Inspection on 29/04/09 for The Coach House

This inspection was carried out on 29th April 2009.

CQC 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 CQC judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Key inspection report CARE HOME ADULTS 18-65 The Coach House 206 High Street Honiton Devon EX14 1AJ Lead Inspector Michelle Oliver Key Unannounced Inspection 29th April 2009 09:30 The Coach House DS0000073151.V375198.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 DS0000073151.V375198.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 DS0000073151.V375198.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Coach House Address 206 High Street Honiton Devon EX14 1AJ 01404 43404 01404 549429 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) Readlee Limited Mrs Joanne Read Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places The Coach House DS0000073151.V375198.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. Mental Disorder (Code MD) The maximum number of service users who can be accommodated is 3 Date of last inspection Brief Description of the Service: The Coach House is situated in the main high street of Honiton and is owned by Readlee Ltd and managed by Mrs Joanna Read. It is a large terraced property fronting on to the road, with a large garden to the rear. The facilities and design of the home mean that it would not be suitable for service users with physical disabilities. The home is registered to provide personal care with accommodation for up to three people with mental health needs. At the time of the inspection three service users were accommodated. Fees for service users range from £2,100 - £2,800 per week and include most activities and some phone calls. . General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk The inspection report for the home is available in a folder in the main lounge. The Coach House DS0000073151.V375198.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 2 star. This means that people who use this service experience good quality outcomes. This inspection was undertaken by one inspector over the course of 8 hours on one day. During this time we spoke with people living at the home and staff. We also spent time observing the care and attention given to people by staff. To help us understand the experiences of people living at this home we looked closely at the care planned and delivered to 3 people. All of those living at the home were spoken with during our visit to hear about their experience of living at the home. We also spoke to staff including the directors, head of care and occupational therapist. A tour of the premises was made and we inspected a number of records including assessments, care plans and records relating to medication, recruitment and health and safety. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk. Copies of the inspection report are available from the office. What the service does well: The home provides a safe, comfortable, relaxed and friendly home for three vulnerable people who have mental health issues. One person told us “it’s a great place to live” and another person told us they about to move into accommodation where they will live independently “ thanks to all the help” they’d been given at The Coach House.. Detailed care plans are maintained to ensure care needs are identified and met. People are encouraged to plan realistic goals and supported to meet them. There are good relationships between people living and working at the home. The rights and choices of people living at the home are respected and independence is encouraged. All staff spoken to during this visit told us they enjoy working there and feel well supported by the staff team. They are encouraged to undertake regular training to enable them to meet the needs of people living at the Coach house. People living at the home are supported and encouraged to gain independent social skills and staff work well with other health care professionals to achieve this aim. The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 DS0000073151.V375198.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 DS0000073151.V375198.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): 2. 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. People who consider coming to live here can be confident that the service will assess their needs to help ensure this is the right service for them. EVIDENCE: The manager told us that each person who is referred to come and live at the Coach House undergoes an assessment of need and a detailed risk assessment. Referrals made to the home are considered by one of the providers and the Head of Care, who will discuss the information provided, and decide whether the placement is suitable. Issues considered include whether the person would be compatible with the people who are already living at the Coach House, whether staff are trained and competent in dealing with the individuals’ health and social care needs and whether the environment is suitable. The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 9 We were told that staff would visit the person in hospital, which is usually where people are referred from, and get input from other people involved in the persons care. This will include the person, their care manager, other medical staff such as consultants, staff who have been involved in their care and treatment and family and friends. The person is then invited to visit the home. This process depends on the individual, but they can visit as often as they wish. We were told that one person had visited the home with hospital staff, met staff and others living at The Coach house, were taken to look around Honiton, shown the leisure centre, library and station so they could get a good idea of what it would be like to live there. We looked at the files of two people living at the home. Both included comprehensive records of multidisciplinary health care professionals’ reviews of the assessment and admission process. However, there were no records of the information gathered when people visited the home. Two other people living at the home told us they had visited the home several times. Another person told us they came to visit the home on one occasion, to meet staff and other people who live here to make sure it suited everyone involved. The person told us they only visited one because they wanted to move from where they were living “quickly”. They had been visited “a couple of times” by staff from the Coach House who gave them information about the home. They were satisfied with the amount of information that they’d been given, which helped them to be able to make a decision about moving to the Coach House. The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 10 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): 6, 7, 8 & 9. 