Inspection on 06/01/09 for The Coach House

This inspection was carried out on 6th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Coach House 08/01/07

The Coach House 05/10/05

The Coach House 23/05/05

The Coach House 25/11/04

The Coach House 17/06/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Coach House 1 Hernbrook Drive Horsham West Sussex RH13 6EW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Webb     Date: 0 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: The Coach House 1 Hernbrook Drive Horsham West Sussex RH13 6EW 01403255197 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ms Sharon Anne Waters Name of registered manager (if applicable) Ms Sharon Anne Waters Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 2 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The Coach House is a family run care home providing personal care for older people, and is registered to accommodate up to three residents. The registered provider is Ms Sharon Waters, who is also responsible for the day-to-day management of the home. The home is a detached property located in a residential area, just outside Horsham town centre, West Sussex. Accommodation for residents is provided in three single rooms all with en-suite facilities. Care Homes for Older People Page 4 of 27 care home 3 Over 65 3 0 Brief description of the care home The Coach House is arranged on two floors. Accommodation for residents is provided on the ground floor, with the first floor reserved for the private dwelling of the proprietor and her family. There is a medium sized garden at the rear and front of the property, which is mainly laid to patio, well maintained and easily accessible. The home provides for the needs of elderly people with a degree of mobility and independence. The home does not provide specialist equipment. Fees charged for living at the home range between four hundred and fifty pounds and six hundred and fifty pounds a week. It should be noted that any fee information included in this report applied at the time of inspection and that people may wish to obtain more up to date information from the care home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We undertook this site visit over one day, with the home being given no prior notice that we would be visiting. During the site visit we spent time talking to two of the three residents who live at the home and the Registered Provider/Manager. We also examined records and looked around the building. Case tracking was carried out by examination of records and information held on two residents. The home did not complete its Annual Quality Assurance Assessment (AQAA) and return this to us when requested. As a result of this a Statutory Requirement Notice has been served with a compliance timescale of the 30th January 2009. Because the Care Homes for Older People Page 6 of 27 AQAA was not returned to us by the due date information was not available for us to use before visiting the home on which to make judgements on the quality of service residents receive. Further information regarding this is included in the management section of this report. Two residents surveys were completed and sent to us. Both praise services provided at the home. Additional compliments were made with regard to the Registered Proprietor/Manager, meals provided and the level of care given. What the care home does well: What has improved since the last inspection? What they could do better: A record of all medication entering the home and stock stored must be maintained. This must happen to ensure systems for monitoring medication stocks are safe. Medication must be stored in a lockable facility in line with guidance produced by The Royal Pharmaceutical society of Great Britain The Handling of Medicines in social Care. This must happen in the interests of safe medication handling and for the protection of residents. The registered person must ensure that all required recruitment checks are completed prior to allowing anyone to work or undertake duties in the home, in a paid or unpaid capacity. This must include applying for and where possible obtaining a CRB disclosure and obtaining a POVA first certificate. The registered person must also obtain documentary evidence of any relevant qualifications and training that people who undertake duties in the home have undertaken. This must happen in order that the home can evidence its recruitment practises offer safeguards to residents. Quality monitoring systems are not in place that allow the home to measure if it is achieving its aims and objectives and some record keeping practises do not ensure residents best interests are promoted. Care Homes for Older People Page 8 of 27 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to prospective residents in order to help them decide if the home will meet their needs. Assessment processes ensure residents needs are identified so that they can be met safely. The home does not offer intermediate care. Evidence: There is a statement of purpose and service user guide available. Since our last inspection the service user guide has been updated to include current contact details of the Commission for Social Care Inspection (CSCI). We found contracts of residency to be in place on all three residents files. All have been signed by either the resident or their representative and the Registered Manager. Two of the three residents files contained assessments of needs completed by the Registered Proprietor/Manager and the third a assessment completed by the hospital Care Homes for Older People Page 11 of 27 Evidence: they were discharged from before moving to the home. The homes assessment covers all aspects of Standard 3.3 of the National Minimum Standards for Older People. We spoke to two of the three residents who live at the home. Both informed us that the home had been recommended to them and their representatives and that they were satisfied with the service provided. For example one person explained, Hopefully I will see my time out for the rest of my life at this home. My daughter heard about this home at hospital. Im not a very sociable person, wanted a small private place. This is ideal, I have no complaints, get plenty to eat, peace and quiet, have my television, they supply all mod cons. The home does not offer intermediate care. