow up interventions were not always clearly recorded. Medication practices and procedures were examined. The majority of medication is managed through a monitored dosage system (blister pack). Storage systems within the home were appropriate with medication stored securely within two medication rooms. Where medication required cold storage, the temperature of the fridge was recorded daily and this was noted to be generally within recommended guidelines, Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: however there were a few occasions when this was below the recommended level. Additionally the manager and deputy manager were advised that a daily temperature should be kept where other medication is stored, so as to ensure this does not deteriorate and/or lose its effectiveness. Records showed that this was recorded within only one storage room and between 16/1/2009 and 28/1/2009 there were several occasions whereby the room temperature was above 25 degrees centigrade. On inspection of Medication Administration Records (MAR) evidence showed there was no record of some medicines having been given to the resident when they were due, as the entries on the MAR record had been left blank and not signed or initialed by staff. Where F other (define) was recorded, no further information was recorded on the reverse of the MAR record. Additionally one medication (tablet) for 2 people recorded drug unavailable and no stock on the reverse of the MAR record. It was also noted that for 5 people, Suby G Bladder Irrigation Solution was consistently recorded as no stock and nil available. We were advised following discussions with the deputy manager that the latter was not available as a result of a manufacturing delivery issue. It is of concern that if people require regular bladder `wash outs` so as to prevent infection and the above solution is not available, that an alternative product is used. From discussions with our pharmacist inspector, we were advised there are several alternative solutions available that would be suitable. The manager and deputy manager were advised as part of good practice procedures to compile a list of those staff who administer medication to service users and include their initials and signature. Training records showed that not all staff who administer medication have up to date evidence of medication training and no staff have been assessed as to their continued competence to carry out the above task. This is not in line with Family Mosaics own medication policy which states, No staff member working within Family Mosaic will administer oral medication until they have a certificate of competence. Care Homes for Adults (18-65 years) Page 18 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all people living at the care home are confident that their complaints will be listened to or acted upon. People cannot be assured that staff working within the care home have the skills and competence to deal with people who display aggressive and/or inappropriate behaviours. Evidence: There is an appropriate complaints policy and procedure in place at The Coach House. We were advised that no complaints have been received at the home since the last inspection. From evidence of service user surveys forwarded to us, there was evidence to show that not all people who live at the care home, know how to make a complaint and if the need arose, knew who to speak to. Two surveys returned to us recorded that they knew how to make a complaint however, nothing seems to happen and not sure who is in charge at what time. However another service user survey recorded, If I am not happy I will approach someone in the office. If this is the case, the management team of the home/registered provider must ensure that people are assured that any issues dealt with will be addressed. As seen on previous inspections to the home, there is an appropriate safeguarding policy and procedure in place, including local guidelines. No safeguarding issues have been raised since the last inspection. Staff spoken with demonstrated an understanding and awareness of safeguarding procedures and advised that should an Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: issue arise, information would be passed to the person in charge and/or manager/deputy manager. The care records for one person who can be challenging on occasions, recorded restraint (arms held against the persons chest) being used by a member of staff (bank carer). The record did not include the timeframe of restraint used and the effects this had on the service user. It is of concern that there are people in the care home who are resistant to care and/or exhibit inappropriate and challenging behaviours, however the training matrix provided to us shows that only one member of staff who works at the care home has attained challenging behaviour training. Care Homes for Adults (18-65 years) Page 20 of 34 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 live in a home that is comfortable, safe and homely which meets their needs. Evidence: A partial tour of the premises was undertaken at this key inspection with the deputy manager. Since the last inspection refurbishment of the premises has been undertaken whereby the communal lounge areas have been redecorated/newly furnished and the kitchen area off the main lounge has been refitted and redecorated. Additionally, the home entrance hall has been revamped and this now reflects a modern and homely theme, which people spoken with said was good. The respite room on the second floor has