Inspection on 24/01/08 for The Coach House

This inspection was carried out on 24th January 2008.

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

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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Coach House 04/11/08

The Coach House 18/07/06

The Coach House 05/01/06

The Coach House 10/08/05

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 Trevaylor Manor Newmill Road Nr Gulval Penzance Cornwall TR20 8UR Lead Inspector Rachel Fleet Unannounced Inspection 24 January 2008 11:05 th The Coach House DS0000063988.V350342.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 DS0000063988.V350342.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 DS0000063988.V350342.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Coach House Address 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) Trevaylor Manor Newmill Road Nr Gulval Penzance Cornwall TR20 8UR 01736 332133 coachhouse@swallowcourt.com Swallowcourt Limited ****Post Vacant**** Care Home 9 Category(ies) of Learning disability (9) registration, with number of places The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th July 2006 Brief Description of the Service: The Coach House is a care home offering personal care and accommodation for up to 9 adults with physical and complex needs, who have a learning disability. The aim of the home is to provide specialist support in a homely environment where people can experience a quality of life with the support and care of the staff. Nursing care is not provided, apart from that which can be provided or overseen by the local community or district nursing team. Swallowcourt, the registered provider, is an organisation that provides specialist care for people with special needs and which also owns three nursing homes. The Coach House has its own entrance drive from the Newmill Road, but is in the grounds of and adjacent to Trevaylor Manor, one of the company’s nursing homes. Penzance town is two miles away, and a bus service passes the home twice a day. There is a parking area, and walled gardens for people living at the home to use. The home has recently acquired its own car transport, with occasional use of staff cars or a minibus shared with the other homes, for leisure outings, to get people to health appointments, etc. Accommodation is on two floors, with a shaft lift between floors for those who cannot use the stairs. One bedroom is registered for double occupancy, should two people wish to share. Each bedroom has an en suite toilet, with special door locks fitted on the bedroom doors to give greater privacy if wished. There is a bathroom upstairs, and a level access shower room/wet room on the ground floor, as well as separate toilets. The kitchen off the lounge is used for some food preparation, although the main meal of the day is usually sent from the kitchen of the adjacent nursing home. The dining area is in the conservatory, which looks out over the walled gardens. Weekly fees were from £832.33 - £1386.11, at the time of our visit. These did not include items for personal use such as toiletries and clothing. Reports on the home, by the Commission for Social Care Inspection (CSCI) are displayed in the home’s lounge. The Coach House DS0000063988.V350342.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 experience adequate quality outcomes. This inspection took place as part of our usual inspection programme. It was carried out by Rachel Fleet, who was assisted by her colleague Sue Dewis during a visit to the home that lasted just under seven hours. There were eight people living at the home at the time. We informed the home of our intended visit an hour before our arrival, to ensure certain documentation would be available to us. A CSCI questionnaire on the home (the Annual Quality Assurance Assessment, or ‘AQAA’) had been completed and returned prior to our visit, by the manager Dee Benny. It included current information about the service, staff, and people living at the home, with an assessment of what the home does well, and any plans to improve the service. We had also sent surveys to the home for to each person living at the home, and their relatives / supporters. Six were returned from those living at the home, completed with help from families or care staff, and six were returned from relatives. Of eight surveys we sent to community-based health or social care professionals who support people at the home, two were returned. Of ten sent to staff, six were returned. Our time at the home was partly spent on ‘case-tracking’ of three people. This meant we looked into these peoples’ care in more detail. We met them and got their views where possible, checked their care records and other related documentation (medication sheets, etc.). We observed care, support or other interactions they received or were involved in, and talked with the care staff. We looked at their bedrooms and the shared facilities they used. The three included people with more complex or diverse needs, men and women, and people we wished to follow up as a result of information from surveys or in relation to issues raised at the last inspection, to see if they had been addressed. We spoke with one person who lived at the home, though they had limited communication, one relative, four staff and the manager. We looked around the home, checked medication systems, and read various records relating to staff, catering, and health and safety. Throughout our visit, we observed how people living at the home spent their day, what support they got from staff, etc. We ended the visit by discussing our findings with Dee Benny. The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 6 This report includes information gained from all these sources and from communication about the home since the last full inspection (detailed in our report dated 18 July 2006). What the service does well: When asked, in our surveys, what the service does well, relatives wrote: “The Coach House is a warm and friendly care home where the staff are always happy, and make you feel welcome and part of a family as soon as you walk in.” (My relative) “is well looked after by the staff.” “All aspects of care. The Coach House has a good relationship with parents and families of the people in their care.” “Choose clients well for their compatibility, and the