Inspection on 20/02/08 for The Coach House

This inspection was carried out on 20th February 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 found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Coach House 21/01/09

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

CARE HOME ADULTS 18-65 The Coach House Church Road Baschurch Shrewsbury Shropshire SY4 2ED Lead Inspector Sue Woods Unannounced Inspection 20th February 2008 09:45 The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 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 DS0000071103.V360092.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 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 DS0000071103.V360092.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Coach House Address Church Road Baschurch Shrewsbury Shropshire SY4 2ED 01939 260 150 01939 260 150 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) Select Health Care (2006) Limited Daniel Andrew Brown Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 categories: 2. Learning Disabilities (LD) 8 The maximum number of service users to be accommodated is 8 Date of last inspection Brief Description of the Service: The Coach House is a care home registered with the Commission for Social Care Inspection to provide personal care and accommodation for a maximum of eight adults with a learning disability. The Registered Provider of the home is Select Healthcare (2006) Limited and the registered manager is Mr Daniel Brown who is also the registered manager for The Old Vicarage, a care home on the same site. The home is situated in the village of Baschurch, Shropshire and is within walking distance of the post office, general convenience store and local pubs. The accommodation provided is very spacious and furnished to a high standard All bedrooms have spacious en suite bathrooms and additional bathing facilities are also available. Seven of the eight bedrooms are on ground level. One bedroom is accessed via a steep flight of stairs. The home is situated in wellmaintained extensive gardens. Information is shared with people who live at the home in the Service User Guide. Advocacy support is promoted and a quality assurance system is in place in the form of questionnaires for people who live at the home and relatives. The Coach House DS0000071103.V360092.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 that people who use this service experience adequate quality outcomes. The unannounced inspection of The Coach House took place on 20th February 2008 between 9.45 am and 2.30 pm. This was the first inspection of The Coach House and the inspector reviewed all 22 key standards. Information to produce this report was gathered from the findings on the day and also by review of information received by CSCI prior to the inspection date. A quality rating based on each outcome area for service users has been identified. These ratings are described as excellent/good/adequate or poor based on findings of the inspection activity. On the day of the inspection the inspector spoke with the three people who live at the home and staff on duty. In addition staff completed surveys and the inspector looked at care plans and other documents detailed within the report. Feedback via surveys was also received prior to the inspection from all three people who live at the home, a relative and an advocate. The manager of The Coach House was on duty at the time of the inspection. What the service does well: What has improved since the last inspection? This was the first inspection of The Coach House. The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 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 DS0000071103.V360092.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Procedures are now in place to enable the successful admission of a new service user to the home. EVIDENCE: The Home’s Statement of Purpose and Service User Guide contain the majority of required information to enable someone to decide if the home is suitable for them. The manager is looking at redeveloping these and other documents to make them more user friendly and specific to The Coach House. Although care plans were reviewed prior to people moving from The Old Vicarage to The Coach House there was very little evidence to suggest that assessments of need had been carried out by health or social care professionals. The new organisation has however got a comprehensive admissions procedure that the manager stated he would be using for all future admissions. Prior to moving in people had visited the home and stayed for meals. The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7,and 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care plans generally support staff to ensure that the people living at the home receive care in a way that they prefer. However this may not happen if plans do not reflect peoples changing needs. Risk assessments show that support is given in a safe manner however people may be vulnerable if assessments are not reviewed and updated as needs and circumstances change. EVIDENCE: As part of this inspection two care plans were looked at. Daily routines and likes and dislikes were well recorded to ensure that staff were aware of how people like to have their care and support needs met. However they had not been updated since the move to The Coach House. The manager stated that all files are to be redeveloped using a new person centred format. Work has recently started on producing ‘Life Story’ books for everyone. The manager is involving family and friends in this process. The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 Page 10 Currently care plans do not easily show appointments with health and social care professionals. Risk assessments were in place and had been reviewed however they did not always accurately reflect information contained in the care plan or reflect the new environment. The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,15,16 and 17 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People benefit from supported family contact and involvement however a combination