Inspection on 10/06/08 for The Coach House

This inspection was carried out on 10th June 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

The Coach House 11/08/06

The Coach House 30/01/06

The Coach House 22/08/05

The Coach House 30/11/04

The Coach House 09/07/04

The Coach House 19/02/04

The Coach House 04/12/03

The Coach House 19/09/03

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Coach House 67 Keyhaven Road Milford-on-Sea Lymington Hampshire SO41 0QX Lead Inspector Joy Bingham Unannounced Inspection 10/06/08 09:30 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 The Coach House DS0000011880.V365591.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. The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Coach House Address 67 Keyhaven Road Milford-on-Sea Lymington Hampshire SO41 0QX 01590 642581 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) donnalynfry@tiscali.com Mrs D L Fry Mrs D L Fry Care Home 17 Category(ies) of Dementia - over 65 years of age (17), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (17), Old age, not falling within any other category (17) The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Currently has three service users under 65. No future admissions in this category 11th August 2006 Date of last inspection Brief Description of the Service: The Coach House is a care home providing personal care and accommodation for up to seventeen older people with or without dementia or mental ill health. The home is owned and managed by Mrs Donna Fry and is situated in a quiet residential area of Milford On Sea with local amenities a short walk from the home. The Coach House consists of a three storey building with thirteen bedrooms, nine are single and three of the four double bedrooms are en-suite. There is a dining room and lounge with conservatory overlooking the home’s enclosed rear garden. A stair lift provides access to the first floor. Thereafter 13 stairs provide access to the second floor, comprising two residents’ bedrooms, and a staff bathroom, kitchen and two bedrooms for staff. The provider makes information available about the service, including a statement of purpose and service user guide and the Commission for Social Care Inspection’s report (CSCI) to prospective residents on request. The fees charged are dependent on the type of facility required and the care package and needs of the individual service user. They range from £415 to £500 per week. There are additional charges for hairdressing, chiropody, dry cleaning, manicure and hand massage, private telephone costs, newspapers and toiletries. The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service continue to experience adequate quality outcomes. The purpose of the inspection was to find out how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These included the Annual Quality Assurance Assessment (AQAA) completed by the home, and comments from residents and staff. An unannounced visit to the home was carried out over two days, 10 and 11 June, lasting a total of eleven hours. During this time we were able to have a full tour of the premises, including each of the 13 bedrooms, lounge, kitchen, dining room, conservatory, bathrooms and toilets. We had private discussions with the manager and three staff, three visitors and contact with a large number of the residents of the home. Comments were obtained from professional stakeholders. We sampled staff and care records, and policies and procedures that relate to the running of the home. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Commission for Social Care Inspection (CSCI). What the service does well: What has improved since the last inspection? Two requirements were made at the conclusion of the last inspection and both have been met. These concerned keeping the home odour free and the The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 6 establishment and maintenance of a quality assurance system for collecting the views of residents, relatives and stakeholders. 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. The summary of this inspection report can be made available in other formats on request. The Coach House DS0000011880.V365591.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 The Coach House DS0000011880.V365591.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users’ needs are assessed before admission. They are given opportunity and information to find out about the home before they are admitted. EVIDENCE: Five service user pre-admission assessment records were inspected. These had been completed by the manager, signed and dated. The assessment for each individual led to a number of support plans, and relevant risk assessments. A service users’ handbook was provided and the manager said that she continually updates it and prints one off each time one is needed to ensure all the information is up to date. It incorporates all necessary information and offers both long stay and short-term care. It encourages residents to visit the The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 9 home and sample the atmosphere and level of service. Day care can also be arranged on a regular weekly basis. A months’ trial period is always given before taking up permanent residency. Two people had been admitted to the home recently and we spoke with them to verify that what we were told had been their experience. Records indicated that another resident had stayed there recently for approximately four days respite care. A copy of the last inspection report was available for anyone from the home or visiting to read. It was kept in the office located at the entrance to the home. Nine surveys had been completed by the residents. Some had been assisted to complete the forms by their families. All nine said they had enough information about the Coach house before