staff interact well with each of the clients and relatives.” “Provides a warm, happy, loving family atmosphere for eight very different young people who need such a lot of help to live their lives. I think they really respond to and understand each one, and encourage them to interact with each other.” A staff survey reflected some of this, saying, “Has an open door policy for family and friends.” A professional said, “Would recommend the service for people with diverse needs. Pure health needs are met – no concerns.” We found people can get to know a lot about the home, and staff find out about prospective residents’ needs well, before the home offers them a place. This helps to make sure the home is the right place for anyone that then moves in. People are enabled to make decisions and take some risks, so the quality of their daily lives is better. Individuals enjoy a range of activities in and out of the home, which meet their different interests. They are helped to keep in touch with their families and friends, thus have supportive or long-standing relationships that enrich their lives. People benefit from support given in a way that they prefer and need, partly through seeing a variety of health and social care professionals. They have a balanced diet that promotes their health as well as meeting their preferences. The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 7 People are supported by staff who are caring and competent. The home tries to protect them from abuse and self-harm. This includes using good recruitment practices to ensure prospective staff are suitable to work in a care home. Peoples’ views and concerns are heard, and acted on where necessary. They have a comfortable, clean, homely environment to live in. What has improved since the last inspection? What they could do better: When asked this question, two replies were “They can’t (improve) - they are doing a good job,” and “At this moment in time I cannot see what they could improve.” A survey from a health care professional said, “Ensuring daily activities are carried out, especially following advice and guidance given by professionals.” A social care professional suggested, “Care plans should give more priority to community-based, tailor-made activities with one-to-one support.” A staff member also said, “More staff, so we could have more of a one-to-one for activities,” with another suggesting occupational therapy and outings could be better. We found the home’s Statement of Purpose needed updating to clarify the service currently offered, so people can make fully informed decisions about the home’s suitability for individuals. More detailed care plans and personal risk assessments would help ensure people receive consistent care or support that meets all their needs as safely as necessary. Certain attention to peoples’ care as individuals would ensure that all needs are met in a person-centred way and individuals’ rights are upheld. Medication is generally managed well although some action should be taken to establish even safer systems. Some safeguarding guidance for staff could be improved, to ensure people living at the home are properly protected from abuse. The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 8 We had several complimentary comments about the staff and care they gave. However, they would benefit from further training, to ensure that they can continue to meet the diverse and changing needs of the people they look after. Evidence of routine maintenance and risk assessments is needed to show the environment is kept safe for people living at the home. Safe working practices, including staff fire safety training, must be established, to promote the health and safety of everyone at the home. People are positive about the new manager, but she still has to undergo our registration processes to confirm her fitness to run this home and must thus submit an application form as soon as possible. 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 DS0000063988.V350342.R01.S.doc Version 5.2 Page 9 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 DS0000063988.V350342.R01.S.doc Version 5.2 Page 10 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): 1 & 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure people can find out a lot about the home and the home knows people’s needs well, before the home offers them a place. This helps to ensure the home is the right place for anyone that moves in. However, some written information is unclear about the current service, so people may not make fully informed decisions about the home’s suitability for individuals. EVIDENCE: The Statement of Purpose has much useful detail, but needs some amending to show the current situation at the home. It currently says ‘There will be monthly service user meetings’, but these had not taken place for some months. And ‘All staff will have NVQ 2 as a minimum’, when not all staff had the qualification. Thus it is not clear what people can expect from the home at present. It also indicates the manager is registered with us, but this is not yet the case. We saw a personalised ‘Service User Guide’ in each person’s bedroom and care records file, with their photograph on the front. It had photos of staff, rooms, etc. with a few sentences in large print, to explain about the home. We discussed with the manager how some sentences could be made plainer, to The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 11 further help the reader. People also had contracts and Terms & Conditions of admission, in their care records file. No-one has been admitted to the home since the last inspection. The manager, however, described good pre-admission assessment processes, including involving the person’s family and other current carers, and getting assessments of needs from other relevant professionals - care managers, community nurses or those from the learning disability team, etc. already supporting the individual. Environmental adaptations would be put in place to meet specific needs. People would be invited to visit the home more than once, staying for longer periods of time, a meal, etc. The views of existing residents would be taken into account, to make sure they would not be adversely affected by new admissions. One relative thought this was something the home did well, saying they “Choose clients well