Inspection on 06/03/07 for Coach House Nursing Home The

This inspection was carried out on 6th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Coach House Nursing Home The 26/01/06

Coach House Nursing Home The 16/11/04

Coach House Nursing Home The 11/08/04

Coach House Nursing Home The 01/03/04

Coach House Nursing Home The 27/08/03

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Coach House Nursing Home The Sharow Cross Sharow Ripon North Yorkshire HG4 5BQ Lead Inspector Mrs Rosalind Sanderson Key Unannounced Inspection 6th March 2007 09:30 X10015.doc Version 1.40 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 Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 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 Older People. 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 Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coach House Nursing Home The Address Sharow Cross Sharow Ripon North Yorkshire HG4 5BQ 01765 600541 01765 600189 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) Mr Allan Broadbent Mrs Glennis Carolyn Broadbent Mrs Jill Taylor Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 5 day care places Age range 60 years upwards Date of last inspection 26th January 2006 Brief Description of the Service: The Coach House is a care home providing nursing care for up to 42 older people that may require nursing care. It is a large detached property situated in its own grounds in the village of Sharow, close to the centre of Ripon. Local shops and amenities are located in the village or within the Ripon town centre. There are extensive well kept garden areas that are easily accessible for all service users. Parking is available at the home. Information about what services are available at The Coach House is provided to service users and potential service users in the form of a ‘Statement of Purpose’. The most recent Commission for Social Care Inspection report is also made available to service users and those looking at the home at the same time. Once residence is taken up all service users are ‘presented’ with a ‘Residents Handbook’ that gives extensive and detailed information about what is available for service users and information on daily routines. The range of fees charged per week is £470-£570. This information was correct at the date of this inspection, March 6th, 2007. Additional charges are made for telephone calls, hairdressing, toiletries, chiropody, newspapers, magazines and dry cleaning. Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection has used information from different sources to provide evidence for this report. These sources include: • • • • Reviewing information that has been received about the home since the last inspection. Information provided by the registered person on a pre inspection questionnaire; Comment cards returned from 7 service users and 2 GP’s. A visit to the home carried out by one inspector that lasted for five hours. During the visit to the home eleven service users, five staff and three visitors were spoken with. Records relating to four service users, five staff members and the management activities of the home were inspected. Care practices were observed, where appropriate, and time was also spent watching the general activity within the home. This enabled the inspector to gain an insight of what life is like at The Coach House for the people living there. The registered manager and the Administrator were available to assist throughout the visit and for feedback at the close. What the service does well: People like living at The Coach house. They can be assured that, following a full assessment that their care and social needs will be met. They receive care that has been agreed with them and that is delivered in a way that promotes their dignity and respects them as individuals. The manager and staff liaise with a wide variety of health care professionals to ensure that service users receive the best possible care. Service users comments include, ‘This place is excellent, the staff do a marvellous job’ ‘I wouldn’t want to be anywhere else, I get very well looked after’ ‘I never have to ask for anything, and if I did I know that I would be able to have it…within reason!’ Service users are encouraged to remain as independent as possible for as long as possible and staff are encouraged to promote independence. The food is much appreciated by all spoken with. Mealtimes are seen as social events and staff are available to assist when needed. Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 6 Service users enjoy the activities on offer at the home and enjoy the well kept grounds. Many commented they were looking forward to the summer months. Service users at the home feel that their opinions matter and that they are taken into account. One service user said, ‘I have completed a questionnaire that asked if we had any concerns, I had a small one and I know they took it seriously because it was put right immediately’. The staff at the home are extremely well trained and this ensures that the service users receive the best possible care. 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. The summary of this inspection report can be made available in other formats on request. Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. 6 is not applicable. Quality in this outcome area is excellent. Service users can be assured that their health and social care needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records showed that a thorough pre admission assessment is carried out for all prospective service users. Information about service user’s needs is gathered from varying sources. This includes from GP’s, healthcare professionals involved in the individual care of the service user and, where appropriate, social services. Service users take a full and active part in the assessment and are encouraged to sign to indicate their agreement with it. The manager explained how careful consideration is given to existing service users needs when deciding on future admissions. This means that, as far as Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 9 possible, prospective service users will not be admitted if they could potentially have a detrimental effect on current service users care. Where possible, all service users are visited prior to their admission and if they are encouraged to visit the home as well. This gives the service user an opportunity to get to know key members of staff prior to their admission and hopefully be greeted by a familiar face when they arrive at the home. All information that is gathered about the health and social needs of service users is used to formulate the plans of care for each service user. Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is excellent. Service users receive health and personal care in a safe way that respects their privacy and promotes dignity and independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All service users have a written care plan that details how their health and social care will be delivered. The plans are based on information received during the pre admission assessment and reviewed and updated as needed. All activities that the service user may be involved in have been the subject of risk assessment and this ensures that service users are cared for safely whilst maintaining their independence and choice. All staff are aware of the care plans and were seen referring to them during the course of their duties. Staff were seen speaking respectfully to service users and giving them the opportunity to express their wishes. Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 11 At each shift change all staff receive current and up to date information about the needs and wishes of service users. Staff are able to contribute to discussions about service user’s care. The records showed that all service user’s healthcare needs are kept under regular review and where indicated relevant healthcare professionals are involved as well as the service user and their families. Service users comments include, ‘This place is excellent, the staff do a marvellous job’ ‘I wouldn’t want to be anywhere else, I get very well looked after’ ‘I never have to ask for anything, and if I did I know that I would be able to have it…. within reason!’ The registered manager arranges for all staff to receive training vital to their role and to enable them to care for service user’s specific care needs. A staff member confirmed that they receive sufficient training and are able to approach the manager if they feel they require more specific training. This is always provided. As well as the mandatory training, staff have received training in other areas including nutrition, ear syringing, syringe driver training and wound care. The trained nurses at the home each have a ‘link nurse’ role to liaise with staff in the primary Care Trust. These roles include links for Palliative care, Infection control and Tissue Viability. Policies and procedures relating to the administration of medication ensure that service users receive their medications promptly and in a safe way. Medication records that were looked at showed that this was the case. All controlled drugs were recorded and stored correctly. Temazepam tablets were stored correctly with robust recording and checking facilities to ensure they are kept safely. Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. Service users are able to lead fulfilling lives. Service users individual and collective dietary needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Activities provided at the home have been devised following consultation with service users so ensuring that it meets their wishes and preferences. Recent activities include trips out to Melmerby, craft afternoons and film afternoons. All service user’s are encouraged to participate but their wishes respected if they choose not to. On the day of this visit service users and staff were busy preparing for an Easter bonnet competition. Church services are held in the home and ministers from different denominations visit on a regular basis. Service users who wish to continue to attend church with assistance from families, friends of the church, or staff form the home. Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 13 Forthcoming activities and summaries of recent activities are published in the monthly newsletter that is provided to give information to service users and relatives. The newsletter also gives information about what has been happening at the home and encourages people to put their views forward. A service user said, ‘The staff do an excellent job with activities and I really enjoy them!’ The home is currently without an activities organiser but there are sufficient staff available at all times to ensure that service users social needs are met. Service users confirmed this. The manager confirmed that efforts were being made to recruit in this area. Careful consideration is given to the dietary needs of service users. Service users have had a nutritional assessment carried out where indicated and have close links with the dietician. There is a six-week menu provided that is kept under review. There is a choice at each mealtime and alternatives are always readily available. Special diets such as diabetics and vegetarians can be catered for. Any special diets are recorded in the individual care plans. Consideration is given to providing ‘enriched’ diets for those service users that require this. Staff are made aware of any dietary issues for service users during the handover period. Staff were observed assisting service users at mealtimes. This was done in a respectful and dignified way. The cook is aware of his responsibilities in relation to safe handling and preparation of food; a recent visit by the environmental health officer confirms this. Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. Service users are listened to and are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users and their representatives are aware of the complaints policy in the home and know whom to approach should they have a complaint. They feel confident that any complaint will be taken seriously and acted upon. Information about the complaint policy is contained within the ‘Residents Handbook’ that all residents are given. The complaints book is available in the reception area. The complaints procedure allows the complainant to follow an informal and formal route. Details of advocacy agencies are made available to service users and their families. A relative said, ‘I would see Mr Broadbent or Matron straight away if I had any concerns’. The adult protection policy and procedure ensures that service users are fully protected. Staff are aware of the whistle blowing policy and their responsibilities. All staff were very clear about reporting procedures following any disclosure. Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Quality in this outcome area is excellent. Service users benefit from a clean, safe and homely environment that is able to meet individual and collective needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The well-kept grounds are accessible by ramp access from the dining area or from individual bedrooms on the ground floor. Some service users have access to private patio areas outside their bedrooms. Service users particularly enjoy the grounds and were looking forward to the summer. A covered area is provided for protection from the sun when needed. One commented, ‘I love sitting out in the gardens it is so peaceful, weather permitting.’ Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 16 There is a programme of renewal and redecoration in order that the home continues to be decorated to a high standard. The home has recently refurbished some bedrooms to provide more accessible en suite facilities. Additional profiling beds have also been purchased. Thee improvements have greatly enhanced the quality of life for those concerned and assist the staff to care for service users in a safe way. All other equipment used for the care of service users is used in a way that promotes service user safety. Individual service users are assessed for the use of equipment and advice is sought from occupational therapists and physiotherapists for the best available equipment for individual service users. All service users that require the use of a wheelchair have them fitted for their individual use, these are checked on a regular basis to ensure they continue to be safe for use. All necessary fire checks are carried out and staff have received regular training. All fire doors to service users bedrooms are kept closed at all times. Fire doors in communal areas are fitted with devices that allow them to be held open and close automatically when the fire alarm sounds Laundry facilities are on site and the equipment is suitable for its purpose. Staff are provided with personal protective equipment and are fully aware of their responsibilities for infection control. There is a link nurse for Infection Control who liaises with the Infection control nurse from the primary Care Trust. A relative commented, ‘……..always looks smart as do all the residents here.’ Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. Service users are cared for by safe and well-trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff rotas provided show that there are sufficient numbers of staff on duty at all times and the skill mix on each shift is good so that service users are well cared for. There is a core group of staff that have worked at the home for a long period of time. Additional staff are provided at busy periods, for example a staff member works up until 11pm at night to assist the three night staff and a further member comes on duty at 7am again to assist the night staff at this busy time. This ensures that all service users have their needs met in a timely fashion. All staff receive an induction when they join the home. The induction covers all the ‘Skills for Care’ requirements and goes further to provide staff with the specific skills they need to meet the needs of the service users in a way that promotes dignity and respect. This includes basic nursing skills required such as bed bathing, bed making, listening skills and addressing dignity and respect. An example of this is making sure that service users are addressed in a way that they choose. Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 18 56 of staff have achieved qualifications at NVQ levels 2 or 3. Staff are provided with excellent training opportunities once they have completed their induction and/or NVQ qualification. This year to date staff have received training in over twelve care areas that have been relevant to current service user’s needs. Examples of the training include tissue viability (for trained nurses and carers), nutrition, catheter care, ear syringing and general wound care. There are two work-based assessors at the home to enable staff to continue and progress through their NVQ qualification. Staff were observed having time to spend with service users and spending time helping service users at lunchtime. This was done in an appropriate way and a way that promotes service users dignity and respect. Staff files showed that the manager follows robust recruitment procedures and this contributes to protecting service users. Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. Quality in this outcome area is excellent. This home is well managed by a manager who has adopted a culture of openness and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is competent and qualified to manage the home. She is a first level registered nurse who has completed her NVQ level 4 in management and has additional qualifications in palliative care and teaching. She has developed good links with community and hospital professionals. This enables her to ensure that all staff at the home keep up to date with current trends that Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 20 relate to health care of the elderly. She is responsible for all clinical decisions in the home, this was confirmed by the administrator. Observation on the day of the visit showed she has an open door policy. Staff confirmed this by saying how they would feel free to approach her at anytime. Staff receive supervision on a regular basis as well as an annual appraisal. Written records of these meetings are kept. Staff stated that they found this useful. Regular team meetings are held. Service users are encouraged to manage their own finances. The manager does not look after any personal monies for service users. Quality assurance within the service is carried out on a regular basis. The results of these surveys are analysed and published in the monthly newsletter. Areas that surveys are carried out for include admission procedures, food provided, activities, and the physical environment. Future surveys will be sent to GP’s and people who visit the home. The provider and manager ensure the health, safety and welfare of service users and staff within the home. This is achieved by making sure all health and safety requirements are met and risk assessments that are in place are reviewed regularly. The electrical wiring installation at the home is due to be retested within the next four weeks. Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Coach House Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 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 © 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 Nursing Home The DS0000028026.V332181.R01.S.doc Version 5.2 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!