they moved in so they could decide if it was the right place for them. Eight of the nine surveys were clear that they had been supplied with a contract of residence. The residents we spoke with could not remember their experience of actually arriving at the home but said they were unable to think of any way this could have been improved for them and spoke well of the support they had received. The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical health care needs are met in some areas for most of the service users. However, more attention to the management of medication is necessary to ensure residents are fully protected and supported. Care plans are weak in the holistic approach to care planning and need development in order to ensure care and psychological/emotional support to the whole person. The processes for adjusting care and keeping all staff fully informed are unclear which can mean that required action is not followed through comprehensively by all the staff. EVIDENCE: Five of the care plans were inspected. They concentrated on the physical care needs including mobility, continence, nutrition, awareness and communication with guidance for staff to follow. We noted that some were very detailed and they demonstrated that some thought had been given to person centred planning of their physical care. They included a monthly review that was dated and signed. The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 11 Although the required basic contact details were available in the residents’ personal records limited recording was made about the level and style of family contact. We were told that all of the residents were experiencing some degree of dementia and we noted a small number presented quite advanced symptoms, so we expected to find some recording of personality and personal identity beyond the physical needs, with guidance to the staff on managing certain behaviours. Some residents were prone to wander and others to asking repeatedly the same question, or repeat the same action. This was discussed with the manager who agreed it should be part of the assessment and care planning process when looking at the needs of the whole person. Files showed evidence of visits from and to their General Practitioners, opticians, and annual dental check ups. The chiropodist visits regularly. There were areas relating to personal care where we perceived a degree of uncertainty about how matters were handled. We received different information/guidance depending on whether we spoke with the manager, a member of staff or looked at the records. The following examples refer: At lunchtime to the question whether any of the residents were diabetic, the deputy manager said ‘no, none’. Another member of staff said someone was ‘borderline’. However, one resident’s care plan recorded she was a diet controlled diabetic, ticked as high risk, and guidance to staff was ‘ensure no sugary foods are given’. The care plan referred to the use of daily test sticks but no recording of these test results were found. A carer told us this is now done periodically by the district nurse, yet the manager told us it was essential and expected that this was done by the staff every day. She agreed to follow this up with the staff group. The monthly review records indicated a change in the night pattern of activity for one resident on the second floor, yet the manager was unaware of this fact and the implications of this for the waking night staff. There was no written evidence available that any special provision to attend to this had been made. The medicine cupboard in the kitchen was inspected, and the records were checked. It was obvious from the outset that the style and location of the cupboard was unsuitable. It was a hot June day and the oven was in use. The temperature was taken in the cupboard and found to be 31.5 degrees. Instruction on some of the stored medicine was to be kept below 25 degrees. The wooden cupboard doors were very difficult to open with the key as they were slightly out of alignment. The manager said that she was ordering a new drug cupboard with an inner controlled drug cupboard and agreed it was necessary to re-site it in an alternative location. Other issues needing attention were: The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 12 On the medicine administration sheet the day of the week and the date attached to it did not always synchronise. Although the staff member spoken with was aware of this, the manager expressed some surprise and it has the potential to cause confusion. • For one resident there were three omeprazole capsules allocated by mistake on one day and only one the following day (both errors). There was no apparent note made by the member of staff checking them in to reassure that the errors had been detected. • One resident had apparently missed receiving her eye drops for two consecutive lunchtimes. The manager was not aware of this. • MST that should have been returned was still held in the cupboard. The manager removed it to return it to the chemist. • it was unclear whether patches of buprenorphine, that was about to run out, had been re-ordered. • Of the medicines kept in the fridge-one container’s instructions ‘once opened to be kept upright’ was not being followed. • One resident had medication in the drug cupboard but we could find no record of it on the administration sheet. All of these points were drawn to the attention of the manager who noted the importance of following them up. We reminded the manager of her role and responsibility in supervising and monitoring the staff performance in this very important aspect of care. A medication procedure was located in the drug cupboard for easy reference. Staff had been given training in drug procedures. From the nine survey returns the home scored a positive 94 satisfaction