Inspection on 13/10/05 for The Coach House

This inspection was carried out on 13th October 2005.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Coach House 26/05/09

The Coach House 03/06/08

The Coach House 25/05/07

The Coach House 04/07/06

The Coach House 06/03/06

The Coach House 01/02/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Coach House Mythe Road Tewkesbury Gloucestershire GL20 6ED Lead Inspector Ms Tanya Harding Unannounced Inspection 13th October 2005 13.00 The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 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 DS0000062579.V257406.R01.S.doc Version 5.0 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 Adults 18-65. 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 DS0000062579.V257406.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Coach House Address Mythe Road Tewkesbury Gloucestershire GL20 6ED 01684 299507 01684 299507 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) Kentwood Ltd To be Appointed Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Home to initially open with four rather than six service users and two service users will be using the two spare rooms as living rooms. The connecting doors installed for this purpose must be removed before the final twoplaces are filled. Confirmation of this has been received from the provider. 1st February 2005 Date of last inspection Brief Description of the Service: The Coach House is part of a large house that has been divided in two to provide two registered care homes. The home provides care and support to service users who have challenging behaviours. The home is set in its own large grounds a mile outside the town of Tewkesbury. Accommodation is provided over two floors. The residents all have single rooms. There is a communal dining / lounge area and a small kitchen. A small staff office is provided but the manager’s office is located in the adjacent home. The home provides 24-hour care and support and also organises its own day care activities. There is a designated staff team supported by the acting manager, who was previously the deputy manager. The home is owned and run by Kentwood Care Limited and was first registered in July 2004. The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was supported by the acting manager and lasted approximately five hours. At the start of the visit lunch was being prepared. One service user had just returned from a community activity and the person talked about going out again later on in the day. The service user enjoys being active and this is accommodated by the home. Another resident spoke to the inspector about things they enjoy doing and this including dancing with support from staff. Positive interactions were observed between staff and residents although some responses to the more difficult behaviours should be closely monitored for appropriateness. What the service does well: What has improved since the last inspection? There was evidence of better planning of activities and of service users accessing more community based and structured in-house activities. Regulation 26 visits are carried out by the Registered Provider as required previously. Several new staff have joined the team and this should mean less reliance on agency staff and better consistency of approach. The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Procedures for assessment prior to admission could not be assessed and concerns remain about the robustness of the process. EVIDENCE: One person has moved out of the home since the last inspection. A new resident has moved in six weeks before the visit. This was an emergency admission and the reasons for this were explained to the inspector. The person looked settled into a routine and appeared comfortable with staff. The pre-admission assessment for the new resident could not be examined on this occasion. In the last report a recommendation is made to provide copies of the assessment on service users’ files, as the originals are kept in the Organisational office in another town. The manager agreed to make this information available to the Commission. This is because concerns were identified following the last admission with regards to the assessment and admissions process. Other information was available about the person, including care plans and pen picture from the previous placement. At the time of the visit the home could only accommodate five residents, as one person has the use of an adjacent bedroom as their living area. The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 10 Care planning systems and other information about people’s needs is available by could be further improved through introduction of person centred plans, as this will ensure better involvement of service users in the process. Service users’ personal information may not always be suitably protected. EVIDENCE: The home hopes to adopt the Person Centred approach and a communication book in this format was seen for one person. This came from the person’s previous past placement, but the manager and staff had acknowledged the value of information being presented in this way and are planning to implement person centred principles in care planning for other residents in the home. The manager agreed to provide a sample format of the new care plan to the inspector for reference. A senior staff member with responsibility for implementing care plans was interviewed. She was not aware of the person centred planning but advised of her commitment to involve service users and other staff in the process. The necessary guidance and training about person centred principles should be provided. The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 10 A file containing personal information about a service user was found in the kitchen. The staff advised that this is not the usual storage place for this information. It was noted that the kitchen is used for some administrative tasks mainly because there is a shortage of other suitable places for this in the home. The space in the kitchen is already very limited and consideration needs to be given to how this is managed. The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 16 Service users are supported to lead individual lifestyles and self-expression is promoted. EVIDENCE: The residents are supported to retain individuality of appearance and offered choices of what activities to take part in. People access community facilities such as hairdressers, shops, pubs and colleges. Staff explained that one person was quite reluctant to take part in activities other than those in their room. The resident now enjoys spending time in the communal areas and staff felt this has been a significant progress for the person. An aromatherapist attended the home on