Inspection on 10/01/06 for Coldwells House and The Stables

This inspection was carried out on 10th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 but made no statutory requirements on the home.

Other inspections for this house

Coldwells House and The Stables 23/04/07

Coldwells House and The Stables 18/05/06

Coldwells House and The Stables 23/08/05

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

CARE HOMES FOR OLDER PEOPLE Coldwells House and The Stables Coldwells Lane Holmer Hereford Herefordshire HR1 1LH Lead Inspector Wendy Barrett Unannounced Inspection 10th January 2006 09:45 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 Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 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. Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Coldwells House and The Stables Address Coldwells Lane Holmer Hereford Herefordshire HR1 1LH 01922 624413 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) Ms Karen Anne Rogers Care Home 28 Category(ies) of Dementia - over 65 years of age (25), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (25), Old age, not falling within any other category (25), Physical disability (3), Physical disability over 65 years of age (25) Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The arrangements detailed in the Statement of Purpose and Service User`s Guide submitted as part of the registration application must be fully implemented within twelve months of the date of registration. Mrs Rogers must work a minimum of 30 hours each week at the home until a separate Care Manager has been registered. The category PD must be limited to the named individuals residing at the home at the date of registration. 23rd August 2005 2. 3. Date of last inspection Brief Description of the Service: Coldwells House is a detached late nineteenth century period house on the outskirts of Hereford city. The Stables is a modern detached house separated from the main building by a small courtyard/patio area. Although the home is close to the main A49 road it is in a small, rural lane and there are good views of the surrounding countryside from many windows. The Stables is registered to accommodate up to three younger adults with care needs arising from a physical disability. This service is limited to the individuals currently accommodated. The main building has been adapted for its current use and a purpose-designed extension was built in 1995. This part of the service accommodates twenty five people over the age of sixty five years who have care needs arising from the general ageing process, dementia, physical disability or mental disorder. All the bedrooms are single occupancy and some have en-suite facilities. Throughout the home there are three large lounge/diners, four bathrooms, a shower room and a number of separate W.Cs. Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken on one day between 09.45am and 12.45pm and 2.00pm and 3.45pm. A new Provider was registered in July 2005. At this time there was a considerable amount of work required to meet current standards. Additional work has been identified by Mrs. Rogers since she took over the home. A routine inspection took place on 23rd August 2005. Additional visits took place on 7th October and 17th October 2005. The Commission’s Pharmacy Inspector undertook an inspection of the medication arrangements at the home on 13th October 2005. The Provider met with the lead Inspector and the Co-ordinator of the local vulnerable adults strategy on 19th October 2005. The purpose of this meeting was to discuss the possible risk factors for residents while the development of the overall service was being addressed. The focus of the current inspection was on the premises and the care planning arrangements because these are aspects of the service that required a lot of attention at the time the new Provider was registered. For this reason it has not been possible to fully inspect and score many of the National Minimum Standards. Feedback questionnaires were sent to the home prior to this inspection and the Provider was asked to distribute them to residents, relatives and visiting professional workers. No responses have been received and the Provider agreed to check that these have actually been distributed. The Provider is undertaking responsibility for the everyday care until a separate Care Manager has been registered with the Commission. An assistant Manager is in post and is supporting the Provider with this work. What the service does well: Many of the staff who were employed by the previous owners have chosen to stay at the home. It has been a very challenging time for them because they have to change from a very traditional way of working to one that is considered good practice these days. The residents’ benefit from having staff who know them well and the quality of the service is improving as the staff adapt to the changes and the physical environment is upgraded. The care staff keep good records of the care they provide to each resident on a daily/nightly basis. Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 6 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. Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 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 Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The Provider carefully considers referrals for admission to Coldwells House so that the home only accepts new residents who have needs that can be met at the home. EVIDENCE: Referrals for admission are carefully assessed by the Provider to ensure that the home does not accommodate new residents who have needs that cannot be met. It is proposed that in the longer term Coldwells House will accommodate low to medium dependencies. The Provider has requested a review of the needs of some existing residents who have high care needs that may be more appropriately met in an alternative care setting. Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8 The current records of care need to be developed to show more clearly how decisions are reached about the overall plan of care for each resident. The records don’t show how the residents’ needs are being regularly reviewed by senior staff to ensure they are receiving the care they need. The residents are receiving attention to their everyday health care needs but this work needs to be more carefully monitored and recorded. EVIDENCE: Observations of residents who rely on staff to help them with their personal appearance indicated that there is better attention to this area of care e.g. hair care, clothing, shaving. There are detailed records kept of daily care and instructions received from district nurses etc. They contain good information although some staff may need further guidance so that they use appropriate language. These records are not yet detailed enough and the Provider has set up a new system that will meet the current standards. There has been little progress made in completing these new records and a requirement is made to address this work. It is particularly important that areas of most vulnerability e.g. challenging Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 10 behaviours, skin care, are picked up as they emerge and risk assessments and subsequent care plans are put in place and regularly evaluated. The ‘falls’ specialist nurse has been invited to the home to do a training session with the care staff, and there was an example of advice sought for a specific resident who had several falls at the home. The resident benefited from this referral because he has now been supplied with hip guards to try and prevent serious injury. The husband of a resident who was unwell in bed and waiting for the GP to visit was very happy with the care his wife had received since coming into the home a few weeks previously. The Commission’s Pharmacy Inspector has inspected the service and will be monitoring compliance with requirements and recommendations relating to medication management. Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 13 There is better attention to the social needs of the residents so they can have a varied lifestyle. Relatives are able to maintain contact and visit when they wish. EVIDENCE: Residents who were able to comment on their experience at the home felt satisfied – ‘I’m well cared for, I had a nice bath this morning’, ‘I’ve just been for a walk’, ‘I’m looking forward to games later on’. An activities organiser has been employed so that residents can be offered a variety of activities depending on their interests. A daily record detailed things like bingo, exercises, pot planting, one to one chats, quiz. Three ladies were observed playing cards in one of the lounges. This new service will significantly improve the quality of life for the residents. The cook felt that the meals were much better now. There is a pre-planned menu (although this is not yet displayed for residents to read) and the cook is consulted about the food supplies. There is better attention to encouraging residents to eat their meals in comfortable surroundings. One of the areas that will need to be covered in the new care planning system is the dietary needs and preferences of individual residents. The standard cannot be fully assessed until these are developed. Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 12 Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Parts of the accommodation are badly in need of attention, and this is very evident when entering the home. However, there has been a considerable amount of work already completed, and not immediately apparent, to improve the quality of the physical environment. EVIDENCE: Refurbishment of a lounge at the front of the building was due to be completed within two to three weeks of this inspection. This has been a big piece of work with new windows, re-plastering and electrical work needed. This room has now been out of use for a long time and a requirement is made to complete the work within the timescale offered by the Provider at the inspection. New carpeting to entrance hall, corridors and stairway is due to be fitted in the near future. Once again, the work must be completed soon as the existing floor coverings are very stained and worn. A small lounge on the ground floor is poorly furnished and is badly in need of attention. Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 15 Many bedrooms have been completely upgraded and are very attractively furnished and decorated to a high quality. Two upstairs bedrooms now have en-suite facilities and will provide much better quality accommodation. There were two bedrooms containing personal items belonging to residents who were not currently occupying their rooms. These rooms should have been locked, or at least personal property packed and stored in a secure area of the home. . Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 The general presentation of the home indicates that, although the residents’ everyday needs are being addressed there is too little staff time or supervisory attention to make sure that all the day to day tasks that arise in a care home are receiving prompt attention. EVIDENCE: Two care assistants (one a senior); a junior trainee, a cook, a maintenance worker and an administrative assistant were on duty at the home. The Provider arrived at the home during the inspection. The activities organiser was at work between 10am and 3pm. The assistant Manager was on leave. There should have been a third care assistant on duty but this person had been required to cover a night duty. There was no cleaner at work although the Senior care assistant believed a cleaner had been at work the previous day. The care assistants were very busy dealing with immediate, everyday care tasks and it was reasonable to assume they would not have time to address additional tasks that needed attention e.g. re-stocking paper towel dispensers, packing and securing personal property laying untidily in the unlocked bedroom of a resident discharged the previous day. Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 36, and 38 There is too little effective oversight of the service on a day-to-day basis so that things that need attention are not being picked up and dealt with as promptly as they should. EVIDENCE: The Provider is currently required to spend a minimum of 30 hours a week at the home managing the everyday care. This condition of registration will end when a separate Care Manager is registered. An assistant Manager is in post to support the Provider although she was on leave at the time of this inspection. This, and previous inspections, identify examples of shortfalls in the overall supervision of the service. Managers should be picking up work that needs doing and ensuring that the work is done. The meter and cleaning materials cupboards were unlocked, posing a safety risk to residents. The record of weekly fire alarm tests indicated that there had been no test done since 12th Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 18 December 2005, newly fitted paper towel dispensers were empty, an oxygen cylinder (apparently rarely used) was stored in a resident’s bedroom but the required warning notice was not displayed. Although the Provider explained that the resident kept removing the notice, there was no evidence of the situation being managed to ensure safety. Staff who are left in charge of the home must have sufficient time to supervise the care being provided. There are arrangements in place for a contractor to come in and undertake legionella checks on the water system. An electrical installation certificate was obtained following the fitting of a new boiler in the kitchen. A full electrical check was undertaken in 2004. Staff received fire safety training from a qualified trainer in October 2005. The trainer is due to return to the home to repeat this training for staff who missed the first session. Health and safety will also be covered at this time. Fire drills were addressed as part of the training. Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 19 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 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 2 x x x x x x x STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 1 x x x 1 x 1 Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 20 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 OP7 Regulation 15 Requirement Each resident must have a comprehensive plan of care to show how care needs will be met. Risk assessments and associated plans of care must be produced for residents who present risk to themselves or others through their activities. The refurbishment of the front lounge must be complete and the room ready for resident occupation. The entrance hall, corridors and stairs must be re-carpeted. The Provider must submit monthly reports to the Commission that demonstrate the way the service is being monitored and developed. Personal property belonging to residents who are away from the home must be stored securely. Fire safety equipment must be checked regularly and kept in working order e.g. alarm to be tested weekly, dorgard batteries to be replaced promptly. (Immediate requirement) DS0000064831.V277782.R01.S.doc Timescale for action 28/02/06 2 OP7 13(4)b 15/02/06 3 OP19 23(2) 15/02/06 4 5 OP19 OP33 23(2) 26 28/02/06 31/01/06 6 7 OP35 OP38 16(2) l 23(4)a 31/01/06 11/01/06 Coldwells House and The Stables Version 5.1 Page 21 8 OP38 13(4)a 9 OP38 13(4) c Cleaning materials that may be hazardous must be kept in locked storage area. The meter cupboard door must be kept locked at all times. (Immediate requirement) Management arrangements must ensure that staff in charge of the home each day monitor and promptly address work required to maintain the safety and welfare of residents. 10/01/06 31/01/06 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 OP38 Good Practice Recommendations A health and safety checklist may assist staff left in charge of the home to monitor health and safety work. Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN 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 Coldwells House and The Stables DS0000064831.V277782.R01.S.doc Version 5.1 Page 23 - 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. 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