about receiving the care and support the residents need. Comments include: • I am very happy and cared for. They are very kind and helpful. • I like it here. Relatives’ comments include: • I am more than happy with everything here. • The home keeps us informed. They always ring us up 24 hours a day if need be. • We like it. It’s family-run. To the question about receiving appropriate medical support there was 100 satisfaction expressed. • The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Able residents are able to take part in peer, age and culturally relevant activities, and participate in a limited way in the local community. They retain the links they wish to have with family members. Residents would benefit from more stimulation and programmed activities both in–house and external. People are provided with home cooked and varied nourishment. EVIDENCE: The home offers residents the use of a lounge and a sunny conservatory. On arrival at the inspection there were a number of residents in the lounge and cheerful ‘dated’ music was playing. They confirmed they liked the music. The dining room displayed a weekly list of activities sometimes organised by the staff and sometimes involving external visitors. It included armchair exercises, board games, puzzles, quizzes, worship TV, music tapes, motivation sessions. No-one could remember going out on a trip at any time but the staff assured us that the staff do accompany some residents to the shops in Milford and occasionally take them for a short car drive to the sea front. The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 14 In the rear garden, overlooked by the conservatory, there was an absence of colourful plants. There were many planters full of weeds that could have been used. The lawn was uncut and uneven. For visual interest ideas about a water feature, more colour and bird feeders were discussed. The service user guide includes reference to the activities that are available. The manager said she would like to have a people carrier and organise longer trips out. Some families are supportive and visit very frequently and some do go out with their families and friends. In response to the question about the activities 7 surveys said they were 100 satisfied, two were partially satisfied, leaving room for some improvement. The staff were able to tell us about the responses of some residents to join or not join in with certain activities and the fact that their preferences are respected. However, we discussed the possibility of enhancing the care plans to include more detail about the social, cultural, recreational and occupational characteristics of each person in order to help identify lifetime interests and hobbies, and to make the activities more person centred. During the day three people visited. They told us they visit whenever they like, are always made welcome and are given hospitality. We were told that even Christmas days have been spent at the care home with their family member. The service user guide includes information on contact with family and friends. Visitors are asked to inform the person in charge of their arrival and departure and people are expected to sign in and out of the visitors’ book for safety reasons. We were told by the more able residents that there were no restrictive rules about when to go to bed and times to get up and they could use their rooms whenever they wished. During the day there was evidence of one reserved resident using their room and preferring their own company. However they did join in with the meal times. The manager said that people may bring in any items of their own that they wish to. Although all rooms were furnished and complete there was limited evidence of people bringing in much personal memorabilia, which is important for a client group with dementia. The preparation and serving of lunch was observed. During the preparation time a number of residents came to the door of the kitchen for contact and communication. The staff member had no choice but to divert from her task of cooking to remind them of the appropriate time for lunch and redirect them on where to go. This was done kindly and patiently. The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 15 The lunch on the day of the inspection was home made cottage pie, mixed root vegetables, carrots, sprouts, followed by stewed apple and custard. The later meal was soup, pizza, side salad and strawberry cheesecake. The residents seemed to enjoy the main meal and no complaints were offered. We noted however that the frozen sprouts were boiled for a very long time before they were served and must have lost some integrity. Carrots were also duplicating what was in the root vegetable mixture when an alternative vegetable would have made for more interest. Comments about meals at the Coach House include: • Everything is fine • The food is very good • We get plenty to eat • We can see the food being cooked • The meals are good • My mum likes a marmalade sandwich if she’s hungry and they will always do that for her. The home has a menu plan and the manager confirmed that all residents can contribute comments and ideas for change. Of the 9 survey returns 5 said that the meals are always good and 4 said they are usually good. The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know that all complaints will be taken seriously and acted upon. They are protected by staff training and awareness of safeguarding issues. EVIDENCE: Of the 9 surveys returned 8 said they knew how to make a complaint. All knew who to talk to if they were unhappy about anything. The service user guide provides a complaints procedure that incorporates timescales. A complaints log was available but did not contain an entry. As we were aware of at least one complaint which has occurred during the last inspection period and