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. People can be confident that the service has a clear care planning system in place, but this does not always provide the information that staff need in order to ensure that health care needs are met. Peoples’ choice is sought and acted upon where possible. EVIDENCE: All people living at The Coach House have individual plans of care. These provide comprehensive information about health and social care needs and how they can be best met. Care plans show that progress is monitored and The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 11 that changes are made accordingly. Plans are written, and reviewed, in conjunction with other health care professionals and plans are agreed by the person concerned, if they wish, and the Head of Care. This means that people are included in how they choose to have their care provided and how they will be supported and encouraged to meet assessed needs. We spoke to two people currently living at The Coach House who confirmed that they had been included in the drawing up of their plans, in regular reviews, told us what their care plans contained and confirmed that they felt comfortable and supported in raising any matters that they did not agree with. One person told us they did not want to be involved in their care planning. This was confirmed when we looked at individual plans of care. Care plans are detailed and set out details of all aspects of people’s personal and social support needs and the day-to-day action that needs to be taken by staff in order to ensure the care plans are followed. Great emphasis is placed on agreement with the person whose care is being planned to make sure that goals are what they want and steps to meet them are achievable. The service operates a key worker system, which means that each person living at The Coach House has a member of staff allocated to them, who can communicate with the person and provide support and encouragement to meet individual goals. This is done with the involvement of the person. We saw detailed information relating to how people’s independence and confidence had been increased in a well planned and monitored way. This included educational and vocational as well as leisure activities. For example one person wanted to pursue a vocational interest and plans included details of how this would be accessed. Another had a personal aim and we saw detailed information about how this would be achieved undertaking monitored stages all of which worked towards meeting other goals such as increasing communication and independence. However, care plans did not include details of health problems that some people had or how these would be managed or prevented. For example one person is diabetic and another is prescribed medication for controlling asthma. We discussed this with the occupational therapist employed at the home and the head of care. The occupational therapist told us that they are currently working to improve the quality of detail included in care plans. We were shown a recently compiled care plan that included clear, comprehensive details of the assessed needs of a person and how the goals would be worked towards and reviewed. Since the last inspection an individual daily record has been maintained for each person living at the home. The information included is comprehensive and clearly shows whether progress has been made during any one day towards The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 12 meeting individuals’ aims or goals, good descriptions of behavioural issues and the day’s events. For example; a care plan detailed how a person aimed to undertake an educational course, with realistic steps to enable them to reach their goal. Daily records clearly showed how the person had worked towards meeting their aims, such as going to college or undertaking work at home. The home accommodates people who have been identified as exhibiting behaviour that challenges the system and who may be at risk of extreme self harm. Comprehensive risk assessments are therefore drawn up and control measures put in place, based on any such risks that have been identified through the care plan. People we spoke to were aware of any restrictions placed upon them and understand why they are there. There is a rota at the home for jobs that need to be done as well as shopping and cooking. All residents take a turn with these jobs as well as being responsible for keeping their own rooms clean and tidy. One person told us they didn’t agree with the rota system and would prefer to undertake chores on a daily basis as they arose. This had been detailed in their care plan and their chosen system was being monitored to make sure the system was fair and that other people were in agreement. The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 13 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: 12, 13, 14, 15, 16 & 17. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at The Coach House can be confident that they will be supported to make choices about their lifestyles through using the local community, taking part in appropriate activities and maintaining relationships with families and friends. They are provided with choices of well balanced meals are treated respectfully and consulted in all decisions about their lives. EVIDENCE: We spoke to 3 people living at the home during this inspection all of whom confirmed that staff treat them in a kind and caring way. During the inspection The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 14 we saw staff treating people respectfully, offering choices and being supportive. People living at The Coach House may sometimes present behaviour that challenges the service, and restrictions may be placed on their access to the community during these times. However, generally individuals are encouraged to be independent and are helped to overcome their particular behavioural problems. The home is working hard to encourage people to be as independent as possible, for example some people living at the home are able to use the local facilities and public transport independently now. Care plan goals and risk assessments reflect this work. Transport is available, provided by Readlee Ltd. All staff over the age of 25, who has a current driving license, is insured to drive either of the 2 cars. We were told that it is hoped that another people carrier will be bought so that people living at The Coach House and those living in another service owned by Readlee Ltd will be able to go out together if they wish. Three people we spoke to were happy to tell us about some of the activities they take part in and enjoy. These included both leisure and educational activities. One person told us about some voluntary conservation work they had undertaken and enjoyed and daily records confirmed the activities people take part in are their own choices. One person told us they were undertaking skiing lessons in preparation of a planned skiing trip and another was enjoying ice skating. Cycling, swimming, local trips, including a trip to a zoo recently, indoor rock climbing and going to football matches are just a few of the activities that people told us they have taken part in and enjoyed recently. Two people went, with staff, to a holiday camp recently for a “music weekend”, which they said was “great”. People living at The Coach House are encouraged and supported to maintain close contact with the families and are able to make a free phone call to their families every evening if they wish. We spoke to staff that showed a good understanding of peoples’ needs and were able to describe good practice in relation to maintaining their privacy and dignity. The home employ an occupational therapists to promote independence for the people living at the home, and to support and encourage them to find new and interesting activities for them to participate in. Activities which meet individual interests are sought and all of those we spoke to told us how staff would try to sort out any activities they wanted to take part in. Healthy eating is encouraged at the home and people living there are helped to choose healthy alternatives. People take it in turns to shop and cook for the The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 15 evening meal. One person told us that since living at The Coach House they were now able to do their own shopping and cooking, which is very helpful as they will soon be living independently. The owner said that she was very happy to pay for any courses or activities that interested people living at The Coach House. The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 16 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): 18, 19 & 20. 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. People living at the home benefit from their dignity and privacy being fully respected. Improvement in care planning will is needed to ensure that peoples’ health needs are closely monitored. Medication is generally well managed at the home, but measures should be taken to ensure that all staff complies with the home’s written policies and procedures. EVIDENCE: People living at the home may have severe mental health issues and lack emotional stability. Staff said that they see their role as supporting individuals and enabling them to work towards the independence they want. The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 17 People living at The Coach House do not receive any physical personal care, but do require prompting to attend to their personal hygiene and guidance on the type of clothing to be worn. The home tries to increase the daily living, emotional and social skills of people living there in order that they may at some time live independently. One person is about to move out of the home and told us how they felt “confident” that they were prepared for the move. People are encouraged and supported to make and attend appointments with health care professionals such as doctors, consultants, dentists and opticians. Records are kept of all appointments people attend also information about any treatment or dates of follow up appointments. Care files show that all individuals have regular contact with psychologists and psychiatrists who monitor their emotional wellbeing. Medicines are stored securely in a locked room in a locked cabinet. Since the last inspection the majority of medicines are supplied to the service in individual blister packs supplied by a local pharmacy and some continue to be dispensed in bottles. The homes medication policy and procedure states that medicines received, and dispensed to people living at the home, are recorded on Medication Administration Records [MAR] sheets. We looked at those for the 3 people currently living at The Coach House. Not all were correctly completed and not all medicines were checked and signed for when received at the home. Directions for the administration for some medicines that had been hand written did not indicate that it had been checked by two people to ensure accuracy. In one case medication had been recorded with no indication that the amount or instructions had been checked. One MAR was not accurate; the amount of medicine received was not correct. Staff at the home have undertaken training in the administration of medication and the Head of Care assesses their competencies regularly to ensure they continue to understand safe practices. This reduces the risk of any mistakes being made in relation to medication procedures. Currently nobody living at the home looks after their own medication. The people we spoke to did not express a wish to do so and staff told us that if they did they would be supported and encouraged to undertake this. The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 18 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): 22 & 23. 