Inspection on 26/05/09 for The Coach House

This inspection was carried out on 26th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Coach House 03/06/08

The Coach House 25/05/07

The Coach House 04/07/06

The Coach House 06/03/06

The Coach House 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 17/02/2010.

Key inspection report CARE HOME ADULTS 18-65 The Coach House Mythe Road Tewkesbury Gloucestershire GL20 6ED Lead Inspector Mr Simon Massey Key Unannounced Inspection 26th May 2009 09:00 The Coach House DS0000062579.V375851.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Coach House DS0000062579.V375851.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Coach House DS0000062579.V375851.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 01684 299507 Thecoachhouse@kentwoodsupport.com 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) Lifeways Community Care (Gloucester) Ltd Position vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Coach House DS0000062579.V375851.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 either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 6. Date of last inspection 3rd June 2008 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 Manager who is currently going through the registration process. 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 is £1600 to £2000 per week. The Coach House DS0000062579.V375851.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 on 26th May of 2009 and lasted for 6 hours. The inspector also visited the area offices of Lifeways to check staff records and training programmes. The Inspector met with the staff on duty, all the service users currently living in the home and also had a meeting with a project manager who was covering the home at the time, in absence of a registered manager, who had recently left their position. Records relating to staff training and supervision, medication, care planning and health and safety were examined. An inspection of the environment was also carried out. The Inspector also met with the newly appointed manager, who was applying to be registered, on 12/06/09. What the service does well: What has improved since the last inspection? Clearer records have been put in place to document any restrictions or limitations that are required to protect service users. A more robust and safer staff recruitment and induction process has been put into place. Some parts of the home have been decorated and the carpets have been cleaned or replaced. People using the service are accessing more activities in the community. The Coach House DS0000062579.V375851.R01.S.doc Version 5.2 Page 6 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Coach House DS0000062579.V375851.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.V375851.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Review and revision of the Statement of Purpose and Service User Guide may benefit service users by presenting a more accurate and appropriate picture of the service. EVIDENCE: The home has a Statement of Purpose in place but this needs to be reviewed and updated where necessary. It would be also be useful for this to be provided in different formats. There is also a need to provide an updated Service User Guide. There have been no admissions to the home since the last inspection. The Coach House DS0000062579.V375851.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A framework exists for care planning and risk assessment, although there is some potential for improvement in order to make the approaches more person-centred, robust and consistent. EVIDENCE: A sample of care plans were examined and these were detailed and contained good guidance for staff on a range of issues and service user needs. The staff have been completing behaviour monitoring charts and recording relevant information on a regular basis. Staff have also begun completing a new format titled “behavioural anchors” which provides information around independence skills. Some of the plans did not have dates and it was unclear when they had been reviewed and who had been involved in this. There was also a lack of specific The Coach House DS0000062579.V375851.R01.S.doc Version 5.2 Page 10 goals, particularly in relation to some plans that clearly stated that a goal was required. Also some recording gave only the basic information and lacked detail around the circumstances. There is a need to provide more narrative around behavioural incidents. Staff described how they were supporting service users and the areas they were working on but some of this progress was not reflected in the care planning process. There is a need to provide a clearer link between documentation and practice and it is important that the new manager provides some clarity and direction in this. Through observation and records there was evidence that staff support and encourage service users to make choices and decisions about their daily routines and are making increased efforts to involve people in the daily domestic chores and tasks around the house. The Coach House DS0000062579.V375851.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): This is what people staying in this care home experience: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported to pursue their interests and hobbies, and are able to access the local community with support. EVIDENCE: The records showed that staff have increased the level of activities for service user in recent months, as it was identified that improvements could be made in this area. On the day of the inspection all three service users undertook some activity in the community and were also supported to do tasks or activities of their choosing in the home. Activities included meals out, car trips, shopping, bowling and walking. Staff and service users were positive about the quality and quantity of food provided in the home. Staff have taken steps to increase the user involvement The Coach House DS0000062579.V375851.R01.S.doc Version 5.2 Page 12 in food preparation and menus planning. All food was appropriately stored and labelled and the menus showed that a varied and healthy diet was encouraged but that choice was respected. People living in the home are allowed to eat where they choose and are regularly offered drinks and snacks. Staff explained how the progress made by one person, who was now more settled in the home, had meant a change in the staffing ratios needed to supervise trips into the community. This was a very positive development but this change was not reflected in the risk assessments, and this needs to be updated. There is need for a number of risk assessments to be reviewed and updated. Service users had physical intervention protocols in place but there is a need for these to be reviewed and updated where necessary. Staff confirmed that no intervention had been required for several months. The Coach House DS0000062579.V375851.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported to access the healthcare professionals they require to ensure that physical and emotional health needs are met. Satisfactory arrangements are in place for the handling of medication, promoting service users’ wellbeing and encouraging their independence. EVIDENCE: Medication storage and administration were examined and found to be in order. Staff only undertake this responsibility after training has been completed. There was one protocol for administering a PRN medication that was out of date and needs reviewing. None of the people living in the home are able to self medicate but would be supported to do so if their abilities allowed. The Coach House DS0000062579.V375851.