one safeguarding matter we discussed the need to keep up this record of complaints. The record should include details of investigations that have been conducted and any outcome/action. Both these matters had been brought to conclusion. In discussing the matter of complaints and suggestions the manager expressed an open attitude. The home has recently conducted their own quality assurance from questionnaires and this gave positive feedback in many areas. We discussed the possibility of a suggestions box being available for people to use. We spoke with three staff members. All were aware of and had been trained in whistle blowing and the protection of vulnerable adults’ policies. They were The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 17 able to talk about potential aspects of abuse and expressed readiness to refer any cause for concern to the manager. The residents spoke warmly of their feeling of security within the home, and the staff team. One resident said ‘they don’t talk to one and not the other. I’ve never had any trouble. Another said ‘we are all very happy’. The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 21 24 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Coach House provides a pleasant, homely environment. Some parts of the home are unsuitable for elderly residents with dementia. EVIDENCE: We undertook a full tour of the premises looking in each bedroom, the lounge, conservatory, dining room, laundry, kitchen, food store room, bathrooms and area of staff residence. The home has three floors. All day rooms are on the ground floor. A stair lift is available between the ground and first floor. Twelve steps take you to the second floor where two residents’ rooms are located. These are not en-suite rooms, and we were concerned that there is no toilet or bathroom facility on the top floor for these residents to use. Neither of the residents were able to The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 19 comment on whether this was important to them, either out of reserve, limited spoken English, or some confusion. Generally the home is well furnished and there is adequate provision in each room. There are 13 bedrooms. Downstairs: 4 single, 2 shared rooms (one with en-suite) Upstairs: 5 single, 2 shared rooms both with en-suite. Second floor: 2 single rooms, with staff facility of bedrooms, kitchen, and a large bathroom. There are three bedrooms in the home where the doorway opens immediately on to two steps down before you reach level floor. This is very hazardous for elderly people who may have dementia who would not remember the steps are there. The manager acknowledged that she had forgotten herself and had once fallen into one of the rooms. Also the means of leaving the room involves opening, then holding open the door and climbing up two steps. This is difficult for elderly frail persons. The hazards of continuing to use these rooms and options for changing them were fully discussed with the manager who agreed that there should be immediate risk assessments completed for people occupying these rooms. A requirement has been made to improve this accommodation at the end of this report. There are three bathrooms in the home, one on each floor with a separate wc facility on the ground and first floor. Both ground and first floor bathrooms have bath aids. The ground floor bathroom close to the lounge and dining room is internal and depends on mechanical extraction. At the time of the inspection this did not seem to be adequately removing bathroom odours. The décor in this room is tired and jaded. The mirror is worn and peeling and the sealant around the wash hand basin requires renewal. The light cord requires cleaning or replacing. The second floor bathroom is dedicated for staff use only which means two residents on this floor must descend 12 steps to the second floor to use the wc and bathroom facility. The manager agreed this arrangement does not currently meet the national minimum standards and said she would give it her prompt attention. A requirement has been made to improve this accommodation at the end of this report. Bedroom 1 has a poor odour and this was brought to the manager’s attention. The ground floor wc contained alcohol gel in place of a liquid soap dispenser. The manager said this should have been put in another location. The lounge is light, bright and well furnished. The conservatory leads into the rear garden. The furnishings are tasteful but the chairs need cleaning on the arms where they have become soiled. Some of the home’s carpets have large loud patterns and this was discussed with the manager. She was aware that research around dementia care suggests large patterns can be hazardous for The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 20 elderly people with poor sight or diminished mental capacity who may be distracted by them and perceive them to be steps. We were told that a programme of replacement is underway. The dining room has a number of small tables seating up to four people. The kitchen is large and well equipped. The large window is sealed and ventilation is through the doorway, protected by a fly screen. The extractor was not in working order and on a hot June day with cooking taking place the temperature in the kitchen was very hot for working. We took the temperature and it was 31.5 degrees. The laundry is located at the far end of the ground floor. Access must be through the dining room for most bedrooms. It is small, equipped with a domestic washing machine. The manager confirmed that only personal clothing is washed in the home. We were told that bed linen and towels are sent to an outside laundry. There is no tumble dryer available in the home. Clothes are dried hanging up in the laundry. The entry to the home lacks signage to it. The front wall border lacks plants (we