Inspection on 25/05/07 for The Coach House

This inspection was carried out on 25th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 1 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 04/07/06

The Coach House 06/03/06

The Coach House 13/10/05

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 Mr Simon Massey Key Unannounced Inspection 25th& 31st May 2007 10:00 The Coach House DS0000062579.V334609.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 DS0000062579.V334609.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 DS0000062579.V334609.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Coach House Address Mythe Road Tewkesbury Gloucestershire GL20 6ED 01684 299507 F/P 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 Carol Freeman (awaiting registration) Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Coach House DS0000062579.V334609.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 2006 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 registered Manger who is currently going through the registration process. The home is owned and run by Kentwood Care Limited and was first registered in July 2004. The home’s Statement of Purpose and Service User Guide provide information as to the services that the home provides. The current fee range for the home £1600 to £2000 per week. The Coach House DS0000062579.V334609.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 25th and 31stMay July 2007 and lasted for a total of 10 hours. This inspection looked at the key national minimum standards and was unannounced, though the second visit was arranged in conjunction with the home. This inspection was supported by members of the care staff and by the Manager. The Inspector also met with the Responsible Individual and the newly appointed Deputy Manager. The Inspector had contact with all of the service users who live in the home. Other staff were also observed supporting the service users. Records relating to care planning, medication, health and safety and staffing were examined. An inspection of the premises was also undertaken. A number of surveys were also distributed and returned. The Inspector is grateful to the service users and staff for their input in completing this inspection. What the service does well: What has improved since the last inspection? The home has a new office that enables the staff and management to work more effectively and professionally. The home has implemented the recommended changes following an Inspection by the Commission’s pharmacy Inspector. All staff are receiving regular and recorded supervision from the management. The home has received increased supervision and support from the Provider organisation. There has been a period of relatively few staffing changes, which has helped consistency of working in providing care and support to the service users. The Coach House DS0000062579.V334609.R01.S.doc Version 5.2 Page 6 There has been an improvement in the quality and consistency of daily recording and the developing of more person centred planning. All plans are being reviewed more regularly. There has been an improvement in the day care activities that are being organised and supported 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 DS0000062579.V334609.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 DS0000062579.V334609.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): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Making unplanned admissions to the home could result in people being admitted whose needs cannot be met and also compromises the quality of care and support being provided for existing service users. EVIDENCE: The home admitted one service user in recent months who has subsequently moved on to other accommodation. This was from another service run by the same Provider and was not a planned admission. Whilst this person had an assessment and care plan they were not suitability placed. In view of the complex needs of the other service users, this emergency placement, in the view of the Commission, was ill-advised. The homes Statement of Purpose also does not allow for the admission of emergency placements. The home has an admissions policy that complies with the regulations and the Provider and Manager must ensure that this is adhered to. The Coach House DS0000062579.V334609.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): 6,7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are involved in the planning of their care, which is being regularly reviewed. Service users benefit from increased choice in relation to decisions about their daily lives. EVIDENCE: All service users have assessments in place and care/support plans that are being regularly reviewed. There have been increased opportunities for service user to be involved in developing independent skills, according to ability, and all care plans contain guidance to staff on the management of behaviours. There have been few staffing changes over the previous few months, which has helped the team to work more consistently, which staff stated had been of benefit to the service users. A sample of files were examined and these showed that regular recording was being completed and various aspects of care and support being monitored. A number of risk assessments were seen and these were up to date and contained appropriate guidance for staff. A number of assessments relate The Coach House DS0000062579.V334609.R01.S.doc Version 5.2 Page 10 directly to the behaviours and needs of service users and were seen as being a positive method of increasing opportunities whilst maintaining a level of protection. Improvements have been made in the efforts to encourage service users to develop independence skills. People are now supported to make some of their own snacks, help with a certain amount of their laundry tasks and also some cleaning. People are also being encouraged to make more decisions about their choice of clothes and the furniture and decoration of their rooms. Due to the needs of the service users progress in these areas can be slow and staff demonstrated an understanding of the need for patience and consistency in their approach to these areas. An example was seen of a person centred approach to the care planning with the identifying of medium and long-term goals, and the use of pictures and symbols to improve service user undertrsanding of the plan. One updated assessment, completed in September 2006, showed a link between assessment, care planning, and the subsequent daily recording against the objectives identified. This inspection showed that the home have taken steps to address shortfalls previously identified in this outcome group. The Coach House DS0000062579.V334609.