Inspection on 18/05/06 for Coldwells House and The Stables

This inspection was carried out on 18th May 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 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 10/01/06

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 18th May 2006 14:30 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 Coldwells House and The Stables DS0000064831.V296982.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. Coldwells House and The Stables DS0000064831.V296982.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coldwells House and The Stables Address Coldwells Lane Holmer Hereford Herefordshire HR1 1LH 01432 272414 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.V296982.R01.S.doc Version 5.2 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. 10th January 2006 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 accommodates 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.V296982.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection process included two visits to the service. The first visit was unannounced. The second visit was announced so that the Provider and Care Manager could be present. A sample of feedback questionnaires was handed out to residents and relatives. Staff and residents were interviewed at the home, and there was observation of some everyday activities. Records of contact with or about the service since the last inspection, and held by the Commission, were referenced. What the service does well: What has improved since the last inspection? Since the new owner/Provider came to the home last year she has been very careful only to admit new residents who are suitable for the service. This has resulted in a less dependent group of residents whose needs can be met by the staff and who can enjoy each others’ company and appreciate their attractive accommodation. A separate Care Manager has recently been recruited to support the Provider in overseeing everyday life at the home. The staffing arrangements are better now. Staff can work in a more relaxed, but organised way, and they can spend more time helping residents enjoy social opportunities. The staff are much happier now and feel they are being well supported by their managers. The way that the meals are prepared and presented is one example of the significant improvement in the quality of this service through the past year. There has been a complete transformation of this important part of everyday care. Residents can now have an informed choice of dishes that they can enjoy in very attractive surroundings that make it an enjoyable social occasion. Coldwells House and The Stables DS0000064831.V296982.R01.S.doc Version 5.2 Page 6 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.V296982.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 Coldwells House and The Stables DS0000064831.V296982.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The needs and wishes of prospective residents are carefully assessed to make sure the home will be able to meet the needs and preferences of the individual concerned. EVIDENCE: It is usual practice for the Provider to gather as much information as possible to decide if potential residents’ needs can be met at the home. This includes consultation with other health or social care professionals and with the potential resident or their relative representatives. The written records relating to a recently admitted resident confirmed this practice although a form for completing basic details was not fully completed in this instance e.g. photograph. Most information was, however, recorded e.g. next of kin, G.P., details of personal and health care needs, social history and leisure interests. The resident whose record was inspected confirmed that her admission was successful. She loved her bedroom and said she was very happy at the home. Coldwells House and The Stables DS0000064831.V296982.R01.S.doc Version 5.2 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): 7,8,9 and 10 The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. Each resident has a written plan of care. Although these are bulky documents, the system of recording is working well in making sure needs are being met. Medication is safely managed by staff who are competent to undertake this task. EVIDENCE: Staff are supplied with a pre-printed care planning record format. This is a very bulky document and there will be parts that are not relevant to every individual. It would help staff to access relevant information if each resident’s file was sorted into separate sections so that unused record forms are separated from records in current use. The care plan of a resident was discussed with his wife during the inspection. It was evident that the written description of the resident’s needs and preferences accurately reflected the individual according to his wife’s account. During the discussion the wife described how she knows the staff well and feels that they are giving her husband the care he needs. Coldwells House and The Stables DS0000064831.V296982.R01.S.doc Version 5.2 Page 10 There were other examples of good attention to health care needs e.g. the son of a resident was pleased with the attention his father received from staff during a recent medical crisis, a G.P. had praised staff for identifying and alerting him to a discrepancy relating to a medication regime. All residents seen during the inspection visits had obviously received appropriate support with their personal presentation. This was particularly impressive in respect of two residents who require a sensitive approach with this. Medication is being safely managed by staff who have been trained to undertake this work. The Boots pharmacist was satisfied with the medication arrangements at the home during an inspection the previous week, with only two minor recommendations arising from this. Although night staff have not previously been required to administer medication, the situation could change and the Provider has recognised this. Two of these workers are already considered competent to handle medication, and two others are due to attend a relevant training