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans give clear information so that residents needs can be met. Residents health, personal and social care needs are met. The storage of medication does not offer sufficient safeguards to residents. Residents are treated with dignity and their rights to privacy respected. Evidence: Since our last inspection the Registered Provider/Manager has implemented care plans that are generated from the initial assessment of needs (meeting a previous requirement). These detail residents health, personal and social care needs, including actions to be taken in order that these will be met. The plans also include background information and preferences. The Registered Provider/Manager informs us that care plans are reviewed monthly. Resident access various health care services as and when required. The Registered Provider/Manager informed us residents receive regular chiropody treatment and that Care Homes for Older People Page 13 of 27 Evidence: the District Nurse visits two residents on a regular basis. We examined the medication systems within the home. Medication administration records were in place for all three residents. A record of medication stock is not maintained. A record of each residents medication is recorded in their care plans. Medication was seen to be stored in a plastic trolley that is not lockable. The Registered Manager/Provider informed us medication used to be stored in a lockable metal briefcase but that this was too small for storing the medication for residents currently residing at the home. We discussed this with the Registered Provider/Manager who agreed suitable lockable facilities must be provided. The Registered Provider/Manager informed us she is the only person who administers medication. She has not undertaken medication training. We observed interactions between the Registered Provider/Manager and residents. As at the previous inspection this was found to be caring, sensitive and appropriate. The Registered Provider/Manager demonstrated good knowledge and understanding of the personal care and support needs for each resident. For example she explained, There are no times or rules for bathing. X prefers bath twice a week and X is shy, I make sure we assist discreetly, putting towel round, leaving room when sitting by sink so he can do as much for himself as possible in private. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to maintain close contact with family and friends, and are supported to access the local community and attend personal interests. Residents are provided with balanced, nutritious, home cooked meals. Evidence: We spoke with two residents. Both said that they are able to go out and about, either with family members or with a relation of the Registered Provider/Manager and are happy with the activities in place. One resident informed us, I would never want to live in big place where everyone sits in chairs around lounge. have hobby using computer, have it here, have email access, got my own telephone. The Registered Provider/Manager informed us that a hairdresser visits the home fortnightly. Both residents that we spoke to confirmed that they are able to maintain contact with their families and that there are no restrictions on visiting times. As one person explained, nephew visits nearly every day and niece twice a week, always made welcome, offered a cup of tea, they just walk in, dont have strict rules about visiting. Care Homes for Older People Page 15 of 27 Evidence: The Registered Provider/Manager informed us there are no rules or restrictions applied at the home. Both residents that we spoke to confirmed this. For example one said, no rules here at all, I have breakfast after 10 because I like a lie in, can have meals whenever and where ever I like and the other no rules, if I have headache I can stay in bed, if want meal in room can, its just like living in own home. Fresh home made meals are cooked each day. A menu is not in place that routinely offers choices however we were informed alternatives are always provided when requested. The Registered Provider/Manager informed us that since our last inspection meal times have changed in order to meet residents needs. We received two residents surveys. Both state they always like the meals provided at the home. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel confident to raise concerns and that these will be taken seriously and responded to. Safeguarding procedures are not in place that would offer greater protection to residents. Evidence: There is a written complaints procedure that is included in the Service User Guide. Since our last inspection a complaints book has been implemented. The Registered Provider/Manager stated no complaints have been received. Both residents that we spoke to confirmed they were aware of the complaints procedure and would feel happy to raise any concerns. For example one stated, X says we should mention anything so that she can do something about, if one has to be in a home I cant think of a better one than this, I have no complaints. At our previous inspection the home was advised to obtain a copy of the West Sussex County Council Adult Protection procedures. The Registered Provider/Manager informed us these have been obtained but could not locate them during our inspection. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The building is clean and well maintained, providing residents with a comfortable and safe place to live. Bedrooms are well equipped and meet residents needs. Evidence: The property is a 1870s Victorian house, set in a residential area on the outskirts of Horsham town centre. Residents have access to all rooms on the ground floor and their own en suite bedrooms. All rooms looked at were pleasantly decorated and well maintained. Communal areas consist of the main dining room/lounge, with fixtures and fittings that include wooden beams, a fireplace with wood burner and a piano. The Registered Provider/Manager informed us that since our last inspection windows have been renovated, new carpet laid and areas of the home re-painted. We viewed two residents bedrooms. Both contained personal items and include French doors that lead to direct access to individually, private enclosed garden areas. Baths have handrails fixed to them and bathing equipment is provided. A nurse call bell Care Homes for Older People Page 18 of 27 Evidence: system is in place, with points found in all bedrooms viewed. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are satisfied with people who support them. Recruitment practises do not offer sufficient safeguards to residents. Staff are not trained to do their jobs and support residents. Evidence: The Registered Provider/Manager provides the majority of care herself. She lives on the premises with her retired partner and two daughters. She informed us she provides personal care, her daughters domestic support and her partner room service and general assistance. Three times a week she receives assistance from one employed staff member who works a total of nine hours per week. We examined the recruitment records for the member of staff employed at the home. These included an application form, Curriculum Vitae and three references. The staff member commenced work at the home 3rd November 2008. No POVA first disclosure was in place. An Enhanced Criminal Record Bureau (CRB) disclosure was in place. This has not been obtained by the Registered Provider/Manager but by the member of staffs previous employer. We discussed this with the Registered Provider/Manager who was not aware that CRB disclosures are not transferable. She stated she would apply for a new disclosure quickly. Care Homes for Older People Page 20 of 27 Evidence: We were not shown any recruitment records for the family members who carry out duties within the home. The member of staffs recruitment records give details of training they have obtained during previous employment. This includes obtaining a National Vocational Qualification (NVQ) level 2, food hygiene, life support and fire. Copies of certificates were not available to verify this information. The Registered Provider/Manager informed us she had requested a copy of the NVQ 2 certificate but the member of staff had not yet supplied this. The Registered Provider/Manager informed us that she formally supervises the member of staff but no records are maintained to evidence this. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel that the home is run in their best interests. Quality monitoring systems are not in place that allow the home to measure if it is achieving its aims and objectives. Not all record keeping systems ensure residents best interests are safeguarded. Residents live in a health and safe environment. Evidence: Ms Waters is the Registered Provider/Manager of the Coach House. At the time of our previous inspection she was undertaking her NVQ level 4. At this inspection we were informed she did not complete this. Ms Waters has no formal qualifications. During our inspection we discussed the omissions with regard to some aspects of record keeping. The Registered Provider/Manager informed us, my skills are caring for people not paperwork. Two residents surveys were completed and returned to us. Both praise the Registered Proprietor/Manager, complimenting her with regard to the level of care provided. Care Homes for Older People Page 22 of 27 Evidence: There are no quality assurance systems in place. The Registered Provider/Manager informed us she is constantly checking out with resident how they are and that the home is run as a family. She feels relationships between herself and family members are positive and all parties are able to communicate any concerns and requests. Records are not maintained of discussions between the Registered Provider/Manager, residents and/or relatives. The homes Annual Quality Assurance Assessment (AQAA) was not supplied to us when requested and as a result a Statutory Requirement Notice has been issued. During our inspection we discussed this with the Registered Provider/Manager who assured us this would be submitted by the due date as stated in the Notice. The Registered Provider/Manager explained that this had not been submitted as the person who completes this had been on holiday. We explained that as the Registered Provider/Manager she is responsible for ensuring compliance with Regulations, including the completion and submission of the homes AQAA. She reiterated earlier comments that she finds the paperwork too much and expressed the possibility of another person becoming the Registered Manager. The Registered Provider/Manager informed us that the home does not have responsibility for any residents finances. As previously mentioned in the staffing section of this report one person is employed at the home. The Registered Provider/Manager informed us this person is formally supervised but that no records are maintained of this. We found records in place that demonstrate that the fire alarm, emergency lighting, nurse call system and hot water are regularly tested. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 In line with Regulation 13(2) 06/03/2009 medication must be stored in a lockable facility in line with guidance produced by The Royal Pharmaceutical society of Great Britain The Handling of Medicines in social Care. This must happen in the interests of of safe medication handling and for the protection of residents. 2 9 13 In line with Regulation 13(2) 06/02/2009 a record of all medication entering the home and stock stored must be maintained. This must happen to ensure systems for monitoring medication stocks are safe. 3 29 19 In line with Regulation 19 and Schedule 2 the registered person must ensure that all required checks are completed prior to allowing anyone whether in paid employment or 06/02/2009 Care Homes for Older People Page 25 of 27 unpaid, who undertakes duties in the home. This must include applying for and obtaining a CRB disclosure and obtaining a POVA first certificate. The registered person must also obtain documentary evidence of any relevant qualifications and training for any person who supports residents, whether in paid employment or unpaid. This must happen in order that the home can evidence its recruitment practises offer safeguards to residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!