Care Home: Chy Koes

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What the care home does well Discussions with the people staying at the home form indicate that Chy Koes is offering a service that meets individual need in recognising the choices and wishes of the people who attend the home for their respite stays. For example during the course of the inspection it was apparent that rising times are open, how the day is spent is totally up to the individual and all meals are completely a free choice. Staff interaction with the people in the home was noted to be good. One person commented: it is great here, everyone is very kind, especially my key worker. Staff told us that the working environment was professional but relaxed and enjoyable. Policies and procedures are of a good standard as is the general record keeping as required by legislation. What has improved since the last inspection? The recommendations from the last report have been complied with. Staff are more aware of safeguarding guidance and procedures. Quality monitoring has improved with audits being analysed. An additional two beds have been added to the registration and facilities, aids and equipment are to a good standard. The recording of trips out, activities and interests undertaken has improved enabling more positive evidence that guests have the opportunity to influence their lifestyle whilst at the home. What the care home could do better: We have made one recommendation concerning the filing of information. There are no Statutory Requirements. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Chy Koes Chy Koes Woodland Road St Austell Cornwall PL25 4RA     The quality rating for this care home is:   two star good 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: Michael Dennis     Date: 0 6 0 7 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 Adults (18-65 years) 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 Adults (18-65 years) 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Chy Koes Woodland Road Chy Koes St Austell Cornwall PL25 4RA 0172676045 0172677105 andavies@cornwall.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cornwall County Council care home 5 Number of places (if applicable): Under 65 Over 65 0 0 physical disability sensory impairment Additional conditions: 5 5 The maximum number of service users who can be accommodated is 5. 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 categories: Physical disability (Code PD) Sensory impairment (Code SI) Date of last inspection Brief description of the care home Chy Koes is situated on the outskirts of St Austell. The home occupies the ground floor of a building that incorporates a separate care home for older people on the first floor. There is a large garden with lawns to the rear of the building with garden tables and bench seating. Ramps are provided for easy access. There is limited car parking space at the front of the home. The home provides respite care for up to Five adults with a physical or sensory Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home disability. Accommodation is provided on one floor and service users can access all areas. There is a spacious lounge with a dining area and a well equipped kitchen. There is a large shed in the garden for smokers that is heated and has furniture and a television. Assisted bathing and showering facilities are provided and all rooms have accessible call bells. Care Homes for Adults (18-65 years) 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The key inspection at Chy Koes was an unannounced inspection that commenced at 0900 on the 6th July 2009 and took place over four and a half hours. The registered manager was on holiday so the inspection was ably facilitated by an assistant manager. Chy Koes is a small home, 5 beds, that is offering a short stay respite service. The accommodation is suitable for anyone in a wheelchair. We inspected a wide range of documentation to include records, policies and procedures. As part of this process we case tracked four of the guests care plans. We also spoke with the staff on duty and with one guest present at the time of the Care Homes for Adults (18-65 years) Page 6 of 27 inspection. Prior to the inspection an annual quality assurance assessment form had been completed by the home. The information in this document is referred to in this report. What the care home does well: 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 set out 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. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Procedures are in place prior to admission to ensure that the people being admitted to Chy Koes can be confident that their needs will be met. Evidence: All the people who stay at Chy Koes access the facility by the care management process that involves a social care and financial assessment. The assessment is requested at the time of the referral and is then discussed to ensure that the home can meet the needs of that person. In addition an assessment by the manager or an assistant manager takes place again to establish that the home will be able to meet the care needs of all prospective people being admitted. On this visit they are given the Service Users Guide, the Terms and Conditions of the home, the Statement of Purpose and a brochure about Chy Koes and the staff employed. Prospective people and their families can visit Chy Koes to see the facilities before they decide to stay. Trial respite stays can be arranged. Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: A detailed personal letter of confirmation, with all the relevant information regarding a persons stay is sent to them prior to their admission. A comprehensive care plan and risk assessments are then documented with agreement and input by the service user. