Inspection on 03/01/06 for Coach House

This inspection was carried out on 3rd January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 5 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 28/01/09

Coach House 18/12/07

Coach House 09/01/07

Coach House 28/02/06

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 08/07/2008.

CARE HOME ADULTS 18-65 Coach House 10 Woodwards Heights Off Ward Avenue Grays Essex RM17 5RR Lead Inspector Ron Reeves Unannounced Inspection 3rd January 2006 10:00 Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Coach House Address 10 Woodwards Heights Off Ward Avenue Grays Essex RM17 5RR 01375 396041 01375 393197 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mosaic Essex Mrs Jane Elizabeth Richards Care Home 13 Category(ies) of Physical disability (13) registration, with number of places Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Personal and nursing care to be provided to up to 13 younger adults with physical disabilities. Personal and nursing care for people over 65 years of age is limited to 2 service users whose names are known to the CSCI. Maximum number to be cared for shall not exceed 13. Date of last inspection 24th and 25th February 2005 Brief Description of the Service: 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 home was originally registered to provide care for fourteen service users. This number is to be reduced to thirteen, by the home since registration. The care provision is currently for thirteen service users requiring long-term care 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. Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection, which took place during the day of the 3rd January 2006 and lasted 7 hours. The inspection process included a tour of the building, discussion with the manager, inspection of a sample of policies, procedures and records. Time was taken to talk to three residents, three visiting relatives and three staff. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 6 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5 The admission process is well managed and prospective residents and their families are given sufficient information to be able to make an informed choice. EVIDENCE: The home has an appropriate Statement of Purpose and Service Users Guide. Care plans contained comprehensive pre-admission assessments. Due to the needs of the residents unplanned admissions are not accepted. Prospective residents/and or their representatives are offered the opportunity to visit the home before making any decisions to move in. The manager informed that due to the prospective residents complex needs, pre-admission visits are generally carried out by relatives. Each resident has a contract which includes the terms and conditions of residence. However they do not contain all the information required. Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Care planning systems were clear and appropriate. EVIDENCE: Care plans sampled were seen to be comprehensive and covered all residents’ assessed needs together with appropriate risk assessments. Information provided for staff to meet residents’ needs were clear and concise. Care plans were reviewed on a regular basis and detailed resident and/or family involvement. From observations throughout the day and from discussions with staff, relatives and residents it was clear residents’ needs were being met. The manager informed that Person Centred Planning is being introduced in the near future, which will ensure greater involvement of the residents in the discussion making process effecting their care and daily living activities. Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 9 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 & 17 Social activities are generally well managed. The home provides a range of appropriate activities both within the home and the local community. Nutritional records and storage of food require reviewing. EVIDENCE: Due to the complex needs of the residents, no one is able to gain employment or attend education facilities. The home now has a full-time therapy assistant who has been trained by the home’s physiotherapist to undertake daily physiotherapy activities with the residents and organises in-house activities. The manager informed that it is hoped to employ a second therapy assistant in the future. The home has it’s own transport to enable residents to access a full range of local community facilities including pubs, restaurants, cinemas and the Lakeside and Bluewater shopping centres. The home encourages residents to maintain contact with families and friends with an open visitors policy and enabling where possible residents to visit their families. Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 10 Detailed nutritional assessments are carried out on admission. The home employs two chefs who are both familiar with the preferences and special dietary requirements of the residents. The manager informed that both chefs have had discussions with the community nutritional team and with the community speech and language specialists to enable them to be fully aware of meeting residents’ nutritional needs. Menus seen were wide and varied and appeared nourishing. The home maintains appropriate nutrition records, but unfortunately they were not always completed on a daily basis. This was pointed out at the previous inspection and must now be addressed. The home has a large well equipped kitchen, which was clean and well maintained. The dry goods foods store contained many open packets of food, which should be stored in appropriate containers. The refrigerator contained prepared food which was not labelled or dated. Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 21 Resident’s personal and health care needs are being met by the home. EVIDENCE: Care plans evidenced that residents’ personal care needs were being met by the home. Personal support is provided in the privacy of resident’s bedrooms or in the home’s shower/bathroom. Where possible residents are encouraged to choose and shop for their own clothes, hairstyles etc. All residents are allocated a named nurse who supervises key workers. The home enables residents to access specialist health services, including specialist nurse service, chiropody and physiotherapy. Residents’ visits to their GP or other community health services are recorded in their care plans. Due to the dependency levels of the residents they rely on staff to monitor their medical conditions and arrange for appropriate medical intervention. Medication administration was seen to be appropriately maintained. The manager informed that residents preferences regarding terminal care are fully discussed with residents and their families and end of life plans are completed for each resident. Staff spoken with were very knowledgeable of the residents’ needs and were observed throughout the day to be caring for the residents in a sensitive and unhurried manner. Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The home has appropriate policies, procedures and staff training in place for responding to residents’ concerns and protecting them from abuse. EVIDENCE: Two complaints have been received by the home since the last inspection. Records indicated that the complaints, which did not directly involve the residents or the management of the home, were resolved satisfactorily. The home’s Adult Protection and Whistle Blowing policies were both adequate to protect service users from harm or abuse. All staff have attended Protection of Vulnerable Adults Training and are given a copy of the home’s whistle blowing procedures. Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 - 30 The home provides a good standard of accommodation that meets residents’ needs. However the top floor space has been awaiting conversation for some time. EVIDENCE: The home is a large detached house which has been converted for use for disabled people. It is large and airy which enable residents and their wheelchairs to move easily throughout. Bedrooms are large and equipped with hoists. All were seen to be personalised to individual residents tastes. A lockable drawer is provided in each bedroom. Some of the bedrooms have been redecorated since the last inspection and more are planned. Residents have access to a large lounge/diner and a second lounge. The top floor consists of a large room and sensory room. The large room is used part office part therapy and part storage. The redesign and use of these rooms have been considered for some time but as yet not completed. The home has a large shower room on the ground floor and an adapted bathroom on the first floor. The manager explained that due to the residents’ disabilities the adapted bathroom is not used because the majority of residents need to use a shower trolley. Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 14 On the day of the inspection the home was found to be generally clean and tidy and free from any offensive odours. Due to the extensive use of very large wheelchairs, corridor doors and door frames are continually being damaged. Most of the corridors have been protected however doors and door frames have not. Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,22, 35 & 36 Staffing levels and skills were appropriate to meet the needs of the residents. A wide range of relevant training is available and NVQ training promoted. EVIDENCE: Since the last inspection the home has recruited more support staff, which has resulted in significantly reducing the use of agency staff and improved the continuity of care. The deployment of staff was adequate to meet the needs of the service users. Staff spoken with confirmed that the present staffing levels were adequate to meet residents’ needs. In addition catering and domestic staff are employed. The home’s proprietors make available a wide range of training planned over a year which homes can nominate staff to attend. Staff spoken with expressed satisfaction with the scope of training available and many were training at NVQ Level 2 & 3. Staff at the home receive supervision. Supervision is cascaded down from the manager to nursing staff. Records showed that all the staff were receiving supervision on a two monthly basis. Staff spoken with felt they had a good staff team who supported each other. Once commented that “this is the best home she worked in”. Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 40 & 42 Staff in the home are well supervised and supported by the registered manager. However there are some health and safety issues that need to be addressed. EVIDENCE: The manager has been in post since September 2003. She is a registered nurse, NVQ Assessor and a qualified manual handling trainer. She is at present studying to achieve the Registered Manager’s Award. Staff spoken with said she was easy to approach and supportive. Regular qualified nursing staff, residents and general staff meetings are held on a regular basis. The home has the Proprietor’s comprehensive policies and procedures. The majority of records seen were generally well maintained, others have been commented on in the report. Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 17 The manager was aware of her responsibilities for the health and safety in home. Safety certificates for gas, electrical installation, Portable electrical equipment testing were not available. Regular checks were recorded for the fire protection equipment apart from the emergency lighting. Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 X 2 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 3 X 3 3 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Coach House Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 2 X DS0000015529.V273966.R01.S.doc Version 5.0 Page 19 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation 23(2)(1) Requirement Appropriate storage and office space must be provided which does not impact on space dedicated for specialist treatment. This is a repeat requirement from the previous two inspections. The home must consult the local Environmental Health Officer regarding the storage of food. The home must maintain records of food provided to each service user. Insufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory. The registered manager ensures compliance with relevant legislation including (a) Electricity at Work Regulations 1989 (b) Gas Safety Regulations 1998. The home must ensure regular checks are made on the fire equipment. This includes the home’s emergency lighting. Timescale for action 28/02/06 2 3 YA17 YA17 16(2)( j) 17(2) Schedule 16/01/06 31/01/06 4 YA42 12(1) 16/01/06 5 YA42 17(2) Schedule 2 16/01/06 Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA5 Good Practice Recommendations It is recommended that the contract of terms and conditions be amended to include details of the service users plan including arrangements for review of the plan and any elements of care management which are to be provided by the home. The home should consider adaptations to the first floor bathroom to enable service users to make greater use of it. 2 YA27 Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Coach House DS0000015529.V273966.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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