been newly decorated with a wet room facility installed. The AQAA also details that new sofas for the lounge and a new pay phone have been purchased. It is hoped within the next 12 months that WiFi for the building will be installed so as to enable service users to log on, on their computers, anywhere in the building and that furniture stored on the second floor will be cleared. We were advised that service users were consulted with regards to the refurbishment programme and colour schemes within the home. On inspection of a random sample of individual service users bedrooms, these were seen to be individualised and personalised with many personal effects. The AQAA details that the staff team have supported one person to obtain a Community Care Grant and with this money they have redesigned the whole look of Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: their bedroom and purchased soft furnishings. We were advised that a maintenance person is employed at the care home for 32 hours per week. In addition to this, building maintenance is undertaken by external contractors. A random sample of maintenance records/certificates were examined pertaining to records of fire drills, emergency lighting, fire risk assessments, fire equipment, hoists, passenger lift certificate and gas certificate and all were seen to be in date/well maintained. At the time of the site visit the electrical safety installation certificate was not available and it was not possible to ascertain whether or not this was in date or works were outstanding. Confirmation that this is in date must be provided to us. On inspection of the training matrix, records showed that the maintenance person has up to date training relating to fire awareness, manual handling and safeguarding. Gaps were noted in relation to health and safety, infection control, first aid and COSHH (Control of Substances Hazardous to Health). Care Homes for Adults (18-65 years) Page 22 of 34 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The level of staffing on occasions restricts the ability of the service to deliver person centred care and to ensure that peoples needs, can be met and that they are safe. Inadequate recruitment procedures and insufficient evidence of training for some people mean that residents are not safeguarded and staff working at the care home may not have the necessary skills to meet the assessed needs of residents. Evidence: We were advised by the deputy manager that the staffing levels at the care 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 3 support workers between 20.45 p.m. and 07.45 a.m. each day. We were also advised that funding for an additional member of staff between 13.30 p.m. and 21.00 p.m. has been formally agreed. In addition to the above, ancilliary staff are employed as laundry, housekeeping, domestic and cook. The managers hours are supernumerary to the above and they are on site Monday to Friday 09.00 a.m. to 17.00 p.m. The deputy manager completes 50 of their hours as supernumerary and the other 50 as an RGN on shift. A senior staff nurse is employed at the care home for 17.5 hours per week. Currently staff vacancies are for 2 full time RGN posts and 4 full time support staff posts. We were advised by the deputy manager that staff are divided into teams Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: and these are allocated to each floor for a period of 3 months, then rotated. The rationale for this is to ensure that staff gain knowledge in various aspects of care delivery and get to know individual service users needs. Staff surveys returned to us recorded that tasks were divided fairly. On inspection of 4 weeks staff rosters, these showed that staffing levels as detailed above have not always been maintained. We have not been notified via Regulation 37 Notifications when staffing levels have not been attained and the measures undertaken by the management team of the home/registered provider to address the shortfalls. We were advised that no agency staff have been utilised at the care home and 3 people have been recruited as bank staff. We were advised that the person in charge of the shift does not have autonomy to use agency staff and this must be authorised by a senior manager. We were made aware that there have been difficulties with staff retention and recruitment of new staff, which has proved challenging. Staff meeting minutes for September 2008 recorded that weekend staffing levels are often short as a result of staff telephoning in to cancel their shift. One service user survey returned to us recorded, I would like to see more staff so that they have more time to spend with me. Two staff surveys returned to us, recorded under the heading of what could the service do better, Insuring adequate staffing is always a priority and More staff helps unit to run smoother. Both the manager and deputy manager advised that staff morale within the home is good and new staff appointed have merged well with existing team members, ensuring positive team work. Staff surveys returned to us confirmed that communication within the home is good. At this site visit 4 staff recruitment files were examined, 3 files were for those staff newly recruited to Family Mosaic (The Coach House). The majority of records as required by regulation were evident, however gaps were noted. These refer specifically to the application for one person not clearly recording why they left their previous employer (care home), the Criminal Record Bureau (CRB) details for one person evidencing this was for