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 evidence that individual needs are being met in a way which respects the rights and choices of the people staying at Chy Koes. Evidence: Each person at Chy Koes has a comprehensive care plan in place which has been discussed and agreed with the person and their family or representative. The care plans include all aspects of health and social care including a life history and is goal orientated with actions in place to meet needs. There are appropriate risk assessments in place and evidence of individual preferences and choices. A copy of each plan is given to the person in the home and they are involved in discussing their care planning documentation. There is evidence in place that the care plans are reviewed on an ongoing basis and always when that person is re-admitted to the home. Relevant daily information for each person is recorded on a contact sheet held in the individual persons file. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: Chy Koes aims to recognise personal dignity, privacy and individuality whilst encouraging independence and the right to take risks. One of the people staying at Chy Koes said,it is great here, everyone is very kind, I have no complaints. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. Each person staying at Chy Koes is encouraged to pursue their interests and hobbies and staff can provide assistance where required. Evidence: The assessment process and discussion with the person and their representative identifies and agrees their plan of activity and appointments that that person would wish to continue with during their stay. The home provides transport to enable and facilitate outings from the home to take place. When people attend Chy Koes for their respite stay they are encouraged to go out to the shops, churches, library and cinema as they wish. Good risk assessments are in place to cover the various activities undertaken. Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: Enablers are arranged for activities outside the home and people also attend workshops and day centres. In addition, people are encouraged to pursue their interests and hobbies when staying at the home. People can telephone their family and friends at any time and they can visit at any reasonable time. All visitors to the home are encouraged to sign the visitors book in the entrance of the home. All the staff have responsibility for meal preparation at the home and staff have been trained to the basic food hygiene certificate level. A menu is in place and a record of all meals provided also in place. Each person is asked at every meal what they wish to eat and drinks are also regularly provided during the course of the day. The main meal of the day is eaten in the evening. On the day of the inspection guests stated their preference for lunch which was catered for. The kitchen is well stocked, tidy and clean. Fresh produce is purchased daily and all special dietary requirements are met. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. The people at Chy Koes can be confident that their personal and health care needs will be met. Evidence: Mealtimes, bedtimes and other activities are flexible to support and respect the wishes of the people in the home. Support and assistance with personal care is given as required and recorded in the care plans. Equipment is provided according to individual needs. Individual preferences are taken into account and recorded. Specialist support from occupational therapists and physiotherapists is given as required. People maintain their contact with their general practitioners and community nursing staff provide support as required. The home operates a key worker system which allows for particular additional responsibilities for the staff member to the benefit of the person staying in the home. It was reported that this system was working well. The home does not maintain stocks of medication as the people coming into the home Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: bring their own medicines with them and any surplus is returned home when they leave. Medication administration records were found to be completed appropriately on the day of the inspection. Any person who is assessed as able to self-medicate is provided with a lockable facility in their bedroom. All staff who have medication administration responsibilities have received accredited medication training. The home has in place a good practice medication policy and procedure to guide staff on safe practice. An audit of the Controlled Drugs held on the premises proved to be accurate. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. 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. The people at Chy Koes can be confident that any concerns or complaints are treated seriously and that they will be protected from abuse. Evidence: The home has in place a satisfactory complaints policy and procedure. There is also a leaflet in the home detailing how to make a comment, compliment or complaint. There is a system in place for recording all complaints including details, investigations and outcomes. The home has had no complaints to date. There is a suggestion /comments book for visitors/people/families/staff. The people in the home are aware of who to complain to and how to do this. Staff told us that they had received complaints training. Nearly all the staff employed at the home have received adult protection training with those that have not being booked onto a course. All staff have received adult protection training in their induction and or NVQ training. Whistle blowing policies and procedures are also in place. Information in an easy read format is provided in the entrance of the home on adult protection issues. Care Homes for Adults (18-65 years) Page 18 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. The people at Chy Koes stay in a pleasant, well maintained home that is comfortable, warm and clean Evidence: Chy Koes provides a respite care service for people with a physical disability with care needs ranging from low to high levels of dependency. The environment is suitable for people in a wheel chair. There is a large communal lounge/dining room. Patio doors from the lounge lead into the garden. In the garden is a smoking area for guests as smoking is not