were told they had been recently stolen) and the gravel drive is weedy. The entrance is to the side of the property through a five bar gate which is coded for security. The rear garden has an uneven lawn, and had not been recently cut at the time of the inspection. The planters were either empty or full of weeds, as was the gravel path at the rear. There is ample wooden seating dotted around the garden in need of some treatment. We discussed with the manager that the opportunity to create a colourful and interesting outlook and engagement for the residents had been missed. She has expressed plans to change this aspect of the home’s external environment. In the survey returns from residents the home score 100 for the home being always fresh and clean. The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff group works hard to provide a service to the residents and at times is overstretched. The residents benefit from kind and caring personnel whose skills and understanding would be enhanced with further training and more dedicated care time to engage with them. EVIDENCE: A staff rota was available, demonstrating that the normal roster is two carers for each day shift. A deputy manager works on three days a week from 09:30 to 3:00pm. A cleaner works 3 hours each morning from Monday to Friday. The senior carer is responsible for cooking the meals. The manager said she also works from 11 am to 6pm, sometimes from her own home. At night there is a staff member, who lives on the premises who will be sleeping in and a second night carer who is awake. On the day of the inspection we were concerned to note that the resident carer had been asked by the night staff to change her work pattern from 11am to 8pm shift to a long day of 8am to 8pm. We were told the night staff became were aware there was insufficient staff coming on the next day. The carer was very willing to lengthen her shift, but observation during the day demonstrated this carer was non-stop in her role changing from carer to cook, to activity organiser. She broke off from cooking in order to redirect residents from the The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 22 kitchen, and at times we were told she had had to leave cooking in order to toilet a resident. There was uncertainty about whether she had been able to take a break during the day. This caused us to raise the question with the manager as to whether staffing levels are adequate or incorrectly deployed. She agreed a long 12 hour day was not ideal and that a dedicated cook should be engaged. The survey returns from the residents informed us unanimously that the staff always listen and act on what they say. There was a very high rating given for staff availability when they need them. Comments from the home’s internal quality assurance include: When asked what are the three most impressive aspects of the home all eight relatives included a comment about the staff. • Helpful staff • Caring staff, friendly • staff, staff, staff • Friendliness, how well residents relate to staff • Friendly caring helpful staff • The kindness received by the residents at all times. We noted from the staff records that there are two local staff members, and seven foreign staff, making a team of nine. Staff records were in place and work permits where available for all but one of the staff. We discussed with the manager the need to clarify with the Home Office the legal requirement for a work permit for someone who has residency permission due to relationship, but not a work permit. Staff files were full and in no particular order, making it difficult to check on if legal documentation was included. In the interests of clarity and efficiency we recommended that the files be put into a modular format for easy reference. The staff were very kind and attentive in their approach and interaction with the residents. As most of the staff are foreign and their accents were not all easy to understand we discussed with the manager the importance of clear speech to those who are elderly, sometimes hard of hearing and also have dementia. We observed an occasion when a member of staff failed to raise the step for a resident leaving the chair lift which made it harder for her to get a firm footing and move forward. This was drawn to the manager’s attention. All of the staff are fitted into a National vocational qualification (NVQ) programme. The deputy already has obtained NVQ level 4. Five of the carers are about to complete level 3, and one will complete level 2. Two of the staff are trained nurses in their own country. The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 23 The home’s training records shows that external and internal training is done. The staff confirmed that they undertake training regularly and we viewed copies of individual staff training certificates and other records of instructions. The manager was able to provide a training matrix for staff in food hygiene, diet and nutrition, emergency first aid, moving and handling, health and safety, infection control, fire training and the protection of vulnerable adults. We discussed the level of training for the home in understanding dementia which to date has been very limited. One senior carer told me she had been given training material to read and complete in paper format, which had been helpful. One of the comments from staff in the confidential survey return was in relation to what the home could do better, ‘continuous training for staff to gain new ways on delivering support and care to service users and to provide a better, more effective technique in dealing with clients’ needs’. We discussed with the manager that she prioritise learning through the effective courses provided by the Alzheimer’s Disease Society, given the high number of residents with a diagnosis of