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. People living at The Coach House can be confident that they will be listened to and complaints will be dealt with appropriately. There are good systems in place to ensure people are protected from abuse and the risk of harm. EVIDENCE: The home has a clear complaints procedure, which is displayed around the home, on notice boards, in individuals’ bedrooms and also each person is given a copy when they move into the home. We were told that no complaints have been made to the home or Commission since the last inspection. One of the people living at the home told us they know how to make a complaint and would feel comfortable doing so if they were unhappy about anything. If they were unhappy they would speak to their key worker or any other member of staff. The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 19 All staff at the home have received training relating to POVA (Protection Of Vulnerable Adults) issues. Staff spoken to during this inspection gave us good examples of what they would consider being poor practice or abuse and said they would not hesitate to report any concerns to the Head of Care or one of the Directors of Readlee Ltd. People living at The Coach House at the home are at high risk of self harm and risk assessments have been undertaken, and are in place to minimise these risks. Peoples finances are managed well. People said they had their own bank accounts where benefits are paid and a standing order is set up to pay their contribution towards the homes fees. We looked at financial records for all living at The Coach House and they were accurate and up to date. The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 20 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): 24 & 30. 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. The Coach House provides safe, comfortable, clean and homely accommodation and environment for people living and working there. EVIDENCE: The Coach House is a large terraced house on the main road into Honiton. It has a large spacious lounge as well as a large kitchen-dining room. There is a conservatory to the rear of the house and a large pleasant garden. The home has two bathrooms, one with a Jacuzzi bath the other has a double shower to provide choice, and a downstairs toilet. The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 21 People living at the home are encouraged to treat it as their home and take responsibility for their own rooms. All communal areas are well maintained and comfortably furnished with contemporary furniture and fittings and there were lots of pictures and photographs of those who live and work at the home, giving it an ordinary domestic feel. Several people commented that they liked the way the environment was so relaxed and homely. There are no bedrooms on the ground floor making the home unsuitable for anyone with mobility difficulties. Individuals are encouraged to personalise their rooms and are able to choose their own colour schemes and furnishings and fittings. We did not look at any bedrooms during this inspection but all people we spoke to told us they were very happy with their rooms. Individuals are responsible for keeping their own rooms clean and there is a rota for general household tasks. Since the last inspection a downstairs toilet has been replaced, both upstairs bathrooms have been refurbished, and the lounge and stair carpet has been replaced. The home was clean and hygienic throughout. We were told that the kitchen is due to be refitted, which will include replacing the floor covering, which is worn in places, during the week following this inspection. The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 22 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): 32, 34 & 35. 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. People living at The Coach House benefit from being cared for and supported by staff that are well trained, caring and experienced. Not all staff have been recruited following a robust recruitment procedure. EVIDENCE: The service aims to have at least two members of care staff on duty at all times throughout the day and night. Both directors, the head of care and an occupational therapist are also on duty and available in any of the three homes owned by Readlee Ltd, all of which are in Honiton within walking distance of each other. The homes are also supported by a part time office administrator. The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 23 People living at The Coach house confirmed that there were usually enough staff available to enable them to do what they chose. If there were not then arrangements would be made to make extra staff available. At the time of this inspection the occupational therapist was on duty with one member of staff. We were told that usually there would be another member of staff on duty but they were attending training, which was being held over 2 days. The member of staff on duty at The Coach House frequently left to visit the neighbouring service where another member of staff was also attending training. We spoke to the member of staff who told us that this rarely happens but if it does all staff support each other and ensure that people living at the services are well cared for and can do what they wish. The head of care was also available throughout the