session on 16th June. Coldwells House and The Stables DS0000064831.V296982.R01.S.doc Version 5.2 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): 12,13,14 and 15 The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. Residents are given support to live the way they wish, and their families are encouraged to participate in this work. Meals are planned and presented in a way that respects residents’ needs and preferences and maintains their dignity. EVIDENCE: Residents are receiving the help they need to pursue their chosen lifestyles e.g. one of the younger adults wants to be more independent and explained that the Provider is helping him with this. The second younger adult entertains her boyfriend at the home, attends church and regularly spends overnight stays with her parents. She had an alarm clock to help her get up in time to catch her transport to an external day centre, but staff were checking each morning to make sure she didn’t miss the bus. Visitors were seen at the home during the inspection visits. One relative was cheerfully helping a resident and a staff member in the garden. Two staff, one a qualified physiotherapist, are employed to arrange social activities e.g. trips out into the local community. Other staff described a relaxed routine and more time to spend on socialising with residents. A key Coldwells House and The Stables DS0000064831.V296982.R01.S.doc Version 5.2 Page 12 worker system has been adopted so that each resident has an identified staff member to help them get the best out of their life at the home. The Provider has ordered a ‘History of our family’ book for each resident. This is a very attractive, hard backed book and can be completed by key workers with interested residents and their families. The book will be a valuable record for the family. It will also help staff to appreciate the important aspects of each resident’s life history. There have been comments since the last inspection from a few relatives that suggest communication with them could be improved e.g. relatives not informed when a resident received hospital attention, confusion over allocation of a bedroom. It would be advisable for the new Care Manager to prioritise getting to know all relatives and making them aware of the key worker system and its purpose. This will strengthen the overall picture. Staff were observed serving tea to a group of residents. This was done in an unhurried and cheerful manner with staff giving residents time and any necessary support to they needed to enjoy the meal. The tables were very attractively presented, with tablecloths, serviettes, fresh flower arrangements and a menu for the day. A choice of hot dishes was served from a heated trolley. The staff wore protective aprons to maintain good hygiene. The kitchen assistant was very happy with a new heated food trolley and another tea trolley because they helped the staff to keep food and drinks hot while being transported around the home (Some residents choose to eat in the privacy of their own bedroom). She now worked over the teatime periods so that care staff didn’t have to prepare meals and could concentrate on helping residents. A resident was heard to comment ‘ they came to me at 8pm and asked me if I wanted anything to eat’. It is important to know that snacks are available between meals – particularly during the evenings. Care plans included details to confirm that dietary needs receive regular attention e.g. eating/drinking assessments, nutritional review plus weight monitoring. Coldwells House and The Stables DS0000064831.V296982.R01.S.doc Version 5.2 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): 16 and 18 The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives know how to raise any concerns although some have expressed the view that they have not received a satisfactory response. The Provider and staff know how to recognise and report possible abuse of the residents. EVIDENCE: There is a written complaints procedure at the home. A new system for recording complaints has recently been introduced. There had been no entries to date. This may be an appropriate time to remind staff of the importance of recording all concerns they receive, together with details of action taken to deal with these e.g. a resident described how she had asked for a bedroom door key on more than one occasion but this request had not yet received a response, a relative was disappointed following confused communication about a room allocation. There are, however, examples of good responses by staff. A routine report written by the Provider and sent to the Commission in March 2006 referred to a relative’s concern and action taken by the home to address the problem. Most residents and relatives who completed questionnaires knew who to talk to if they had a problem, and the residents felt safe and well cared for. Staff are due to receive training in July 2006 regarding adult protection procedures. Three training sessions on ‘residents’ rights’ have taken place recently. The Provider has informed the Commission of concerns about the Coldwells House and The Stables DS0000064831.V296982.R01.S.doc Version 5.2 Page 14 vulnerability of particular residents and has spoken to the local Vulnerable Adults Co-ordinator on occasion. Coldwells House and The Stables DS0000064831.V296982.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. Residents live in a high quality, well maintained environment. EVIDENCE: The main building has been completely refurbished during the previous 12 months. It now offers a high quality of private and communal accommodation. The gardens were looking attractive and well maintained at the time of this inspection. The premises were clean and tidy throughout. New carpeting has recently been fitted in The Stables. There were examples of good attention to hygiene measures e.g. liquid soaps and paper towels. Cleaning staff were observed using a purpose-designed trolley for carrying equipment and locking away cleaning materials to keep residents safe. Domestic staffing hours have been increased and daily checks of the premises are undertaken so that any necessary work can be quickly Coldwells House and The Stables DS0000064831.V296982.R01.S.doc Version 5.2 Page 16 identified. There is a Hygiene and food safety policy that was implemented in July 2005. Coldwells House and The Stables DS0000064831.V296982.