the day of the visit and two residents were seen to be receiving some relaxing treatments. Food charts are kept for the residents to provide a record of the food provided and consumed. The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 12 Service users benefit from flexible routines and staffing levels are responsive to the needs of the individuals. One person was having a bath at the start of the visit and two one person has just come back from a shopping trip. The person proceeded to make themselves a drink in the kitchen. The person enjoys going out and are given opportunities to try bowling, cycling, pottery classes, printmaking, swimming and gardening. A daily activity planner was seen in the kitchen. Staff spoken with confirmed that there has been a better uptake of community activities. The manager advised that behaviour challenges are being better managed and this means there are less restrictive practices. Protocol for giving one person time out in their room is not used and the door locks have been amended to ensure the service user can come out of their room freely. The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Some good practices around medication were noted as well as some shortfalls which may compromise service users’ welfare. EVIDENCE: Records provided evidence that medical advice is sought for one person with regards to medication as required. The manager advised that the GP has been asked to provide a protocol which will enable staff to re-administer the medication if necessary. The dentist visits one resident in the home. Medication administration records were examined. The dates on some records were printed off line and staff should be cautious about possible confusion over this when signing for meds. Any amendments to medication dosage / times of administration on MAR sheets should be signed by two people. A protocol for use of rectal diazepam was seen for one person. This was dated September 2004. This had some hand written additions which were not signed or dated. The protocol did not refer to staff requiring training in this procedure and this must be added. Where ‘as required ‘ medication has been administered, the reasons for this are recorded. Staff were clear that the timing of when this medication is administered is crucial as to whether it is going to help the person calm down. The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 14 The protocol for administering this medication was not dated. The manager should establish whether this is still up-to-date. Medication file was examined. This does not provide information about how people want to be supported to take their medication and whether there are issues such as refusal of medication and whether medication is being given covertly. Staff advised that medication is given covertly for at least one person although it was felt that the person knows this and has therefore consented. These details should be established for individuals and added to the files as guidance to staff. Where medication is administered covertly, there must be evidence of a best interest decision involving people outside of the home who can advocate on the person’s behalf. The consent issue must be explored and persons’ views noted. Medication reviews are arranged when required and health issues such as epilepsy are monitored. The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Procedures for responding to aggression offer general rather than individualised guidance and this is not felt to be the best approach to managing behaviours which are different for each person. EVIDENCE: A number of records were examined including protocols for management of violent behaviours. These provided a very general guidance to staff. The absence of specific information about individuals could compromise the quality of support offered in that there may be different triggers identified for people and how staff respond will also vary. For one person guidance is provided in a way of the traffic light system. It has been identified that the person is more likely to display aggression towards staff rather than other residents. A staff member was observed dealing with risk behaviour. This involved the staff member holding service user’s hands to stop the person from pinching and scratching. The manager advised that this is not used as restriction but as a self-protection. This approach should be monitored for appropriateness and effectiveness. Staff spoken with demonstrated a good awareness of what actions they would take to reduce the risks towards other residents if necessary. Incident and restraint records were examined. Some did not specify the type of restraint used. One incident where a staff member placed their foot onto the persons’ stomach was discussed with the manager. The explanation and the description of the event did not raise a cause for concern, but highlighted the need to have a good factual description of the incident. The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 16 Bruise charts are completed to describe any injuries found on service users. There were a number of such records for one person. The manager explained the origin of these and although daily records did not provide a comprehensive detail of the follow up, there was evidence that the person has been taken to see their GP and their relatives have been consulted about the occurrence of the injuries. There is an ongoing issue of self-harm and the manager is looking at practical ways of addressing this. Again it is recommended that the necessary detail and any follow up actions are recorded. The manager confirmed that the practice of ‘time out’ for one person in their bedroom as a response to aggression is not used. Staff who are experiencing difficulties with a service user can summon support from colleagues from the adjacent home through use of pocket alarms. However, it was noted that this help may be delayed because there are fiddly locks on the connecting gates. The manager advised that a keypad security system is proposed for both the internal and the external gates. The home has an adult protection policy. The complaint form for brining concerns to the attention of CSCI should state the contact number 01452 632750. The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 Efforts are made to make the environment as homely as possible although some limitations which compromise people’s safety remain. EVIDENCE: The communal areas and one some bedrooms were seen on the day of the visit, although a detailed inspection of the environment was not carried out on this occasion. Staff spoke about the difficulties they face if a physical intervention is being used. This is because the corridors in the home are very narrow and a two staff approach is