Inspection on 23/08/05 for Coldwells House and The Stables

This inspection was carried out on 23rd August 2005.

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 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

Coldwells House and The Stables 23/04/07

Coldwells House and The Stables 18/05/06

Coldwells House and The Stables 10/01/06

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

CARE HOMES FOR OLDER PEOPLE Coldwells House and Stables Coldwells Lane Holmer Hereford HR1 1LH Lead Inspector Wendy Barrett Unannounced 23 August 2005 09:10 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 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 Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Coldwells House and The Stables Address Coldwells Lane Holmer Hereford HR1 1LH 01432 272414 Telephone number Fax number Email 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 KA Rogers CRH 28 Category(ies) of DE(E) Dementia - over 65 - 25 registration, with number MD(E) Mental Disorder - over 65 - 25 of places OP Old Age - 25 PD Physical disability - 3 PD(E) Physical disability - over 65 - 25 Coldwells House and Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The arrangements detailed in the Statement of Purpose and Service Users Guide submitted as part of the registration application must be fully implemented within twelve months of the date of registration 2. Mrs Rogers must work a minimum of 30 hours each week at the home until a separate Care Manager has been registered. 3. There must be a review of systems and procedures for handling and recording of medication within the home. The Commission must be supplied with a plan of action for the future management of medicines within one month of registration. 4. The category PD must be limited to the named individuals residing at the home at the date of registration.. 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 frrom 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 Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The care home known as Coldwells House and The Stables has changed ownership since the last inspection. The new Provider, Mrs. Karen Rogers, was registered to operate the service at the home on 11th July 2005. The Commission was aware at this point that Mrs. Rogers would have to undertake a considerable amount of investment and effort to achieve a satisfactory quality of service provided. She is currently undertaking responsibility for the care management while she recruits a separate Care Manager. The focus of this inspection concentrated on the most essential aspects affecting residents everyday safety and wellbeing. There has been too little time since Mrs. Roger’s registration to expect more wide-ranging developments to be in place. Progress will be reviewed at future inspections. Four staff were interviewed and invited to share their experience under the new ownership. Three residents were able to share their views and approximately 15 other residents were briefly met around the home. Many residents are too frail to answer questions about their care. Mrs. Rogers was given a few days notice of this inspection so that she could be present at this early stage of her ownership of the home. Because Mrs. Rogers had only been in control of the home for such a short period at the point of this inspection no scores have been awarded in this report. This will be done at a later inspection when the service better reflects Mrs. Rogers’ work. What the service does well: What has improved since the last inspection? Coldwells House and Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 Page 6 The new Provider is already addressing work to improve the quality of the service. A programme of redecoration and refurbishment has started, action is being taken to reduce risks to residents, the quality of the food has improved significantly and additional staff have been recruited. A new and safer system of managing medication has been introduced and a new system of recording individual plans of care has been purchased. At this early stage of new ownership there is a clear objective to move away from an institutional style of care to one that acknowledges the needs and wishes of individual residents. There is also better awareness of the home’s capacity, and where care needs cannot be met satisfactorily there will soon be consultation with other professionals and/or relatives to consider finding a more appropriate service. 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 Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Coldwells House and Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 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 standard(s) 1 There is information available to help prospective residents decide whether the home will suit them. EVIDENCE: A new Statement of Purpose and Service User Guide have been written as part of the new Provider’s application for registration. There is an additional condition of registration requiring the Provider to fully develop the service in line with the description reflected in the above documents. This must be achieved within 12 months of registration. There is also an additional condition of registration that restricts the category PD (physical disability – younger adults) to the named individuals currently accommodated. Coldwells House and Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 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 standard(s) 7,8,9 and 10 There is a considerable amount of work to do to make sure that the residents care needs are met. Work is underway to achieve this. EVIDENCE: New care planning records have been brought into the home although staff will need more time to complete them for each resident. The format of these records covers all the necessary aspects of assessment and care planning and they are already in use in two other care homes owned by Mrs. Rogers. Many of the residents are very dependent on staff to help them with their personal care and daily routines. This usually arises from dementia related conditions. There were indicators that this attention is not satisfactory e.g. poor physical presentation (clothing), toast on the carpet next to a resident, facial hair growth on several gentlemen and one lady, lack of evidence of a staff presence to provide company, diversion, occupation. An immediate requirement was made after this inspection to ensure the comfort and dignity of residents at all times. The Provider has recognised that the home may not have the capacity to respond appropriately to the care needs of some residents. There are Coldwells House and Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 Page 10 proposals to request community care re-assessments where necessary. Relatives will be consulted as part of this process. This is a welcome proposal. It is very important that care homes operate within their capacity. Otherwise residents are at risk and staff have unrealistic demands placed on them. A few residents were able to communicate effectively and they relied less heavily of staff support with their personal care and daily activities. They all considered the staff were kind and respectful. They also felt they received any support they required. Coldwells House and Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 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 standard(s) 15 The quality of the food has significantly improved since Mrs. Rogers registration. There is further attention required to make sure the more dependent residents are given the support they need to enjoy their food and drink in comfortable surroundings. EVIDENCE: Residents and staff commented on improvements to the meals service. One resident said ‘we used to get cubed chicken about four times a week. Now the meat is better’. The cook said ‘ we can buy the food we want now’. A Senior Care Assistant said that residents could now request a cooked breakfast. There was a request that staff should make more effort to present dinners attractively on the plate. The observation of a frail resident in a lounge armchair, with food on the floor beside her, indicates a need for a re-assessment of the support needed to access and enjoy meals and the suitability of the place where food is served. This