permitted indoors. Access to the garden from the lounge is on the level. At the front of the home car parking is available although this can be busy at times. The home has five single bedrooms each with their own hand basin and call bell system. Each bedroom has an adjustable height bed and a lockable space is provided for the storage of money and valuables. Radiators are noted to be of low surface temperature. Within the home is a large shower room with a w.c., an adjustable height wash hand Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: basin and grab rails. The shower can be used whilst sitting, standing, or in a shower wheelchair. There is also a large bathroom with adjustable height bath and wash hand basin and electric ambulift to offer maximum independence. Additional equipment in the two new rooms includes overhead gantry lifts. The home was found to be very clean on the day of the inspection. All the staff have cleaning responsibilities and duties. The laundry is provided with suitable equipment to meet the needs of the home. A good selection of protective clothing is provided for infection control purposes. A part time staff member has been employed for house keeping duties. Given that this home provides for short term respite care it presented as being relatively homely, with the communal areas being domestic in style. Care Homes for Adults (18-65 years) Page 20 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. The people at Chy Koes are cared for by capable and caring staff in sufficient numbers to meet the needs of those currently living in the home. Recruitment procedures protect vulnerable people. Evidence: All the staff are issued with job descriptions that are specific to Chy Koes. The care staff fulfil all the kitchen and laundry duties in addition to their care responsibilities. A Housekeeper is now employed who supports the care staff, thus reducing their ancillary duties. During the day there are a minimum of two care staff members on duty. On the day of the inspection there were two care staff and one assistant manager. At night there is one waking staff member and one sleeping in staff member. Additional staff may be on duty at any time based on the assessed needs of the current guest group. Cornwall Council has a comprehensive recruitment policy and procedure that is adopted within the home. We were unable to inspect the staff files on this occasion as they were securely locked away. The Registered Manager was on holiday and the Assistant Manager on duty did not have access. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: There is a six month probationary period for all new staff. New staff members receive induction training that meets the Skills for Care guidance. Training needs are identified through the annual appraisal and supervision process. A training matrix is then put in place which shows when training is due and what has taken place. An assistant officer has training responsibilities in developing and keeping up to date the training matrix. Staff at the home are receiving regular support and guidance from the manager through the supervision process and regular staff meetings. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. The people at Chy Koes stay in a well managed home. Management and the staff team strive to provide a stimulating, safe environment where people are respected and their rights upheld. Evidence: The registered manager is a level one registered nurse who has also obtained her registered managers award qualification. She keeps her nursing qualification up to date and regularly attends statutory and good practice training. The manager works full time hours over a four day week and is on call when not working at the home. She is supported in her duties by assistant managers who have all been given specific responsibilities. The Registered Manager was on holiday at the time of this inspection and one of the assistant managers on duty presented as knowledgeable and capable around her specific tasks and responsibilities. Monthly statutory visiting reports from the responsible individual are being completed Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: and kept at the home. The manager attends monthly Cornwall County Council managers meetings and holds regular meetings for her own team. Additional administration support in the form of a part time clerical post has now been filled. The home has carried out a quality monitoring audit of their service and generally feedback in the questionnaires looks positive. A full and comprehensive Annual Quality Assurance Assessment was completed and returned to the Commission when we asked for it. The management and safety representative have a commitment to the health and safety of the service users. There are health and safety risk assessments in place, including detailed fire risk assessments. Heating and electrical systems within the home are serviced and maintained. All hot water taps have water regulators that ensure legal compliance. We accessed a number of records, policies and procedures during this inspection and make one recommendation as a result. Whenever possible it is recommended that all records pertaining to an individual are kept on a single file personal to that person. This should assist in compliance with the Data Protection Act, Freedom of Information Act and enable risk assessments and audits to be more readily achieved. An example is accident forms. Keeping them on the relevant persons file will enable the opportunity to monitor and risk assess as necessary. Care Homes for Adults (18-65 years) Page 24 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 Adults (18-65 years) Page 25 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 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 1 41 It is recommended that all records pertaining to an individual are kept on a single file personal to that person. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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. 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