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): 12,13,15,16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are benefiting from increased opportunities to identify and follow their interests and also be more integrated into community life. People are being supported to have more involvement in, and responsibility for daily tasks. EVIDENCE: Improvements were noted in the provision of daily activities. This is as a result of more flexibility in terms of the make up of groups who participate in certain trips and also a more pro-active approach from the staff team and manager. Staff commented that the increased options had resulted in less incidents of challenging behaviour generally from service users. The newly appointed Deputy explained how they planned to develop the activities further by exploring more options and increasing the structured routines that people could follow. One service user expressed satisfaction with their routine and The Coach House DS0000062579.V334609.R01.S.doc Version 5.2 Page 12 also explained how they were looking forward to some different activities that were being planned for the future. It was also explained how more flexibility in the staffing rota had allowed for cover to be provided when it could be best utilised for the benefit of activities and outings for the service users. The staff team keep a monitoring record of all activities undertaken during a month. The home currently shares a Chef with the adjoining home and food of good quality is provided for the service users. People have some opportunities for preparing snacks in the home’s own small kitchen and it was explained that there are plans to increase the involvement of the service users in choosing their own individual menus. Staff interviewed stated that the food was nutritious and that choice and personal preference were catered for. One service user said that they enjoyed the food. People can choose were they eat their meals. On the week following the inspection the home were due to take a group on holiday. This would be the first time they have had been able to do this and a high staffing ratio is being provided, including the Manager, to best promote its success. Whist the overall outcome for these standards has been judged “adequate”, some aspects were seen as “good” and it is acknowledged that the home are continuing to make efforts to improve this aspect of their service. The Coach House DS0000062579.V334609.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): 18,19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clear guidance and recording supports service users to receive their personal care in a way that promotes their privacy and dignity. Service users are supported to access the healthcare professional they require to ensure that physical and emotional health needs are met. EVIDENCE: The home has implemented the recommended changes following an inspection from the Commission’s pharmacy Inspector. All medication was appropriately stored and all records appeared correct and up to date. People’s medication has been regularly reviewed, and any changes have been closely monitored by the staff team. Service users have access to outside professionals and any advice or guidance was clearly recorded. The home regularly involves outside health professionals in the reviewing of care and support. The Coach House DS0000062579.V334609.R01.S.doc Version 5.2 Page 14 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. Service users views are listened to and acted upon and systems are in place to ensure service users are protected. EVIDENCE: Efforts are made to communicate effectively with service users and staff are aware of the different approaches that are required with individual people. There has been an increased use of signs and symbols and further work is planned around communication training for staff. Recording shows that staff listen and respond to concerns and staff were observed communicating effectively with people. Due to the needs of the service users it would not be possible for them to follow a formal complaints procedure but there was evidence from recording and observation that people are sufficiently confident in their environment, and with the staff team, to express themselves. The home has responded appropriately to any concerns or issues raised by families. The home has correctly notified the Commission of incidents when physical restraint has had to be employed. Records show that this is used as a last resort, and then only by staff who have received the training. Whilst there has been an increase in incidents relating to one service user over the previous two months, generally the gradual overall decrease in incidents observed at the previous inspection has continued. There were some good examples of detailed recording and it was evident that the staff team have made improvements in this area. The Coach House DS0000062579.V334609.R01.S.doc Version 5.2 Page 15 Staff were observed supporting service users and interacting in a calm and appropriate manner. All staff receive training in de-escalation and low arousal approaches to working with challenging behaviours. This is accredited training, that is monitored with updates being organised by the management when they are due. Staff spoken with considered they had the skills to put this training into practice and felt that a more consistent approach being deployed by the whole team was helping to promote a calm and improving atmosphere within the home. It is also evident that increased activities away from the home can make the environment and service users behaviour and needs easier to manage and support. Further comment around this is made under the Lifestyle standards. The Coach House DS0000062579.V334609.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): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the needs of the service users. Service users are supported and encouraged to personalise their living space according to personal taste and needs, and are encouraged to be involved in decisions relating to replacement of fixtures and fittings. EVIDENCE: The home is generally well maintained and decorated throughout, though due to some behaviours care has to be taken with the choice of furniture and fixtures and fittings. Bedrooms are personalised when there is an interest or need but some people have a preference for minimally decorated and furnished accommodation. There is an ongoing programme of redecoration and some areas are due to be painted soon. Due to the needs of the service users this needs to be planned carefully and there was evidence that this was being done. The outside area is well maintained and spacious though some concern exists around the loose chippings in the main communal area, as service users are The Coach House DS0000062579.V334609.R01.S.doc Version 5.2 Page 17 sometimes throwing these. The home are considering ways of addressing this issue. The home have addressed the concern over access to the property with the provision of an intercom at the main gate. This provides easy access for visitors and also maintains the safety of the service users. The home now has a designated office, which has enabled the staff and management to work more effectively. The home was clean and hygienic throughout. The Coach House DS0000062579.V334609.