dementia. The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 36 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents benefit from a homely environment, where their health, safety and wellbeing are supported by kind attitudes. All the residents, particularly the more frail residents, would benefit from the service providers having more training in dementia and providing an increased level of day-to-day management and supervision. EVIDENCE: The service user guide informs that the owner and manager, Mrs Donna Fry, has over 33 years of relevant experience. She has owned the Coach House since 1994. She is a registered nurse in mental handicap and has obtained the registered manager’s award and national vocational qualification (NVQ) level 4. The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 25 The last inspection required the manager to establish and maintain a system for reviewing and improving the quality of the service provided at appropriate intervals. Since then Mrs Fry has surveyed the opinions of the relatives on behalf of the service users, and visitors to the home and provided us with a copy of the results. She told us she has also considered providing a confidential suggestion box for people to comment or give ideas for improvements. We discussed quality assurance being further developed by her consulting formally with care managers and medical and nursing staff who engage with the home. In the Suggestions for improvements section comments from relatives include: • More interaction between staff and residents. • More activities to entertain patients • More outings or activities • The home runs smoothly as it is • Everything seems to be taken care of • Can’t say anything to improve their circumstances. The manager said she would like to provide transport for outings for the residents when she is in a position to purchase an appropriate vehicle. We discussed the current client group that the Coach House accommodates. We were told that all the residents have dementia to some degree. Mrs Fry said she had not had specialist training in dementia care. We made a requirement as a priority that she pursue further professional training for both herself and her staff. The manager is aware of her responsibility to provide for the health and safety and welfare of the residents. Some of that role is delegated to her deputy. Records and policies were in place, and service agreements and receipts for maintenance of equipment were inspected and found to be in order. The accident book had received entries by staff members as events/incidents happened. We discussed with the manager that she countersign each entry to verify she is aware of the incident and takes any remedial action to ensure if there is a hazard that it is not repeated. Staff told us that they receive regular supervision and Mrs Fry also confirmed she meets with staff. Notes of what is discussed with the agreed priorities are not given to the staff members, and it was recommended that this should be done. We discussed the level of day-to-day management that Mrs Fry is currently providing. During the course of the inspection we had received indicators that the home requires a greater input of management time and attention to reassure that she is actually in control on a day-to-day basis. Examples of concern include: • not knowing the name of one of the residents who had been in the home for some time • being unaware of some changes in residents’ needs The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 26 • • • • not seeing some of the obvious needs for TLC around the home and the grounds unaware that the night staff had needed to adjust the duty roster lack of monitoring of some of the staff practice uncertainty about some of the drug administration. Mrs Fry acknowledged that she is looking for someone else to pick up responsibility in the day-to-day management of the Coach House. However she said that she had found discussion about what could be improved relatively easily both stimulating and motivating. The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 27 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 1 2 X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 3 3 2 The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (1) Timescale for action Care plans must cover the social, 01/10/08 psychological and emotional needs of each resident to ensure they receive holistic care. The manager must supervise the implementation and maintenance of the care plans on a day-today basis to ensure all of the assessed needs are met. The manager must ensure that 01/08/08 medication is administered safely and regularly monitor and keep under review the staff’s adherence to the recording and storage and handling of medication, to ensure there is no mishandling. An appropriate drug cupboard must be provided and allocated in a suitable place in the home, to ensure medicines are accessible by staff and held at appropriate temperatures. The manager must ensure a risk 01/09/08 assessment is completed by a competent person for each of the residents using rooms with steps and ensure all residents are DS0000011880.V365591.R01.S.doc Version 5.2 Page 29 Requirement 2 OP9 13 (2) 3 OP19 13 (4) (a) The Coach House 4 OP19 23 (2) (j) 5 OP36 10 (1) provided with safe and hazard free accommodation. The manager must provide a toilet facility to the two residents on the second floor, to ensure each resident has access to a toilet close to their bedroom accommodation. The manager must manage the care home on a day-to-day basis with sufficient care and competence to ensure the staff team are well lead and the ongoing health and well being of each resident. 01/10/08 01/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Coach House DS0000011880.V365591.R01.S.doc Version 5.2 Page 31 - 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!