their previous employer and not Family Mosaic, no recent photograph for one person and no evidence of a POVA 1st for the manager, yet their CRB was issued after they commenced employment. The AQAA details under the heading of our plans for improvement in the next 12 months, To carry out POVA 1st checks. Completed records of induction were available for 3 out of the 4 peoples files examined. The induction record for one person showed that some elements were incomplete. At the time of the site visit, a random sample of staff training records were inspected, however in some cases the training review sheet was seen to be incomplete. The manager advised that she was in the process of completing and updating the staff training matrix. A copy of the matrix was forwarded to us. This showed that there are Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: gaps in both core subject areas (fire awareness, health and safety, COSHH, safeguarding, first aid, food hygiene and infection control) and other specialist areas e.g. nutrition, catheter care, Multiple Sclerosis, Epilepsy, acquired brain injury, diabetes, pressure area care, challenging behaviour etc. Both the manager and deputy manager advised that they were aware of the shortfalls and further training is planned for staff. It is of concern that not all staff have up to date manual handling training and records showed that the 3 bank staff have not received this training. The AQAA details under the heading of our plans for improvement in the next 12 months, Ensure all staff are trained to the required standards and this is reflected in the service delivery. The AQAA also details that within the last 12 months a training officer has been recruited to provide in house training and to source external training. The manager advised that at the time of the site visit both she and the deputy manager were awaiting a start date to commence NVQ Level 4. Additionally 9 members of staff have attained NVQ Level 2, 2 people are currently undertaking NVQ Level 2 and 1 person has achieved NVQ Level 3. On inspection of the staff supervision tracker this showed that the majority of staff have not received regular formal supervision in line with National Minimum Standards recommendations. The AQAA details, All staff working in The Coach House have monthly supervisions and annual appraisals where objectives are reviewed. This did not concur with the inspectors findings and was confirmed by support staff spoken with. On inspection of the Thurrock Council compliance visit report dated 14/1/2009, the Quality Support Officer undertaking the visit also found that regular supervision of staff was not taking place. Care Homes for Adults (18-65 years) Page 25 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general the home is run in the best interests of the people who live at The Coach House, however, deficits identified could potentially affect positive outcomes for residents. Evidence: From discussions with the manager, we were advised that they have been in post since 2/9/2008, following the resignation of the former manager. We were advised that between May 2008 and September 2008, the deputy manager acted up into the manager role. The manager has over 15 years experience in housing, general nursing, community care, community empowerment and at a strategic level with a non departmental public body sponsored by the Department of Health. The manager has a degree in Health Service Management and is a RGN (Registered General Nurse). As already stated previously, the manager is looking to commence NVQ Level 4. Staff surveys returned to us recorded that they felt the newly appointed manager was approachable, providing support and encouragement when required. One staff survey Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: recorded, The manager is available with support and so is the deputy manager, and will answer any queries, which is encouraging. All of the staff surveys returned to us felt that the service provided at The Coach House was very good and the care needs of service users were well met. The manager advised that the ethos of the service is to, provide care and support without discrimination in accordance with individual service users needs. To deliver a responsive service, working closely with external agencies and providing the best possible care. Wherever possible for people to retain their independence and skills. It was evident at this site visit that 4 out of the 6 statutory requirements as detailed within the last key inspection report (18/12/2007) have been addressed satisfactorily. At this inspection it was clear that some systems within the home and record keeping have been overlooked as a result of no manager within the home for several months. It is evident at this inspection that further development is required in relation to some aspects of care planning/risk assessing, medication practices and procedures, that there is an appropriate training programme in place for staff which enables them to update their existing knowledge and ensuring that staff receive regular supervision. All sections of the AQAA were completed and the document returned to us when requested. The information recorded provides a reasonable picture of the current situation within the service, however in some cases there is limited evidence to support the claims made within it. Evidence of this is highlighted within the main body of the report. Records showed that staff meetings and service user/relative meetings are held at the care home on a