Inspection on 10/07/08 for Coatham Nursing Home

This inspection was carried out on 10th July 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Coatham Nursing Home 30/06/10

Coatham Nursing Home 07/07/09

Coatham Nursing Home 31/07/07

Similar services:

Ashlea Mews Residential Home

Eastwood

West Lodge

Arran House

Avenue Community Nursing Home

Cosin Lodge

Farmborough Court

Cragston Court

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOME ADULTS 18-65 Coatham Nursing Home Coatham Road Redcar Cleveland TS10 1RA Lead Inspector Val Daly Key Unannounced Inspection 10th July 2008 09:00 Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 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 Coatham Nursing Home DS0000068492.V368209.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 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. Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coatham Nursing Home Address Coatham Road Redcar Cleveland TS10 1RA 01642 482208 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) vinodhukkeri@yahoo.co.uk Gradestone Limited Mr Peter John Joy Care Home 21 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (21) of places Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st July 2007 Brief Description of the Service: Coatham Road is a 21-bedded care home for Adults aged 18-65 who has a mental disorder. The home is a converted property on three floors with the majority of bedrooms being on the first and second floors. There are fifteen single bedrooms and three double bedrooms. On the ground floor there are two lounges, as well as the kitchen and dining room. The home is situated near to Redcar town centre and is within short walking distance from the beach. It has easy access to local amenities and is directly on a bus route. Many of the Residents have lived in the home for a number of years. The home charges fees in the range £354 to £500 per week. Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use the service experience adequate quality outcomes. This inspection was a key unannounced inspection and was completed by two inspectors in one inspection day. As a key inspection, all of the key standards were examined. This was to check that the home meets the standards that the Commission for Social Care Inspection say are the most important for the people who use services, and that it does what the Care Standards regulations say it must. A number of records were looked at including assessments of people who use the service and plans of care, staff recruitment records, complaints and maintenance records along with the annual quality assurance assessment. The provider had completed an Annual Quality Assurance Assessment prior to the inspection. The AQAA is the services self-assessment of how they think they are meeting the National Minimum Standards. This information is received prior to the inspection and it is then used as part of the inspection process. On the day of the visit the manager provided the information and documentation required. The Commission for Social Care Inspection sent five surveys to the home for people who use the service or their relatives to complete. One was completed and returned from a relative. Comments received can be read within the report. This was a positive inspection; people were open and friendly and welcomed discussion about the home. What the service does well: Each person who lives at the home has had their needs assessed to make sure the home can give them the care and support they need. Coatham Road provides a clean, pleasant and well-maintained home for people to live. Staffs work well together as a team to provide the people who use the service with a comfortable and homely environment. Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Risk assessments are required for all people who use the service for the use of hot water. All people who use the service must be given the opportunity for personal development and be able to take part in appropriate activities. Advice from a Dietician should be sought to ensure a nutritionally balanced and varied diet is offered to people. The home has a complaints policy in place, however this requires updating to include the name and address of the Social services Contracts and Commissioning Department. The safeguarding procedure requires further development and must include the ‘No Secrets’ guidance. An effective quality assurance and monitoring system must be in place. The results must be available to the people who use the service and the commission. The manager should have supernumerary hours to ensure he is able to carry out the administration work in the home. The registered provider must provide written reports following his monthly visits to the home. Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 7 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. Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 8 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 Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have their needs assessed prior to admission. EVIDENCE: Since the previous inspection new assessment documentation had been introduced. Two sets of care files were examined and the assessment documentation covered areas such as; physical needs, preferred personal hygiene, dressing, breathing, sleeping routines, elimination, food preferences, mobility/dexterity, dependency, moving and handling, nutritional, risk of falls and mental capacity. There was sufficient information relating to the person concerned. Where a need had been identified in the assessment a care plan was in place. There was a heading for life history, however this had not been completed in either of the files. Both assessments had been signed by the person. Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are supported to become as independent as possible but at the same time staff look at the risks to keep them as safe as possible. EVIDENCE: Each person who uses the service has an individual care plan. In the two care files examined the needs identified during the assessment had a care plan, which had been signed by the person. The plans showed the appropriate interventions needed. Both files examined require a plan for social, recreational and occupational needs. There were two sets of daily notes written, one by the nurse on duty and another by the parson’s key worker. However in one of the files examined there was not always a daily entry from the nurse and the description of the person’s mood and behaviour often differed greatly to the notes made by the key worker. As the documentation was new evaluations had not been carried out, however dates for these were in place. Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 11 Risk assessments were in place for areas such as; smoking absconding, aggressive behaviour. As hot water outlets are not thermostatically controlled risk assessments are required for all people who use the service for the use of hot water. A comment card from a relative of a person who uses the service stated, ‘The care home is run like a family. My family member is treated as one of the family’. Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People at the home are supported by staff, while maintaining links with their families and friends. They are able to make choices about their lifestyle. However this is limited for some people. EVIDENCE: From discussion with people who use the service there are more opportunities available for those people who are able to go out and about independently. Two people said they couldn’t go out as often as they want to, due to there not being enough staff. One person said she couldn’t go out to get her pension when she wanted to and would like to more than just watch television. Another person interviewed had two jobs, both on a voluntary basis. He also attends college on a computer course, has completed a first aid course, reading and writing class and has enrolled for a numeracy class starting in September’. He commented’ The carers are helpful’. Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 13 One person said ‘I like my room very much, computer, stereo and radio’. Another person said ‘The rooms are nice and clean, the bedcovers are always being changed’, the staff are all right’. There is a notice board in the dining room and any forthcoming events, outings or minutes of meetings are displayed there. Two people interviewed said friends and relatives were welcome to visit. One person had regular outings with a family member. Menus were examined and there seemed to be repetition with some foods, for example sausages were offered four times in one week. The manager was advised to seek advice from the Community Dietician to ensure a healthy, nutritious menu was available for the people who use the service to choose their meals from. Three people interviewed commented on the food and whilst they said it was always well cooked there was a lack of variety. They felt that there was not always enough food at tea times, another example being sausage rolls and pickle being offered and having too many paste sandwiches. The manager said he would ensure more choices were available. Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have personal support when they need it so they can be as independent as possible. Healthcare needs are met, which ensures that people stay healthy. EVIDENCE: Two care plans were examined which detailed the personal support needed and given to the people who use the service. Each person has their own General Practitioner and they also consult with other health professionals when needed. Policies and procedures are in place for the ordering, receipt, storage, disposal and administration of medication. However a policy and procedure, along with a risk assessment needs to be developed for people who may wish to self medicate. A comment card from a relative of a person who uses the service stated, ‘They care for the individual as a person not a number’. If the care home need to get in touch they phone me or another family member’. Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who us the service are able to express their concerns and have access to a complaints procedure. However this need to be developed further. To protect the people from risk of harm robust adult protection procedures need to be in place. EVIDENCE: The home has a complaints policy in place, however this requires updating to include the name and address of the Social services Contracts and Commissioning Department. The safeguarding procedure in the home was incorrect in that it described management making the decision whether or not a suspected case of abuse would be referred to adult protection. ‘No Secrets’ guidance must be followed. Records showed that staff had received training regarding adult protection; two members of staff interviewed confirmed this. They said they report any suspected abuse to the manager. Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service live in a comfortable environment. EVIDENCE: A tour of the home was carried out. Since the previous inspection re decoration and some refurbishment had taken place. Bedrooms contained personal possessions. There were locks on the bedroom doors. The manager said some of the people had a key for their door and others did not wish to have one. In a double bedroom a privacy screen was not in pace. This is required to maintain dignity and privacy. In the main lounge, new furniture had been purchased, however some of the chairs were stained. There was also cigarette burns in the carpet. Two people interviewed who use the service commented that as there was only one toilet on the ground floor there was often a queue to use it. Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 17 For those people wishing to smoke the proprietor had provided a wooden building outside, to the rear of the home, with seating and a television. The home was found to be clean and tidy. There was an odour in one of the bedrooms. The manager said he was trying to resolve this. Discussion took place with the manager of the need to be mindful of the growing dependency of some of the people who use the service, and the possible need of some additional equipment to meet their future needs. Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment procedure needs to be more robust to protect the people who use the service. There needs to be sufficient members of staff on duty to meet the needs of the people who use the service. EVIDENCE: Three staff files were examined. None of the files had a reference for the person’s previous or most recent employer. In two of the files the person had been employed before their CRB check was in place. History of employment was not always fully explained and stated years rather than specifying months. It was also recommended to the manager that the reference forms be developed further to enable more written comments to be made. There were no interview notes or induction training in the files. The policy for the recruitment and selection of qualified staff was not followed in the home. For example it stated that the director interviewed qualified staff and the manager said this was not the case. Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 19 The home has a staff-training file in place with individual records. There were records to show that staff had received training recently in Food Hygiene, Infection Control and Adult protection. This training was delivered via DVD’s. Eight staff had received training in Fire Safety. Although individual records are in place it is not clear how up to date staff are with mandatory training as previous training is not recorded. Two members of staff interviewed said they enjoyed working at the home, being part of a small team, helping the people who lived there. A formal supervision system for staff was in place. Staff had received one supervision session as the system had been introduced in June 2008. Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There must be evidence that the views of people who live at the home are sought on how the home is run, so they know that their views are valued and are used to improve the service. Health and Safety training for staffs is required to ensure the people who live at the home are safe from risk of harm. EVIDENCE: The manager has been in post for a number of years. He is a Registered Mental Nurse and is currently undertaking the Registered Managers Award, which he hopes to complete by the end of 2008. The home has a duty rota in place. However this showed that the manager is working twelve hours Monday to Friday and six hours on a Saturday and Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 21 Sunday. He has been working this schedule for several weeks in a row. There is no supernumerary time within his working hours. The manager said that the home has a quality assurance system in place and surveys are sent to people who use the service. However this is carried out by the Registered Provider and there was no evidence of the outcomes of the surveys. The Registered Provider visits the home regularly and the manager said he talks to staff and people who use the service. However there was no written evidence in the home, in the form of regulation 26 records. There had been meetings recently for staff and the people who use the service. The manager said he was trying to develop this further, to have meetings three monthly. Records for personal allowances showed that people who use the service have access to their money. In the main there were two signatures in place for each transaction, the first one being the person themselves and the second a staff member. When it is not possible for the person to sign, two members of staff should do this. Two members of staff check the money every evening. The home has health and safety policies in place, however there was no evidence to show that staffs has received training this year and there were no historical training records. Maintenance records were examined and fire checks, PAT testing and water temperatures were found to be up to date. The gas safety certificate was out of date; records showed the last test was 17/04/07. This is required to be carried out annually. Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 22 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 2 X 2 X Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 YA9 Regulation 13 (4) Requirement Risk assessments are required for all people who use the service for the use of hot water. This is required to safeguard the people who use the service. This is outstanding form the previous inspection. All people who use the service must have opportunities for personal development. All people who use the service must be given the opportunity to take part in appropriate activities. All people who use the service must be given the opportunity to take part in the local community The meals provided to the people who use the service must be varied and nutritionally balanced. A policy and procedure, along with a risk assessment needs to be developed for people who may wish to self medicate. Timescale for action 08/09/08 2. YA11 16 (2) (n) 08/09/08 3. YA12 16(2) (n) 08/09/08 4. 5. YA13 16(2) (m) 16 (2) (i) 08/09/08 08/09/08 YA17 6. YA20 13 (2) 08/09/08 Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 24 7. YA23 13 (6) Robust adult protection procedures must be put in place. This is required to protect the people from risk of harm. Reference from the person’s previous or most recent employer must be in place. A CRB check must be in place prior to a person being employed. History of employment must always be fully explained. All staff training must be up to date. Although individual records were in place it was not clear how up to date staff are with mandatory training as previous training is not recorded. An effective quality assurance and monitoring system must be in place and the results must be available to the people who use the service and the commission. The registered provider must visit the home at least once a month, speak with people who use the service and staff, inspect the premises and prepare a written report (regulation 26) The registered provider must ensure that the gas system and equipment are inspected as required and documentation to confirm compliance is obtained. 08/09/08 8. YA34 19 (1) 08/09/08 9. YA35 18 (1) 08/09/08 10. YA39 24 (1) 08/09/08 11. YA39 26 (1) 08/09/08 12. YA42 23 (2) 08/09/08 Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 25 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 YA22 Good Practice Recommendations The homes complaints policy should be developed further to include reference to the authority funding the resident’s care. This is outstanding from the previous inspection. The manager should have supernumerary hours to ensure he is able to carry out the administration work in the home. 2. YA33 Coatham Nursing Home DS0000068492.V368209.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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