for their compatibility.” A relative confirmed that in their case, the decision to move in was made “with the help of the Social worker, doctors and family”, since the person themselves couldn’t express their opinion clearly. One relative wrote, “We are delighted how A. has settled and how well she interacts with staff and clients.” The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 12 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): 6, 7 & 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are good care planning systems, although there is a possibility that some people will receive inconsistent care that does not meet their day-to-day needs because they are not always used properly. People are enabled to make decisions and take risks, which enriches their daily lives, although assessment of risk is not always sufficient to ensure they will be managed appropriately. EVIDENCE: We looked at three care files, which had a lot of information in them. We saw six-monthly reviews had been done, which included discussing the information in them with the individual and/or their representatives. This is an improvement since our last inspection. Staff said that they found the care files useful, and they were the source of information on any changes that may have occurred with the people living at the home. We saw the home had responded to some changes in individuals’ The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 13 needs, obtaining specialist equipment for them - a shower chair for one person, to promote their safety when showering, and beds with variable heights for others, helping both them and the staff assisting them. Care files had sections on peoples’ personal profiles, moving / assisting them, night time assessment, assessment of needs of daily living, their medical profile, and a personal development plan. A separate care plan identified their needs, stated a goal, and provided for an action plan. We saw this had not been completed for all needs identified through the assessment process. Thus staff did not have clear or full information on how to meet day-to-day needs of the person. For example, we saw ‘wheat free diet’ written in one place in a file but nothing written under ‘Special dietary requirements’, so the individual may be at risk of being given food containing wheat. In some cases, no link was made between the care plan and daily care recordings. The latter contained some good information, although other entries were unhelpfully vague – for example, stating, ‘Good mood’ with no description of what that might be for that individual or little indication that the person’s various needs were met. We discussed this with the manager, who told us she had been trying to improve care planning since coming into post. Although there is no involvement of advocates at the home currently, the Cornwall Advocacy Service has been used in the past. When asked about whether people were able to make decisions about what they did daily and whether staff act on what people say, one relative wrote, “Cannot communicate but she seems to be catered for,” and another comment was, “Staff read her moods as unable to communicate.” We saw information on each person’s basic likes or dislikes was readily available to staff. Staff were able to tell us of the regular routines of the people we case tracked, and spoke with sensitivity and respect. We saw they offered assistance in a discreet way, and there seemed to be great warmth between staff and the people they cared for. The manager’s line manager is appointee for two people living at the home, who we were told do not have anyone else to help them manage their financial affairs. We checked personal monies held by the home for three people. Two signatures were recorded on individuals’ personal monies records when staff handled money on their behalf. Cash balances matched the final totals shown. Receipts were kept, though dates did not always match the date of entries on records. The manager agreed to follow this up. An interest-free bank account is used for residents’ monies solely. Christmas presents had been bought with peoples’ money for their relatives, by staff, on behalf of residents. We advised that there should be more clarity about this arrangement, and written guidance for all concerned. The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 14 Risks attached to daily living – when moving, using bed rails, or going out, etc. - were recorded for each person, but with insufficient detail. For example, what could happen if these risks were not managed, or any control measures in place. One person was said to have swallowing difficulties, but nothing said that this meant they might choke, or how this risk might be managed. Thus assessed risks to people’s wellbeing may not be managed correctly, because staff do not have necessary information. This issue was identified at our last inspection. The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 15 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): 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People enjoy a range of activities in and out of the home, which are appropriate to their diverse needs. They are enabled to maintain contact with their families and friends, thus have supportive relationships that enrich their lives. And they have the benefit of a balanced diet that also meets their preferences. EVIDENCE: During our visit, one person was helped with their sewing; they said they also enjoyed painting, several of their paintings being displayed around the home. Their visiting relative was happy with the care the person received, confirming that they were able to continue with their hobbies. Staff said people enjoyed the weekly aromatherapy sessions and found them very relaxing. There are also weekly music therapy sessions, which again staff said people really enjoyed. The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 16 People’s care files contained a Weekly Activity Rota. In one case what was stated on for the day of the visit (baking) did not occur. We spoke with a care staff member who told us they would be making cakes that day, but they did not seem to have specific plans to involve anyone else. An activities programme in the office was otherwise generally followed, with one person out at college when we arrived, and another going