regular basis. The manager advised that it is hoped for these to be conducted monthly. There was evidence to show that Regulation 26 visits have not been undertaken monthly and records available were for July, August and December 2008. We were advised that a quality assurance (satisfaction survey) was conducted in February/March 2008. Records showed that out of 10 surveys issued 8 were returned and these were completed with support from family members where required. The results of the survey scored 82 . The AQAA provides a list of policies and procedures currently available within the home. The organisation has a Health and Safety Officer who ensures that there is compliance with policies and procedures. As previously stated there are gaps in training pertaining to health and safety, COSHH and infection control. Care Homes for Adults (18-65 years) Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 28 of 34 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 6 15 Care planning at the home must identify, and be effective in meeting all residents assessed needs and ensure these are regularly updated and reviewed to reflect the most up to date information. So as to ensure that staff have the most up to date information and can provide appropriate care to meet individual peoples care needs. 01/04/2009 2 9 13 Risk assessments must be 01/04/2009 devised for all areas of assessed risk so that risks to residents can be minimised. Records must be explicit, detailing the specific risk, how this impacts on the person and steps to be taken to reduce the risk. To ensure that risk areas are identified and staff are aware of the associated risks Care Homes for Adults (18-65 years) Page 29 of 34 to peoples health and wellbeing. 3 13 16 All people are given the opportunity to engage in appropriate in house and community based activities. So that people feel valued and do not become bored. 4 17 17 Where people are at risk of losing weight, maintain appropriate nutritional records, including weight gain or loss and appropriate action taken. So as to ensure peoples health and wellbeing. 5 20 13 People must be protected from harm by having their medication administered safely and in accordance with the prescribers instructions. This will ensure peoples health and safety and that they get their medication. 6 20 13 Medication must be stored under suitable environmental conditions and records of the temperatures of the storage areas must be kept to show this. This will ensure that residents receive medicines that are effective. 7 20 13 When medication is not administered to residents, records clearly record this, the rationale why they are 23/03/2009 23/03/2009 23/03/2009 22/03/2009 31/03/2009 Care Homes for Adults (18-65 years) Page 30 of 34 not and any action taken to address the above. This will ensure that staff have all necessary and up to date information. 8 20 18 All staff who administer medication to residents must be appropriately trained. This will ensure that staff are competent and have the skills to carry out the task safely. 9 23 13 Ensure that all staff receive appropriate training relating to dealing with challenging behaviour. So that staff will feel confident, have the skills to deal effectively with issues raised and people in the home are protected from harm. 10 23 13 Physical and/or verbal 23/03/2009 aggression by residents is understood and dealt with appropriately. Physical intervention is used only as a last resort and in accordance with policies and practices of the home and other legislation. So as to ensure residents safety and wellbeing. 11 33 18 Ensure there are sufficient staff, on duty at all times. 23/03/2009 01/05/2009 30/04/2009 Care Homes for Adults (18-65 years) Page 31 of 34 So as to ensure the needs of residents are met according to their specific needs and dependency. 12 34 19 Ensure that robust recruitment procedures are adopted at all times and all records as required by regulation are sought. This will ensure that residents and others feel assured that they are safeguarded by the homes procedures. 13 35 18 Staff receive appropriate training to the work they perform. This refers specifically to core subject areas and those conditions associated with the needs of people who have acquired brain injury and/or a physical disability. This will ensure that staff, have the competence, confidence and ability to meet peoples care needs and people living at the care home will feel reassured that their care needs will be met by suitably trained staff. 14 36 18 Ensure that staff, receive regular supervision. This will ensure that staff, feel supported and able to carry out their role. 23/03/2009 01/06/2009 23/03/2009 Recommendations Care Homes for Adults (18-65 years) Page 32 of 34 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 2 3 4 5 17 19 20 21 22 Nutritional and fluid charts are consistently completed for those people who are at risk of losing weight. Outcomes of healthcare appointments and follow up interventions are clearly recorded. Compile a list of names, initials and signatures for those people who administer medication. End of life decisions and strategies for individual people are recorded within their plan of care. Make appropriate arrangements to ensure that all people within the home know how to make a complaint and feel confident and assured that their concerns will be listened to. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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. 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