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): 32,34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service user needs are met by a motivated and effective staff team who are provided with regular training, which helps ensure they have the necessary skills and knowledge to meet the needs of the service users. Some shortfalls in the recruitment process and the implementation of policy may compromise the safety of service users. EVIDENCE: At the time of both visits there were sufficient staff on duty to meet the needs of the service users. Staff were observed interacting appropriately and confidently with service users. Records showed that appropriate staffing levels are being maintained and that the use of agency staff is kept to a minimum. Staff interviewed stated that they were well supported and had all had regular training in the managing of challenging behaviours. The new office space was also seen as having a beneficial effect to staff in terms of being able to record notes, read information and have discussions about care issues. It was also seen as being essential to have a space in which staff could be de-briefed following any challenging incidents that may have occurred. The Coach House DS0000062579.V334609.R01.S.doc Version 5.2 Page 19 Staff were knowledgeable about the needs of the service users and the various approaches that worked best with individual service users. There was evidence of a good standard of recording being regularly completed and staff appeared motivated and committed to providing a high standard of care and support. Staff demonstrated their motivation to progressing service user’s independence skills and supporting them with strategies to improve their quality of life. There was evidence that practice is evaluated and reviewed and that the staff team are willing to develop the care and support that is delivered. The home has improved its approach to communication techniques, there is now a staff member trained in “Total Communication.” This person provides input for the staff team and some future ideas and plans were described to the Inspector. Newly appointed staff had been mentored during their induction period, and one person interviewed stated that they had been very well supported by the management and the rest of the staff team. During their initial months of employment staff complete all the required statutory training before being enrolled onto NVQ training. All staff have received regular recorded supervision and the team have also been having regular staff meetings. Since the previous inspection the home have reviewed their smoking policy, though during the first day of the inspection staff were observed breaching these guidelines. The management need to ensure that the policy is understood and implemented. Staffing files contained the required information and the required checks are being completed on all new staff. When difficulties with CRB’s have occurred, the Provider has liaised appropriately with the Commission. The Inspector was concerned about an aspect of the recruitment process that was considered unsatisfactory and has communicated these issues in writing to the Provider. Work undertaken by the Manager and Provider have improved the performance in relation to the Staffing Standards. The overall outcome for these standards has been judged as “good”, though some parts were seen as “poor.” The Coach House DS0000062579.V334609.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): 37,39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management of the service promotes the safety and wellbeing of the people living in the home and there are systems in place which help to monitor and improve the quality of the service. EVIDENCE: The Manager is currently going through the registration process, having been acting manager during the absence of the previous manager. They have been pro-active in introducing guidelines for staff, increased support and supervision and the updating and improving of the care plans. Leadership and guidance is being provided to the staff team in the area of care planning and support for the service users. The Manager is person centred in their practice and appears open and transparent in their approach to the running of the home. All administration and recording examined was up to date and had been completed to a good standard. The Coach House DS0000062579.V334609.R01.S.doc Version 5.2 Page 21 The provision of the new office space has helped improve the effectiveness of the management of the home. Whilst this is primarily an area for staff and management to work in, this area is generally accessible to the service users if they choose, which helps promote a homely and inclusive atmosphere. The Provider has undertaken regular Regulation 26 inspections and these have provided action points for the home. Quality assurance audits are also completed, again with feedback being provided to the Manager and staff team. All fire testing and maintenance has been completed and health and safety inspections are carried out regularly. A safe environment is maintained and promoted. Whilst the overall outcome judgement for these standards is “adequate” some aspects were seen as “good” and the inspector acknowledges the improvements that are being made in the management of the service. The Coach House DS0000062579.V334609.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 3 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 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 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 3 3 x 3 X 3 X X 3 x The Coach House DS0000062579.V334609.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 YA2 Regulation 14(1) Requirement The home must ensure that admissions are planned and that the needs of prospective service users can be met. Timescale for action 30/06/07 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 DS0000062579.V334609.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 DS0000062579.V334609.R01.S.doc Version 5.2 Page 25 - 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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