out for a drive. And we saw staff spent some time with those given musical instruments or games. Comments from relatives’ surveys included, “Staff take my relative on shopping trips & outings in the car which he seems to enjoy very much.” A community professional thought that more priority should be given to “community-based, tailor-made activities with 1-1 support.” The home has recently acquired a car for outings, etc., with staff cars also used sometimes. The manager said the head office had evidence of appropriate insurance cover for the drivers. Staff also said the home is getting a car suitable for wheelchair users; one said that they would like to see more opportunities for wheelchair users to get out and about, and felt this would happen when they got this car. A relative commented, “The Coach House has a good relationship with parents and families of the people in their care.” One staff member said the home “Has an open door policy for family and friends.” We saw from staff rotas that staff accompany people if necessary, to enable them to visit people away from the home. One relative wrote, “He loves all the company of the other residents.” Staff said that people were always offered choices about what time they got up, went to bed, what to do during the day, and what they wore. They were also able to make limited choices about food. The manager said some people accompany staff when they go to clean or tidy individuals’ rooms, helping as they can with this. One person who lived at the home took themselves to the garden when they wanted to smoke. A visitor we met thought the staff were wonderful, and encouraged their relative to be independent. A relative’s survey included, “He loves the food,” and people appeared to like the lunch they ate during our visit. We discussed with the manager that some staff could communicate better as they helped people with their meal. Main meals are fetched from the kitchen in the adjacent care home, although minutes of staff meetings showed that staff wanted to cook at the Coach House occasionally. Evening meals are made at the home, according to what individuals want or prefer. The menu looked balanced and varied across the week, with specific choices at lunchtime (the main meal of the day). Staff said when ordering what people wanted on a daily basis, they ensured each time that kitchen staff were aware of special dietary needs such as for people with diabetes. The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 17 Snacks were available, with salad items seen in the fridge; the manager said petty cash was also used to buy items that individuals wanted on an ad hoc basis. The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 18 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): 18 – 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from support given in a way that they prefer and need, through input from a variety of relevant professionals, which enhances their general wellbeing. Attention to individualised care needs improvement, to ensure that all needs are met in a person-centred way and individuals’ rights are upheld. Medication is generally managed well although some action is necessary to establish even safer systems. EVIDENCE: Comments on surveys from relatives included the following: “My relative has been at the home for over two years…he has settled and is very happy. Staff love him and treat him with love and affection. As far as the family are concerned, the Coach House supports all his needs and we couldn’t ask for anywhere better.” “As X is unable to communicate, the staff relate and interact well with her moods.” The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 19 “…Is very happy at the Coach House…He is always clean, and his clothes are well washed and ironed. He has a good life there…He likes to come home for a little while, but is always happy to get back to the Coach House.” “Provides a warm, happy, loving family atmosphere for eight very different young people who need such a lot of help to live their lives. I think they really respond to and understand each one, and encourage them to interact with each other.” A professional commented they “Would recommend the service for people with diverse needs. Pure health needs are met – no concerns.” The care files showed that the home worked with health care professionals to ensure people’s health needs could be met, with people regularly seeing GPs, psychologists, and opticians. The home had sought advice from an occupational therapist and subsequently obtained specialist equipment for someone. The manager said there was also support from a consultant specialising in care of people with Downs syndrome and dementia, and support from district nurses. However, one person’s notes stated they had an open bleeding wound, but with no subsequent contact with district nurses or other follow up recorded, to address this problem. A health care professional suggested the home could improve by “Ensuring daily activities are carried out, especially following advice and guidance given by professionals.” We saw switched off monitoring/listening devices. The manager said they were used between bedrooms and the lounge, for monitoring people prone to seizures, when they were in their bedrooms. However, she was not aware of any guidance at the home to ensure they were used appropriately, without affecting individuals’ privacy unnecessarily. The home uses a blister-pack medication system, dispensed from a mobile storage unit, which a staff used during our visit. The manager is considering observation of medication administration as part of staff appraisal. Peoples’ photos were on their medication records, as is good practice. Medication received into the home had been recorded on individuals’ medication administration record sheets; unwanted items were appropriately recorded elsewhere. We saw one handwritten instruction for a medication, which had not then been signed and dated by two people to confirm the correctness of what was written. The manager said she’d look into this. No controlled drugs were being used, but the home has correct storage facilities and a register. No items needed refrigerated storage, but the manager described appropriate systems for keeping such items if necessary in future. She said she monitored items prescribed for occasional use, requesting