of poor record keeping and inadequate staffing levels suggest people may not be having a healthy diet or having access to activities outside of the home affecting the overall quality of their lives. EVIDENCE: Family contact is important to people living at the Coach House and staff support this to happen. One relative who completed a survey said she is ‘Always welcome and keeps in regular telephone contact’. Staff at the home support and encourage people to take part in in-house activities such as crafts and games such as skittles. The home has a flat screen TV that is very popular with the people living at the home. The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 Page 12 Weekly planners seen reflected only minimal activity, namely housework and family visits. The reason for this, recorded on the planner of one person, is that he doesn’t like to plan events but just do them. The current staffing situation within the home however severely affects the ability for people to make choices for activities outside of the home either pre planned or spontaneous. The staff team maintain an individual record of all foods eaten and this was seen during the inspection on the care files reviewed. The home does not use menus for meal planning. The manager could not demonstrate that people are offered a choice in their diet and some records seen did not support nutritious options. It was reported that a dietician has regular input to support one person living at the home although this is not reflected in the care plan. The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 18,19 and 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People are supported in ways that they prefer and their physical and emotional needs appear to be met however the lack of written up to date information in some circumstances may suggest that peoples current or changing needs may not be met. People are protected by effective systems for the storage and recording of medication. EVIDENCE: Care plans seen identified in detail how a person prefers for his personal care to be carried out and outlined preferred routines. Staff, at the time of the inspection, were seen to interact well with the people they were supporting and it was apparent through smiles and other gestures that people had a good rapport with the staff. Surveys supported this observation as an advocate for the people living at The Coach House noticed ‘how well respected and spoken to all clients are by staff’. He went on to say that ‘carers always listen to service users and they are always treated well’. The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 Page 14 A relative commented via a completed survey that she was impressed that staff receive training to support identified health care needs. There were some differences in the support that the manager said a person needed or received and what was recorded in the care plan. (See requirement for standard 6). Medication arrangements are generally satisfactory. On the day of the inspection the manager had yet to complete a protocol to support the administration of medicines required ‘as and when’. When the inspector visited the sister home the following week such protocols had been implemented for everyone. On the day of the inspection the home was seen to be working closely with a local health care professional to support a man to receive some tests. This joint working will hopefully improve the person’s quality of life. The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People are protected by procedures in place for managing concerns and complaints and can be confident that their concerns will be listened to. EVIDENCE: The Coach House has a complaints procedure that is shared openly with relatives and advocates of the people living at the home. One file seen contained a copy of the pictorial complaints procedure. Select Healthcare has their own policies and procedures for complaints, protection and abuse. These are being introduced to the home gradually over the next few months but are available for reference. There have been no complaints received by CSCI or the home about the service provided at The Coach House. Arrangements for the handling of people’s money are said to be being ‘radically changed’ by the new providers and therefore were not reviewed on this occasion. The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 24 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are provided with a clean, well-maintained and safe place to live. EVIDENCE: The Coach House opened in August 2007 and comprises of largely single story accommodation. There are only currently three people living at the home and therefore only part of the building is being used on a regular basis. All areas were seen to be clean and ‘homely’. One person was happy to show the inspector his room and other areas of the home. The manager said that the home has a cleaner for five days a week although she was not working on the day of the inspection. The maintenance worker however was available and explained his role across The Coach House and The Old Vicarage. He reported that he doesn’t yet have a budget for his works but all works required are authorised without a problem. On the day of the inspection the manager pointed out minor repairs that were in the process of being addressed. The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 Page 17 There were no fire exit signs anywhere in the building and the manager stated that he would address this issue although the local fire officer had not required them when the home was registered. Cleaning products were seen stored securely in a locked laundry room. Data sheets were available to support products seen although risk assessments have yet to be completed. The manager is addressing this with the support of the home’s health and safety officer. The manager said that the homes domestic washing machine is adequate to support the current amount of laundry however the providers are to replace it with a bigger one once occupancy increases. The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34, and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are