significantly compromised. The home is providing accommodation to people who display behaviour challenges or regular basis and consideration should be given as to how such difficulties can be overcome. The requirement made in the last report regarding the access arrangements to the property to ensure ease of access to visitors and to promote a positive image of the service have not been met. The acting manager advised that there are plans for these improvements but was not sure of the details and timescales. The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 18 Since the inspection the registered providers have confirmed their plans to provide an intercom system on access gates by January 2006 and to provide electrical gates by July 2006. Staff were aware of the infection control procedures in the home and confirmed that personal protective equipment was available. The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 34 The residents are supported by a committed staff although the large proportion of the team are new and may not yet be familiar with people’s needs and how these should be met. Assessment of the recruitment procedures could not be carried out effectively and significant concerns about this process will remain until the necessary evidence is provided about the robustness of the process. EVIDENCE: Staff spoken with were clear about the requirements of their respective roles. The senior staff member gave examples about how they would monitor the competency of support staff. New staff are asked to read care plans and support guidance as well as policies and procedures. A staff member was seen communicating effectively with one person in Makaton. Newer staff have to learn these skills and may not establish an effective rapport with the person until then. Several new staff have been employed in the home and this should reduce the reliance on agency staff in due course. The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 20 A number of staff files were examined for new and existing staff. Significant shortfalls were identified in the information which is kept about the staff employed in the home. This included lack of pre-employment checks and details which would contribute the assessment of fitness. This was concerning as a requirement to ensure the necessary information was obtained and kept was issued in the last report. To follow up non-compliance, an immediate requirement was issued to the home and to the registered providers to ensure all required documents are obtained and made available in the home within a week of the inspection. Written confirmation that the necessary documents are now in place has been provided to the Commission. The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed. EVIDENCE: The acting manager has applied for registration with the Commission. A new deputy manager has been appointed. The manager confirmed that one of the registered providers has started making regular visits to the home. Last two visits have been unannounced. However, evidence of Regulation 26 visit was not available in the home. In addition to providing a copy of regulation 26 reports to the Commission, a copy should be kept in the home. The Coach House DS0000062579.V257406.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x x Standard No 22 23 Score x 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 x x x 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 x 16 3 17 Standard No 31 32 33 34 35 36 Score x 2 x 1 x x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Coach House Score x x 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x DS0000062579.V257406.R01.S.doc Version 5.0 Page 23 YES 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 YA1 Regulation 14 Requirement Provide copy of the preadmission assessment for the new resident. Ensure assessment documentation is available for inspection. Personal information must be securely stored but remain accessible to staff as needed. Protocol for administration of medication by rectal route must be revised to ensure this is upto-date and states that only staff appropriately trained in this procedure can administer the relevant medication. (This training must be delivered by an accountable health professional) Where medication is administered covertly, there must be evidence of a best interest decision involving people outside of the home who can advocate on the service user’s behalf. The consent issue must be explored and the person’s views noted. Ensure recording of restraint records provides details of which techniques were used. DS0000062579.V257406.R01.S.doc Timescale for action 31/12/05 2 3 YA10 YA20 17 13(2) 30/11/05 31/12/05 4 YA20 13(2) 31/01/06 5 YA23 13(7)(8) 31/12/05 The Coach House Version 5.0 Page 24 6 YA24 12(4)(a)& 23(2)(a) 7 YA34 19 and Sch 2 & 4 The manager must review and revise the access arrangements to the property to ensure ease of access to visitors and to promote a positive image of the service. (Timescale of 31/04/05 not met) The manager must ensure that the recruitment procedures comply with the regulations, are followed at all times and that the required information about staff is obtained prior to people commencing employment and kept as necessary (Timescale of 31/03/05 not met. Now subject to immediate requirement). 31/01/06 31/10/05 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 2 3 Refer to Standard YA6 YA10 YA23 Good Practice Recommendations Guidance and training about person centred principles should be provided for staff responsible for implementing this approach. Use of the kitchen for administrative tasks should be reviewed and a more appropriate solution should be found. Incident records should provide a clear description of what happened and actions taken by care staff. Approach where staff hold service user’s hands to prevent scratches and pinches should be monitored to ensure this is the most appropriate way of managing risk behaviours and not used to restrict the person unnecessarily. Where handwritten amendments are necessary to the information pre-printed on MAR (if not changed by the pharmacy), this should be added and signed by two staff. Information about how people like to be supported to take their medication should be established and added to the medication file. The telephone number for the Commission should be added to the complaints form. Copies of regulation 26 visit should be kept in the home. DS0000062579.V257406.R01.S.doc Version 5.0 Page 25 4 5 6 7 YA20 YA20 YA22 YA26 The Coach House 8 YA24 Difficulties faced by care staff when managing aggressive and challenging behaviours due to limitations of the environment should be identified and consideration should be given to how these can be overcome. 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