day. All staff are encouraged to undertake NVQ training after they have completed a 3 months probationary period. Information received prior to this inspection told us “all staff have or are working towards NVQ2 and encouragement is given to NVQ 3 and above”. Readlee Ltd had a good response to a recent recruitment drive and has employed a number of staff since the last inspection to work at all services owned by the Company. The service has a robust policy and procedure to be followed when employing staff but we saw evidence that this had not been complied with consistently when we looked at 3 of the 4 employment files looked at during this inspection. For example, one person had been employed before a police check had been applied for, another was employed before the result of a police check had been received and no proof of identity was available in the file for another member of staff. [We were told that proof of identity would have been seen by the interviewers at the time of interview.] We were told that staff had not worked alone before the result of police checks had been received. Not complying with the services’ employment procedure and policy puts people, who use the service, at risk of being cared for by staff who have not been employed using a robust recruitment procedure. We were told that currently 6 recently employed staff are undertaking induction training. Training is comprehensive covering topics including medication, protection of vulnerable adults, food hygiene, infection control, The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 24 health and safety, Mental Health Legislation, Mental Capacity Act and communication and also includes an assessment of what staff have learned from the training. Staff also receive training in how to deal with situations which could challenge them [ De- escalation training] and ways of protecting themselves if they are subjected to potential harm, whilst ensuring that the resident is also protected [ Breakaway and Physical Intervention training] The induction training programme meets good practice guidelines. The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a well managed, safe home where their views and wishes are listened to and they are included in the running of the home. EVIDENCE: Mr & Mrs Read, Directors of Readlee Ltd are experienced social workers, have over 10 years experience in residential care and Mrs. Read is registered as the manager of The Coach House. The structure of management is currently under review and we were told that Mrs Read may not continue to manage the service. The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 26 We were told that relatives, and visitors, of people living at the Coach House have recently been asked to complete a Quality Assurance survey so that the level of satisfaction with services at The Coach House could be assessed. However, a report, which would be made available to interested parties, has not yet been produced. There are regular meetings for those living in the home and records show that they are offered as much choice as possible about how they lead their lives. A questionnaire was completed by the manager prior to the site visit, which provided information about the people living in the home, staff, and fees and indicates whether necessary policies are in place. The information helps the Commission prepare for the inspection. Information provided by The Coach House prior to this inspection, indicates that the service complies with health and safety legislation in relation to maintenance of equipment, storage of hazardous substances, health and safety checks and risk assessments. All windows above ground floor level are fitted with restrictors, in order to minimise the risk of falling from these windows. No radiators have been fitted with covers, but risk assessments, which have been undertaken, indicated that covers were not needed at this time. We were told the service is operated in an “open door” management style encouraging people living and working there to speak openly without fear of being judged or in any way victimised. Confidentiality is respected and if a person wishes to speak privately they can do so at any time to whoever they wish to speak to. The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 27 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 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 2 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 4 13 4 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 2 X X 3 X Version 5.2 Page 28 The Coach House DS0000073151.V375198.R01.S.doc 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 YA20 Regulation 13[2] Requirement Arrangements must be made for the recording and administration of medicines received into the care home. [This relates staff not signing to indicate medicines have been given, or not given, medicines not being signed for when received at the home and amounts of medicines being incorrectly recorded] Before a person is employed to work at the Care home unless the information specified in 1-7 of Schedule 2. [This relates to 2 people being employed prior to the results of a Police check being received and no proof of identity included in the recruitment file for another.] Timescale for action 28/05/09 2 YA34 19[1][b] 28/05/09 The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA2 YA6 YA22 Good Practice Recommendations Pre admission assessments of health and social care needs should be recorded and kept in the care home. Details of people’s health care needs and how these are managed should be recorded in individual care plans. The complaints procedure should include up to date information relating to how people may contact the Care Quality Commission if they wish. The Coach House DS0000073151.V375198.R01.S.doc Version 5.2 Page 30 Care Quality Commission South West Region Citygate Gallowgate Newcastle upon Tyne 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. 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