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28,29 and 30 The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. There are enough staff to meet the needs of the residents and staff receive training so they can do their job well. New staff do not start work until the Provider is sure they are suitable to work with vulnerable adults. EVIDENCE: A recently employed Senior Care Assistant described a satisfactory recruitment procedure that complied with legislation e.g. she had not started work until a satisfactory Criminal Records disclosure had been received. Another recently employed care assistant felt that she had been well supported during her introductory period even though she had previous experience in a similar post. She worked a few shifts alongside more experienced staff to help her get to know the residents. A third care assistant felt that staffing levels had improved and she could now go about her work in an organised but relaxed way. This positive change was borne out by observations of staff as they went about their duties during the inspection and by comments made by them – ‘I love coming to work now’. One of the interviewed staff was aware that she would be meeting with the new Care Manager the following week for a one to one supervision session. She was working towards an NVQ level 3 award. Information from the Provider confirmed that twelve care staff have achieved an NVQ level 2 award Coldwells House and The Stables DS0000064831.V296982.R01.S.doc Version 5.2 Page 18 (or above). This meets the target of 50 detailed in the National Minimum Standard. Coldwells House and The Stables DS0000064831.V296982.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 and 38 The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The residents are benefiting from a substantially improved service that confirms the Provider is able to discharge her responsibilities fully. EVIDENCE: The Provider has been overseeing the everyday care management since her registration last year. It is commendable that she has succeeded in turning a failing service round, with the support of a dedicated staff group. This has involved extensive investment in premises improvements, introducing safe systems of work, and maintaining the morale of loyal staff and care of residents throughout this challenging period. A separate Care Manager has now just started work at the home. Staff and residents were already expressing confidence in the new manager – ‘she is hands on, introducing Coldwells House and The Stables DS0000064831.V296982.R01.S.doc Version 5.2 Page 20 good things already’. When the Care Manager has settled into her new post she will need to apply for registration with the Commission. She should give priority to making herself known to all relatives and confirming with them how they can most effectively communicate with her e.g. through the key worker system. Key worker staff should also be advised how to develop their relationship with relatives of their residents, and all staff should know how to receive and pass on any requests or concerns so that they receive prompt attention. This should include keeping records e.g. use of the new complaints register. The Provider is very experienced and has a good knowledge of legislative requirements and recognised good care practices. She has identified a quality assurance system that has been specifically designed for care settings and has already undertaken one consultation exercise with relatives. The new internal systems for staff incorporate regular audits of the service so that a satisfactory situation can be monitored and maintained e.g. regular evaluation of care plans, regular audits of health and safety aspects. There were examples of health and safety training provided to staff e.g. fire safety instruction on 9th May, 4th June and 5th June (18 staff attended this session). A Care Assistant mentioned recent training in the care of substances e.g. cleaning materials that could be hazardous to health. Coldwells House and The Stables DS0000064831.V296982.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 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 x x x x x 3 Coldwells House and The Stables DS0000064831.V296982.R01.S.doc Version 5.2 Page 22 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. 2 Standard OP7 OP33 Regulation 17(1)a (Schedule 3.) 24 Requirement All care records must include documents listed under Schedule 3. e.g. photograph. The chosen quality assurance system must be fully implemented to produce reports of reviews that are supplied to the Commission and made available to residents. Personal property belonging to residents who are away from the home must be stored securely. (Previous timescale extended) (e.g. Door key must be supplied to resident referred to in this report) Timescale for action 30/06/06 20/09/06 3. OP35 16(2) l 20/06/06 Coldwells House and The Stables DS0000064831.V296982.R01.S.doc Version 5.2 Page 23 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 OP7 Good Practice Recommendations The care plan files should be re-organised so that unused recording forms are separated for records currently in use. This will make the relevant information more easily accessed. The arrangements for receiving and addressing requests, concerns and complaints from residents and relatives should be reviewed with all staff to ensure these are always effectively dealt with, and records maintained to evidence this work. The development of the key worker system, and the appointment of a separate Care Manager, will support this exercise. 2. OP16 Coldwells House and The Stables DS0000064831.V296982.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Office The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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.V296982.R01.S.doc Version 5.2 Page 25 - 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!