Inspection on 10/03/09 for Coxwold and Priory

This inspection was carried out on 10th March 2009.

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

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

Coxwold and Priory 27/03/08

Coxwold and Priory 17/01/07

Coxwold and Priory 18/01/06

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Coxwold and Priory 9 Coxwold Grove Hull East Yorkshire HU4 6HH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: George Skinn     Date: 1 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Coxwold and Priory 9 Coxwold Grove Hull East Yorkshire HU4 6HH 01482508953 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Avocet Trust care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 12 The registered person may provide the following category of service only: Care Home only Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Learning Disability Code LD - maximum number of places 12 Date of last inspection Brief description of the care home Coxwold and Priory consists of 5 separate houses. They are all part of the Avocet Trust organisation, which is a registered charity. The houses are located at 9 9a Coxwold Grove and 33 35 Priory Grove, all are registered to provide care and accommodation for adults with a learning disability. The houses are located in Gipsyville close to the Hessle Road shopping area to the west of Hull. There are shops, pubs, medical centres and post offices all within walking distance of the houses. 12 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 28 Brief description of the care home Public transport to various parts of the city is easily accessible or a car is used which is arranged through peoples mobility benefits. Each house has a sitting room, kitchen dining room, a garden, a driveway with parking space and staff facilities. All of the bedrooms are single. Information on the services is made available for people via the Statement of Purpose. Service User Guide and inspection report. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one (1) star. This means that the people who use this service experience adequate quality outcomes. The key inspection has used information from different sources to provide evidence. These sources include: Reviewing information that has been received about the home since the last inspection. Information provided by the registered person on an Annual Quality Assurance Assessment AQAA. Comment cards returned from people who live at the home and staff Care Homes for Adults (18-65 years) Page 6 of 28 A visit to the home carried out by one inspector. A site visit was carried out which lasted four (4) hours. We spoke with the people who live at the home and staff and we looked at records relating to the people who live at the home, staff and management activities of the home. During the visit care practices were observed where appropriate and time was also spent watching the general activity within the home. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Date of last inspection 13th March 2008. Senior staff were available to assist throughout the day. The current weekly fees range from 1056.98 GBP to 2449.65 GBP. What the care home does well: What has improved since the last inspection? What they could do better: At the present time there are three staff sleeping in buildings on a night time and no waking staff. Following conversation with staff it was apparent that one of the people who live at the home does get up during the night and wanders and if the staff member who is sleeping in does not hear him he could be vulnerable and even leave the building undetected. It is therefore recommended that the company reconsider the night time staffing arrangements and maybe have a waking night staff to ensure the safety of all the people who live at the home. Currently night staff are sleeping on a camp bed in one of the peoples lounges, this does inhibit that persons freedom choice to use the lounge while the staff are using it for sleeping in purposes. The company need to review this and more appropriate arrangements provided. This has been identified at previous inspections as a requirement but has made been a recommendation in this inspection due to the fact that while this inhibits the persons choice it does not put the person at any significant Care Homes for Adults (18-65 years) Page 8 of 28 harm. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed prior to moving into the home. Evidence: We looked at four (4) files which belonged to the people who live at the home. We saw that these all contained an assessment of the persons needs done by both the home and the placing authority. We saw that there was a copy of the Local Authority Care plan that had been developed from the Local Authority Community Care Assessment and we saw an Individual Programme Plan (IPP) that had been developed by the home in the files. We saw that for one person who was thinking of moving into the home there had been a comprehensive admission process which involved all those who had an interest in the persons care; this included health care professionals and the person. Visits had been made to the home and the admission was being undertaken gradually at the persons own pace. The home were compiling a transition file which evidenced all of the meeting and discussions undertaken regarding the move. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported through a care planning and risk assessment process to live the lives that they choose. Evidence: We looked at four (4) care files, one from each house. We saw that all contained support plans that had been completed with the people who live at the home being at the centre of planning. The care files had lots of information regarding peoples needs including life histories, preference lists, risk assessments, moving and handling assessments, epilepsy management and treatment plans, reviews, various monitoring charts for behaviour bowel care and nutritional intake. Some contained guidance for staff on how to enable the person to maintain their independence. We saw that the individual care plans consisted of support plans and management plans. The management plans were added information for particular tasks and these were usually put in place when some element of risk has been identified; we saw that the support plans were written in a person centred way. We saw that care plans had been evaluated on a monthly basis and a summary written that detailed how effective the Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: support plans were. We saw that reviews of care plans were held with family members and professionals present where appropriate. Staff members spoken with were aware of peoples needs and confirmed they had time to read support plans and update themselves with new information. We saw that daily recording detailed the care provided to people. We saw that Behaviour Management plans were in place that gave staff clear instruction in how to deal with issues as they arose. We saw that the care files were signed by staff to evidence they had read and understood them. At the last inspection it was noted that one person did not have the proper risk assessments in place for the use of bedrails and other restrictive equipment which was being used to ensure her safety; this had been addressed and we saw the risk assessments on the persons file. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to undertake activities that are on the whole their choice, and are supported to maintain relationships and have their dietary needs met Evidence: None of the people who live at the home are currently engaged in work placements however, we saw that everyone participated in a wide range of activities to continue their opportunities for personal development. We saw that each person who lives at the home had a weekly activity plan which included staff support with activities of daily living around the home for some people. These included helping in the kitchen assisting with meal preparations or observing staff as they completed this and tidying their rooms. We saw that people who live at the home take part in a very active social life in the community which included bowling, swimming, shopping, visits to the hairdresser, Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: walks out, going for meals at the pub and visiting friends. We saw that two of the people who live at the home support Hull City; they both have a season pass and attend all the home games. We saw that people who live at the home continue to have a holiday at least once a year and have in the past gone to Euro Disney. We saw that people who live at the home continue to be supported to visit their parents or relatives at home or were visited by them at their own home. We saw that the acting manager and staff continue to promote a healthy eating menu but tried to balance this with peoples likes and dislikes; special treats are offered on occasions. We saw that any restrictions were clearly recorded in the persons care file and where possible agreed. Some of the people who live at the home have been assessed by the dietician and the home followed the recommendations given. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to meet their personal care health and medication needs. Evidence: We saw that support plans had been developed that covered the persons health and personal care needs these included preferences and likes and dislikes. We saw that monitoring charts for behaviour monitoring, epileptic seizure, activity, bowel function nutritional intake, and weight records were in place. We saw that people accessed a range of health care professionals for example hospital consultants, specialist nurses, speech and language therapists, dieticians and occupational therapists. We saw that people attended appointments with dentists, chiropodists and opticians. We saw that people who live at the home have been involved with producing a document called Healthy Me; this detailed the health professionals involved in the persons care and the dates of appointments. The Community Team Learning Disability (CTLD) had been approached to assist in the preparation of Health Action plans. We saw these had been completed for all of the people who live at the home. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: There continues to be no one who lives at the home who is able to self-medicate. We saw that there continues to be written policies and procedures in place for staff to follow regarding administration of medication. We saw that records were in good order and accurately recorded all medication given. We saw that the proper arrangements are still in place for the storage of medication. The home continues to have information leaflets stored in the the medication files to ensure staff were aware of what the medication was for and what side effects to look out for. At the last inspection it was unclear as to whether the training the staff had received with regard to administering medication was accredited. This has been resolved and the manger told us that Boots were undertaking the medication training and this was accredited. We saw that the competency of the staff continues to be monitored with regard to medication. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by policies and procedures to be protected from harm and to raise concerns. Evidence: We saw that the home continues to have a complaints procedures which is displayed. At the last inspection it was noted that the complaints form used could contain an outcome section to show the complainants satisfaction with the outcome of the homes investigation; this has not been done so remains a recommendation. The home told us that they had received two (2) complaints since the last inspection; the CSCI have received no complaint about the home. The home have been the subject of four (4) Safeguarding Adults investigation by the Local Authority one of which is still ongoing. We saw that staff continue to have access to a copy of the Local Authority policy The Protection of Vulnerable Adults POVA. Avocet as a company ensure that all staff have received training about Safeguarding Adults and this is refreshed when needed. Staff told us they understood about protecting people and they have a good knowledge of POVA and the actions that they would take should they suspect an incident of harm had occurred. People continue to be supported by the staff to manage their personal finances; records and receipt of purchases continue to be kept. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: The acting manager is aware of their responsibilities regarding the referral and investigation procedures it is advisable, however, they complete Safeguarding Adults training with the Local Authority specifically for managers. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean warm and comfortable home. Evidence: 9 and 9a Coxwold Avenue are two detached properties each with three bedrooms, one en suite and one which is used as a staff office. Each house has a sitting room kitchen/diner a large rear garden and a driveway to the front with parking space. The integral garages had been converted into an extra downstairs room with the addition of en suite facilities including a walk in shower. In one house this room is utilised as a sensory room and in the other it is an activity room. There is a separate bathroom in each house. 35 Priory Grove is a large four bed-roomed bungalow with an assisted bathroom complete with ceiling track hoist, a sensory room, a kitchen, a lounge/dining room and utility room. A mobile hoist is available for staff to use to safely move people. 17 Priory Grove is a three bedroom semi-detached house with a sitting room, kitchen/diner, a large rear garden with some landscaping and a driveway to the side with parking space. Upstairs there is a bedroom, bathroom, a small sitting room for the people who live at the home and a sleep in room for night staff. The houses we looked at were clean, well decorated, nicley furnished, homely and Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: have secure gardens. Staff had helped people to personalise their bedrooms. We saw that one person has oxygen stored in their room for their use; there needs to a clear sign on the bedroom door indication this and the homes fire risk assessment needs to be updated to reflect the situation. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by a staff team that are trained and supervised in their roll. Evidence: Staff recruitment files are not available at the home as they are held centrally within the organisation; these have been looked at on previous inspections and no issues or concerns were found. Staff told us that when they had been recruited they only started working if they had a satisfactory Criminal records Bureau (CRB) check and all references had been taken. Sometimes staff have to start work before the CRB check is complete this is called working with a 1st POVA check. Avocet ensure these people are closely supervised at all times and records are used to demonstrate this; no one is working at the home currently under a 1st POVA check. The company now employ a central coordinator for all of the staff training and they have ensured that all induction training now meets the guidelines and requirements of all of the recognised training bodies. At the last inspection it was noted that the staff were not receiving the required amount of supervision per year; this has now been addressed and we saw that staff have received supervision at least once every 2 months, sometimes sooner if needed. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: The acting manager told us that the staff had received all the mandatory training but records which evidence this were poor and did not show when the training had been done or when it needed updating. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not supported by an experienced manager, systems are in place to maintain their health and safety but the quality assurance still needs to extended to include the opinions of other stakeholders. Evidence: The home currently has no registered manager, there is currently a deputy manager in post and she has worked there for just over a week, however she has worked for the company for a number of years as a senior in another establishment. This management arrangement is satisfactory for the time being, and as an interim measure, but will not be sufficient in the long term and is not a satisfactory substitute for a full time manager on site. The home have now implemented the company quality assurance system, however this still needs to be extended to include the opinions of other health care professionals who have an interest in the care the people who live at the home. Senior managers continue to visit the home by virtue of regulation 26 on a regular basis, the company have recently introduced a new format for these visit and this now fully Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: identifies areas for improvement and sets time scales for completion. Staff told us that meetings take place on a regular basis. The home continues to have a Health and Safety file that includes a copy of the Health and Safety policy and risk assessment. There are additional risk assessments relating to the use of the equipment around the home risk of falls, hot water, fire and cleaning materials. An Electrical wiring and gas safety certificates are available at the home to show that these areas are safe and do not pose a risk to the people living and working in the home. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 22 The home should record if the complainant is satisfied with the outcome of any investigations undertaken into complaints made. the manager should complete Safeguarding Adults training specifically aimed at managers. The bedroom where the oxygen is stored needs to be clearly marked and the homes fire risk assessments needs to be updated to reflect this. The home should revise the way training is recorded so this can be readily assessable and show in greater detail when training has been done and when this needs updating. The company should employ and register a manager for the homes, this will ensure consistency not only for staff but also for the people who live at the home. The home should expand the Quality Assurance system in place to include the opinions of other stakeholders like doctors and nurses. 2 3 23 24 4 32 5 37 6 37 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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