they be discontinued if not given for some time, which is good practice. The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 20 We saw one item prescribed to be taken only when a particular problem arose was being given regularly. This had not been discussed with the person’s GP, to consider if the problem had worsened, etc. The manager agreed to address this and monitor similar situations in future. No record was kept when medication for emergency use was taken out of the home, for people going on outings. The home was advised to speak to a pharmacist about appropriate recording of such items. The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 21 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): 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples’ views are heard in a variety of ways, and acted on where necessary. There are systems in place to ensure that people living at the home are protected from abuse, neglect and self-harm, although guidance for staff could be improved to ensure as much as possible that they are safeguarded. EVIDENCE: Comments on relatives’ surveys we received included, “I have never had any concerns about my relative’s care, but I am sure if I did it would be dealt with properly.” One member of staff said that if they felt any resident was unhappy they would encourage them to share their concerns. They said that they felt staff would know straight away if any resident were unhappy because they are such a close unit. The complaints procedure was in an ‘easy read’ format in the Service User’s Guide. The full version needed to include that people can contact us at any point in the complaint process, and not just if they are not satisfied by the service’s response as is currently written. The manager said she would address this. We saw the one complaint in the home’s log related to neighbours complaining about noise from the home (made by residents) had been addressed by the The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 22 manager and the group manager. We have not investigated any complaints about the home since the last inspection. People living at the home seemed at ease with the staff supporting them. Three staff we spoke with had all had training on safeguarding adults, and were able to describe differing types of abuse, including that ignoring someone could be deemed abuse. They gave good replies about what they would do if they suspected abuse was occurring, and knew whom to contact outside the home if necessary. They had not had any training on the Mental Capacity Act 2005, but the manager was looking into this. The local authority’s guidance (‘Alerter’s Guide’) and other good information were kept in the office. However, the home’s own policies hadn’t been reviewed for over two years. The safeguarding policy did not guide staff on what action they should take; the whistleblowing policy said an investigation would take place, without any indication that other relevant agencies would be informed of any allegation first. The manager said not everyone has inventories of their property yet but that this is being addressed, to ensure clarity about possessions - including equipment such as hoists that belong to individuals rather than to the home. She was clear that other professionals (social worker, district nurse, etc.) would be contacted to carry out an assessment if staff thought a bedrail or other potential restraint was needed for someone. This would ensure they were only used appropriately. The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 23 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): 24 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a comfortable, clean and homely environment, although more evidence of routine maintenance is needed to show people live in a safe environment. EVIDENCE: A professional felt one of the home’s strengths was that it “Provides a quality environment, particularly bedroom/conservatory/garden.” Everywhere looked tidy, nicely decorated and furnished in a homely way. Areas of the home have recently been re-carpeted. Bedrooms we saw were personalised, reflecting individuals’ interests and preferences (colours, transport models, photos of family pets and members). One had sensory lighting. Some en suites had grab rails. Lockable storage facilities were seen in some bedrooms. We made a recommendation at our last inspection that blinds should be fitted to the roof of the sun lounge/conservatory so that the room does not get The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 24 unbearably hot for those using it. The manager confirmed these are to be fitted this Spring, when monies will be available in the new budget. There was easy access to the garden from the conservatory, and we saw people using the table and chairs outside regularly during our visit. We asked if there were any plans to ensure the environment was suitable for people with dementia, since at least two people have dementia. The manager said an occupational therapist had discussed lighting with the home, but other plans would be developed on an individual basis depending on how existing residents’ needs changed. The home looked well maintained. However, there was no evidence that checks were done regularly to ensure aspects of the environment or equipment, etc. were still safe to be used (see also the last section in this report, on ‘Conduct & management of the home’, with an accompanying requirement made to address this). Staff wore disposable blue aprons during the lunchtime we observed to prevent cross infection whilst handling food after care-giving. There was a cleaning rota for equipment (wheelchairs, hoists, etc.), and the home looked clean throughout. One survey noted there was only the occasional odour, when people used the toilet. We noted this once during the inspection, when a privacy curtain across the ground floor corridor was used rather than shutting the bathroom door, to allow space for moving a hoist, etc. We discussed with the manager that better odour-control was necessary, to ensure people’s dignity was upheld. The laundry room had a washing machine with appropriate programmes for cleaning laundry properly. The manager described appropriate methods for dealing with soiled items, including use of alginate bags and the sluice cycle. Disposable gloves and aprons were seen