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe environment for service users in which they are respected and treated with dignity but shortfalls in the required notification of incidents potentially compromises this. EVIDENCE: The home has complaints procedure in place which complies with the regulations and staff spoken with knew how to raise issues or concerns with the Provider. A complaint was received by the home early 2009 and this was not reported to the Commission as it should have been. The issues concerned have now been addressed by the home. There were also two incidents involving service users, identified during this inspection, that should have been reported to the Commission. This lapse appears to be due to the absence of the manager but a requirement has been issued in respect of this. The Coach House DS0000062579.V375851.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of 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 but improvements are required in relation to maintenance and general cleanliness. EVIDENCE: Some parts of the environment have been updated with new carpets and decorating having been completed. Some parts of the home are a little sparse in terms of fittings such as pictures, but this is supported by the risk assessments in place and meets the needs of the majority of the people living in the home. The individual bedrooms meet the needs of the service users and are decorated and arranged according to personal taste and needs. There are plans for some rooms to be decorated shortly. The Coach House DS0000062579.V375851.R01.S.doc Version 5.2 Page 16 Parts of the kitchen were in a poor state of repair with a broken window and flaking paintwork. The kitchen units were tatty and the ceiling and walls were in need of decoration. There are plans to relocate the kitchen to another room but steps should be taken in the interim to make the present kitchen more hygienic. There is a need for an improvement in the general cleanliness of the home and this is something that has also been recognised by the Provider. It can be difficult for the staff to fully meet the needs of the service users and also perform all the domestic tasks to a high standard. Whilst some service users participate in the domestic chores, due to the needs of people this responsibility is primarily down to the staff. The Coach House DS0000062579.V375851.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by a staff team that relates well to them and has a positive approach to their care and support. Improved formal supervision of staff, increased leadership and direction could produce increased opportunities and improved outcomes for service users. EVIDENCE: At the time of this inspection there were sufficient staff on duty to meet the needs of the service users, and the rotas showed that the correct staffing levels were being maintained. The home currently only has three people living there and there are no plans for further admissions until a new manager is in place. It was evident that staff were working with initiative and were committed to meeting the needs of the people living in the home. Staff were observed communicating and responding to staff in a professional and respectful manner and demonstrated in interview a good understanding of the needs of the The Coach House DS0000062579.V375851.R01.S.doc Version 5.2 Page 18 service users. Examples were given of some changes in approaches to issues that had produced better outcomes for people. Due to the extended absences of the registered manager there had been infrequent formal supervisions of staff. Staff records were in order and showed that the correct procedures were being followed with all the required checks being completed. Staff were observed communicating with people using signs and appropriate language and there is also good use of picture boards and other visual aids to support decision making and choices. Staff were up to date with the required statutory training and the majority of staff have completed NVQ training. All staff had completed training in the management of challenging behaviour and Adult Protection. The Provider has a centrally organised induction programme for new staff that provides training in all the required areas before people move onto work shadowing. The home has had infrequent staff meetings for several months, and it was apparent that the absence of the manager for long periods had contributed to this. Staff spoken to were motivated to improve the team working, communication and consistency and said they hoped that more frequent staff meetings would be a priority for the new management. Staff commented on the difficulties of maintaining a consistent approach and also regular activities when a lot of agency staff have been used and that a lack of leadership and guidance has at times made working difficult and stressful. The Coach House DS0000062579.V375851.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The senior staff have maintained to a reasonable standard the administration and direction of care within the home but the action points identified by the regulation 26 inspections need to be implemented to ensure consistent improvement and progress. EVIDENCE: The home has had extended periods over the past several months without a manager due to sickness and absence. The previous manager has now left and new manager had been appointed but had not yet started at the time of this visit. This has been a difficult time for the care staff but they have appeared to cope well. The Provider has not attempted to fill the vacancies in the home during The Coach House DS0000062579.V375851.R01.S.doc Version 5.2 Page 20 this period. This has helped to ensure that the needs of the present people living in the home have continued to be met. The Provider has completed regulation 26 inspections and these have been detailed and critical and provided actions to be addressed by the new manager and staff team. The Provider has communicated to the Commission their concerns and their plans for the home and are being pro-active in addressing concerns around the environment, staffing supervision and the meeting of the needs of the people living in the home. All health and safety records checked were up to date and correctly signed. There is a need for a fire evacuation practice to be completed and risk assessment completed on the response of the service users. The Coach House DS0000062579.V375851.R01.S.doc Version 5.2 Page 21 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 2 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 2 X 2 X X 2 x Version 5.2 Page 22 The Coach House DS0000062579.V375851.R01.S.doc 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. 2. Standard YA9 YA1 Regulation 13 4&5 Requirement All risk assessments should be regularly reviewed and updated when necessary The Statement of Purpose and Service User Guide must be reviewed and should be easily available within the home All notifiable incidents under regulation 37 should be reported to the Commission. All parts of the home should be clean and of a good hygienic standard. The home must repair the broken window in the kitchen and remove the flaking paint in this area. The home must complete a fire evacuation drill and this must be recorded. All staff should receive regular recorded supervision Timescale for action 23/08/09 23/08/09 3. 4. 5. YA23 YA24 YA24 37 23 23 23/07/09 23/08/09 23/07/09 6. 7. YA42 YA35 23 18 23/07/09 23/08/09 The Coach House DS0000062579.V375851.R01.S.doc Version 5.2 Page 23 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 The Statement of Purpose and Service User Guide should be available in different formats The Coach House DS0000062579.V375851.R01.S.doc Version 5.2 Page 24 Care Quality Commission North West Citygate Gallowgate Newcastle uponTyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. The Coach House DS0000062579.V375851.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!