supported by an enthusiastic team who work hard to meet people’s needs however staffing levels within the home are not enabling people to access community resources and may be compromising safety if existing care plans are accurate. People who live at the home will receive a better quality service if staff that are supporting them attend all mandatory training opportunities in safe working practices. EVIDENCE: Staff who spoke with the inspector were enthusiastic about their roles and enjoyed their work. One staff member said that she was ‘impressed with the facilities’ at the home. Staff felt that The Coach House created a ‘ positive environment for service users and staff’. Staff were described as caring and understanding. A visitor to the home spoke of ‘an excellent staff team’. The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 Page 19 Although feedback into the inspection suggested that staff were well trained there were a number of gaps in people’s training in mandatory subjects. The manager reported that the new provider is aware of this and is looking to prioritise staff training. One staff member on duty at the time of the inspection had done her First Aid training the day before. Some key skills required of staff were not recorded as being received although relatives and the manager were confident that staff were well trained to meet individual needs. Staff files were well organised although some key information was missing. The manager reported that the new provider is aware of gaps and produced a matrix to demonstrate that identified information is being chased up. The manger has improved practice recently by following up at least one of the two references received. Records of recent staff supervision were seen on files reviewed. Staffing levels within the home are an area where improvement is required. Although the manager felt that current staffing levels are safe they do not enable people to receive support outside of the home. When staff were asked what could be improved about the service they also suggested ‘staffing levels’ Staff receive regular and recorded supervision and the manager stated that he is always available for informal discussions. The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39, 41 and 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Existing management arrangements are not enabling effective record keeping and monitoring or allowing the new organisation to introduce its policies and procedures and new formats, all of which are affecting the overall quality of the service. Overall the health and safety and welfare of the people who live at The Coach House is promoted and protected. EVIDENCE: Daniel Brown is the registered manager of both the Old Vicarage and The Coach House. He has NVQ level 4 in Care and is awaiting the finalisation of the Registered Managers Award. In addition he has attended numerous short The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 Page 21 courses and is now a Fire Warden and has attended the Fire Safety for Managers course. The manager feels well supported by the new providers and in particular his line manager. New policies and procedures are being introduced gradually to the staff team and the manager is going to review and adapt the policies to be specific to his service. The manager is currently working a high number of hours on shift at the home and this is having a detrimental effect on the homes management and in particular record keeping. As the manager of two homes he must have time to carry out his role effectively. The provider is aware of this and is planning that by the end of March he will not work on the rota. Health and safety arrangements within the home are satisfactory. A Health and safety policy statement was seen completed by the new provider and routine safety checks are carried out as required. People who live at The Coach House took part in the recent fire safety induction and evacuation. Information sheets to support the use of possibly harmful substances are appropriately stored near to the products.The manager is now in the process of risk assessing the use of all cleaning products within the home. The manager reported a significant increase in the number of trips and falls from one person since his move to the home. He could not access any of the accident forms or demonstrate that the falls are being monitored although safeguards were being implemented to keep him safe. The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 1 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 3 X 2 2 X The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 Page 23 NO 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 YA6 Regulation 15 (2) (b) Requirement Care plans must accurately reflect people’s current and changing needs to ensure that people receive the care and support that they require and the home can demonstrate that it can meet those needs safely. The manager must risk assess peoples identified needs and the environment in which they live to ensure that the home can safely meet those needs. The manager must make sure that people have opportunities to access community resources for leisure and social activities in order for them to live full and active lives as they choose. The home must demonstrate that it offers a choice of meals that are nutritious and balanced. Records must be accurate, available and up to date at all times to demonstrate that the people living at the home receive the care they require and that the home is operating safely and in the best interests of the people they support. Timescale for action 09/04/08 2 YA9 13 (4) (C) 09/04/08 3 YA13 16 (2) (m) 24/04/08 4 5 YA17 YA41 16 (2) (i) 17 (1 – 3) 24/04/08 09/04/08 The Coach House DS0000071103.V360092.R01.S.doc Version 5.2 Page 24 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 DS0000071103.V360092.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 DS0000071103.V360092.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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