available around the home. There was a sink in the laundry with disinfecting skin lotion, but nothing for actually washing hands. The home were advised to seek advice from relevant agencies, to ensure there were adequate facilities to minimise cross-infection. The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 25 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): 32, 34 & 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at the home are protected by the home’s recruitment procedures. They are supported by staff who are caring and competent but who would benefit from further training, to ensure that they can continue to meet any diverse and changing needs of the people they look after. EVIDENCE: Rotas for recent weeks showed there are at least three staff on duty in the day, with two waking night staff from 10pm. The manager was extra to these numbers. When we visited, there was a fourth staff member on duty. We saw additional staff had been rostered to accompany someone on a visit to their family. And a relative said, “When hospitalised recently, staff went with my relative and stayed day and night until my relative was able to come home, so that my relative was with people they knew at all times.” Staff we spoke with said that they enjoyed their work with the residents. They felt that the care was good at the home, that they had time to meet peoples’ needs, and had time to spend with them individually. They spoke of taking people out to see the boats on the sea and for regular walks. However, some The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 26 staff surveys suggested higher staffing levels would be an improvement, so staff could have more one-to-one time with people for activities. During our visit, staff appeared unrushed. We saw they spent some time engaging individually with people. A relative said, “The staff interact well with each of the clients and relatives.” Staff we spoke with said that they had had a good range of training including health and safety matters, epilepsy, and record keeping. They had all got a recognised care qualification, one person’s qualification being particularly linked to care of people with a learning disability. The questionnaire completed by the manager showed nine of 17 care staff have a recognised care qualification (meeting our recommendation that at least half of care staff have such a qualification), with four staff currently undertaking one. A communitybased/PCT health professional has given training on epilepsy. The pharmacy company supplying the home had provided training on medication management. However, staff spoken with hadn’t yet had training relevant to the needs of people they care for - such as on Person Centred Care, Gentle Teaching or Total Communication. The care staff training programme for 2008 included six health and safety topics; three others were more directly related to care, (including person-centred care), but none were about more specific needs of people at the home, such as relating to care of people with dementia or diabetes. We saw there had been concerns about food some staff had given someone with diabetes. We looked at personnel files for three care staff. One had been employed since the last inspection, and their file contained required information, including an enhanced police check obtained before they were employed, and two satisfactory references. We saw the home uses a nationally recognised induction programme for new staff. All staff we spoke with said that they had regular supervision, when they were able to discuss any areas of concern with the manager. This was reflected in surveys from staff. Two of the three staff files we looked at had evidence of recent supervisory meetings with the manager, with training needs discussed. The staff duty rota showed more meetings were planned in coming weeks. The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 27 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): 37, 39 & 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is benefiting from current management of the home, although the manager still needs to undergo registration processes to confirm her fitness to run this home in the longer term. The home’s quality assurance programme helps to ensure that the views of people who live at the home and other interested parties underpin development of the service. There are inadequate systems to promote the health and safety of everyone at the home. EVIDENCE: Dee Benny, the manager, had been in post for three months. She obtained a care management qualification in 2007, and has relevant qualifications and experience from working in similar care settings previously. She intends to apply to become the registered manager for the home. Staff and the visitor we The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 28 spoke with were very complimentary about her. They said that she dealt quickly and efficiently with any issues that were raised. They all felt things had improved since she had been at the home, with one staff survey indicating things were now being kept up to date. The manager said she has regular contact with her line manager, and that the monthly unannounced visits he makes to the home are used as teaching or learning opportunities for her. She also attends the company’s monthly ‘Head of Care’ meetings (for their home managers), as well as meetings for the managers of the company’s homes for people with a learning disability. Although there are no residents or relatives’ meetings, the manager feels there is regular contact with everyone. Since our last inspection, the home has improved its quality assurance systems, having given surveys to people living at the home, their families and to the staff. Surveys for professionals and other visitors to the home will be sent out next. Responses so far have been analysed and responded to on an individual basis. No summary of findings has yet been shared with the groups to whom surveys were sent. It would be good practice to do this, to assure people that their input is valued, and to get an overall picture of the service’s strengths and any areas for improvement, etc. There had been recent staff meetings for night and day staff, with a range of subjects shown in the minutes (including aspects of individuals’ care, to promote consistent and sufficient care, and