should be covered in the immediate requirement regarding the provision of personal care. Coldwells House and Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 Page 12 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 standard(s) 16 and 18 There is a commitment to take complaints seriously and to protect residents from abuse. EVIDENCE: The information literature includes details of the home’s complaints procedure. Residents who were able to express their views said they feel safe. They had all met Mrs. Rogers and felt able to talk openly to her. The vulnerability of some residents has been recognised and plans put into place to make sure their dignity and wellbeing is protected. Mrs. Rogers acknowledged that re-assessment exercises might create anxiety for some relatives. This is understandable, but relatives will be invited to participate in any consultations about future care arrangements. Social work staff will also be asked to offer support where necessary. There is an idea to invite all relatives to meet together with the new Provider so that they can get to know each other. This suggests an open approach where relatives are encouraged to work with staff in protecting those residents who are unable to represent themselves. Coldwells House and Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 Page 13 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 standard(s) 19 The accommodation needs considerable investment to make it comfortable and safe for the residents. There is preliminary work underway to work towards this end. EVIDENCE: A professional fire safety officer has recently assessed the premises. The report of this exercise had not yet been received at the home at the time of this inspection. It was noted that internal doors were being wedged open. This practice unacceptably compromises the fire safety of the building. An immediate requirement was made following this inspection to take appropriate action to remedy this situation. A gate has been ordered to secure the front patio area. Two residents are known to wander and the gate will allow them to enjoy the fresh air without being at risk of wandering too far away. One resident has been allocated a different bedroom that will better suit her needs. Coldwells House and Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 Page 14 Much of the furniture and decoration is past its best. Some of the furniture is not designed to suit the needs of frail, elderly people. A programme of redecoration and refurbishment is already underway in one of the bedroom corridors. Two residents were aware of plans to upgrade their bedrooms and were looking forward to this. One lady was particularly pleased with the colour chosen for her new carpet. There was a slight urine odour in one or two areas of bedroom corridors. Coldwells House and Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27. There are either too few staff, or staff who lack the necessary skill to meet the needs of more dependent residents. There is work underway to achieve a satisfactory situation. EVIDENCE: Mrs. Rogers inherited a duty rota that had been organised by the previous Provider through to October. Although the rota may accurately reflect the numbers of staff at work at any time, it has also been found that it does not necessarily reflect the names of staff who arrive for work. The arrangement of working hours suits staff personal commitments but does not necessarily meet the needs of residents. Mrs. Rogers is reviewing rotas so that there is a more structured approach. Given the arrangements she has inherited she acknowledges the challenge ahead of her. It will be a difficult task and will need a fine balance between needs of the home and the willingness or ability of staff to respond to changes. A new Senior Care Assistant was due to start work within days of this inspection. A cleaner had also been recruited. The records of actual care hours employed at the home since Mrs. Rogers registration confirms that there has been no reduction in staffing levels. The recent recruitment will actually increase the staffing levels. The Commission has been made aware that some staff are dissatisfied with the staffing levels and the workload since the change of ownership. Staff interviewed at the home did not reflect this view although all of them admitted that there are busy periods and changes to routines did present them with a challenge. This is understandable e.g. residents now have Coldwells House and Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 Page 16 more flexibility about getting up and going to bed times. This affects the routines night and day staff have been used to. It will take time for them to get used to this new style of care although it is a welcome development. It starts to move the service away from an institutional approach towards recognition of residents’ right to choice and individuality. Coldwells House and Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33 and 38. The home is run and managed by an experienced person who understands how to promote and protect the health, safety and welfare of the residents in line with legislation and good practice guidance. EVIDENCE: Mrs. Rogers is currently registered with the Commission in respect of two care homes for older people in Herefordshire. Regulatory work at these services and since Mrs. Rogers registration has identified positive developments. Both these homes had previously been failing to achieve a satisfactory standard and Coldwells House presents a similar challenge. The process of registering a new Provider includes investigation of financial viability, business acumen. Coldwells House and Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 Page 18 A Care Manager has not yet been appointed. Mrs. Rogers registration includes an additional condition that requires her to spend a minimum of 30hours each week at the home until a separate Care Manager is employed. She is currently advertising this position. This inspection took place only six weeks after Mrs. Rogers registration. There are examples described in this report that indicate a commitment to address the health, safety and comfort of residents e.g. fire risk assessment, gateway to enable residents to walk outside without wandering away from the home, new care recording system, safer medication management system. Future inspections will addresss longer term developments e.g. adoption of appropriate policies and procedures. Coldwells House and Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x Coldwells House and Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 Page 20 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement Each resident must have an up to date written plan to show how care needs will be met. Timescale for action Completion of new care recording system to commence by 31st August 2005. Priority to be given to most vulnerable residents. With immediate effect. 2. 10 12(1) 3. 9 13(2) 4. 19 23(4) You must ensure that personal care ensures the comfort and dignity of residents at all times. (Immediate requirement contained in letter to Provider dated 23rd August 2005) The Commission must be supplied with a plan of action for the future management of medicines within one month of registration. (Immediate requirement contained in letter to Provider dated 23rd August 2005). You must address the potential safety hazards of wedging open doors, particularly corridor Revised to Wednesday 31st August 2005. Recorded assessmen t and Page 21 Coldwells House and Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 doors. Where this practice unacceptably compromises the fire safety of the building you must take appropriate action to remedy the situation. (Immediate requirement contained in letter to Provider dated 23rd August 2005) necessary action to be completed by 5pm on 25th August 2005. 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 None Good Practice Recommendations Coldwells House and Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 178 Widemarsh Street 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 Stables E52 E02 S64831 Coldwells House V246348 230805 Stage 4.doc Version 1.40 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. 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