planning holidays for them). Windows we checked upstairs were unrestricted, and toiletries were accessible in en suite facilities. The manager said no environmental risk assessments had been written, although she thought these two potential issues did not pose a risk to current residents. Bedrails we saw were fitted with bumpers/protectors; though we did not see any relevant records, we have been told safety checks are carried out daily. A cupboard for storing cleaning materials was locked, appropriately, when we checked it. Although thermostatic valves were fitted, water temperatures were not monitored. There was no thermometer for staff to properly check bath water temperature before anyone got in. The manager did not know if risks from Legionella had been assessed. We have since been told certain measures are in place believed to control the risk, but have not seen a written risk assessment. The manager is obtaining the latest food safety guidance (‘Safer food, better business’), to ensure safe systems for food safety are in place. Records of fridge and freezer temperatures showed temperatures were within recommended levels for promoting food safety. There was no formal guidance for staff about reheating plated lunches from the main kitchen. The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 29 Accident records had been completed. There was nothing to show that individuals’ risk assessments had been reviewed if they had an accident. Staff we spoke with said they had had first aid training in the last year. We have been told there is at least one first aider on duty at all times, although a risk assessment was yet to be done to ascertain what cover is needed. We saw fire extinguishers and emergency lighting had been serviced in September 2007. Records showed fire alarms were usually tested every week; very occasionally the interval had been longer, and the manager said she would monitor this more closely. Staff we spoke with said that they had had a good range of training, including fire procedures and safe handling (- there is a manual handling trainer on the home’s staff). Though most people had had fire safety training recently, three care staff had not, and there had been no such training for nearly a year prior to this. A requirement was made at the last inspection that staff should have training at recommended intervals. The new manager said she had identified on coming into post that training was overdue, and she had plans to ensure those still outstanding would have training in the next week or on their return to work. She and another staff member had been trained as fire wardens, expecting to deliver the training six-monthly. The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 30 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 2 2 3 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 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 3 X X 1 X The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes 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 YA9 Regulation 13 Requirement Timescale for action 31/03/08 2 YA42 23(4)(de) 3 YA42 13(4) Personal and environmental risk assessments must be in more detail and must clearly identify the actions, outcomes and risk management strategies to safeguard and protect individuals living at the home. Original timescale of 30/01/07 not met. Fire drills and fire training for 28/05/08 staff must regularly take place according to the good practice guidelines as recommended by the fire authority. Original timescale of 30/08/06 not met. You must ensure unnecessary 31/03/08 risks to people living at the home are identified and eliminated where possible, so that the home is free of hazards to their safety as much as possible, and activities they are involved in are free from avoidable risks – including risks from: a) Unrestricted windows, b) Hot water, c) Legionella, and d) Reheating food DS0000063988.V350342.R01.S.doc Version 5.2 The Coach House Page 32 by clearly identifying potential hazards & associated risks, consequent actions / risk management strategies, and outcomes, to safeguard people living at the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations You should produce an up-to-date statement of purpose which is clear about the current service offered by the home, so prospective service users can make an informed choice about where to live. More detail is required in the care plans on how services and facilities are to be provided by the home, and how this will meet individuals’ current and changing needs, aspirations, and achieve goals. You must ensure peoples’ health is properly monitored, with problems and potential complications dealt with at an early stage, including prompt referral to appropriate specialist staff (such as continence advisors or district nurses). You should ensure records are kept of all medicines received into the home - including medication originally taken from the home with people going on outings, seeking advice from a pharmacist if necessary about appropriate recording of such items - to ensure that there is no mishandling and an audit trail is maintained. You should update written procedures to ensure staff are aware of their responsibilities in relation to local multiagency safeguarding procedures, so people living at the home are protected from abuse. Blinds should be fitted to the roof of the sun lounge so that the room does not get unbearably hot for people wanting to use the room. You should ensure that staff have training appropriate to their work, linking staff training and development to the needs and individual care plans of people living at the DS0000063988.V350342.R01.S.doc Version 5.2 Page 33 2 YA6 3 YA19 4 YA20 5 YA23 6 7 YA24 YA35 The Coach House 8 YA37 9 YA42 home, so staff can meet their changing needs. You should submit an application for registration of a manager as quickly as possible, because any person managing an establishment without being registered is guilty of an offence. You should carry out and record a safe working practice risk assessment for first aid, to confirm if you have the right first aid provision in this care setting, ensuring the care home can provide first aid when people need it. The Coach House DS0000063988.V350342.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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