Care Home: Coach House Nursing Home

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What the care home does well The atmosphere of the home is friendly, warm and welcoming. People using the service appear relaxed and were seen interacting well with the staff. Choices of meals are offered and food is well presented. The home can cater for special diets, including individual preferences, dietary and cultural needs which, means people should receive food that they like. The accommodation for people is on ground level which assists people with mobility problems to access all areas of the home. People are encouraged to personalise their rooms with items that are familiar to them so that they live in an environment, which they prefer. There is a committed staff team some of whom have worked at the home for many years so residents have people they know looking after them. What has improved since the last inspection? Since the last key inspection the home has improved and updated peoples` care records and introduced more updated risk assessments to monitor individuals` health and personal care needs. What the care home could do better: Social stimulation and the provision of activities has improved but further improvements are necessary so that all people, whatever their interests and abilities are provided with appropriate stimulation and activities that meet their mental health needs. Further development with the care records to promote a more person centred approach to documentation. Establish a system of auditing the service provision for the home, and monitor the findings to show that people are being listened to. Key inspection report Care homes for older people Name: Address: Coach House Nursing Home Coach House Nursing Home Broome Clent Worcestershire DY9 0HB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Christine Potter     Date: 2 0 0 5 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 25 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 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 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Coach House Nursing Home Coach House Nursing Home Broome Clent Worcestershire DY9 0HB 01562700417 01562700417 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Ernest Michael Lane,Mrs Jermaine Kathleen Emily Lane,Tania Mary Hilda Bradley Name of registered manager (if applicable) Mrs Jermaine Kathleen Emily Lane Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: Date of last inspection Brief description of the care home The Coach House is a small homely property situated in a rural area in the village of Broome. The premises have been converted from a grade two listed building and registered to provide nursing care for a maximum of 17 older people. The home has been tastefully modernised in the Georgian style providing a pleasant environment for people. People are accommodated in single or shared bedrooms. All accommodation and communal areas are on ground level which assists people with mobility problems Care Homes for Older People Page 4 of 25 Over 65 17 17 0 0 0 4 Brief description of the care home to access all areas of the home. There are two lounges, a dining area, and communal bathroom and toilet facilities. The home stands in picturesque grounds which are accessible for people to use when the weather permits. Adequate car parking is available to the side of the home via an electronic gate. The home is owned by Mr and Mrs Lane. The manager is Miss T Bradley, who is a registered nurse with many years experience working in the health care sector and care of the older people. Information regarding the home can be obtained from the Statement of Purpose and Service Users Guide, which are available in the home. Information about the fees are not included in the Service User Guide, for up to date information about the fees charged for the service is available on request from the home. Care Homes for Older People Page 5 of 25 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 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, the commission, undertook an unannounced inspection of this service, which means that the home did not know we were coming. This was a key inspection which is an inspection where we look at a wide range of areas. The last Key inspection was the 14/05/2009 and the overall rating for the home was adequate. This report should be read with the previous report. The Coach House returned their Annual Quality Assurance Assessment (AQAA) document when requested earlier in the year. The AQAA is a self-assessment and a dataset that each registered provider has to complete each year and send to us within agreed timescales. The document tells us about how providers of services are meeting outcomes for people who use the service and is an opportunity for them to share with us what aspects of the service they believe they are doing well. Information was gathered from speaking to and observing people who lived at the Care Homes for Older People Page 6 of 25 home. Three people were case tracked, this involved discovering their experiences of living at the home by meeting and observing them, and looking at medication and care files. Case tracking helps us understand the experiences of people who use the service. We received four surveys from people using the service, staff and professionals involved with the home. Care Homes for Older People Page 7 of 25 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 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 Older People Page 8 of 25 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 9 of 25 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. People have enough information to assist them before moving in, so that they know what the home provides, and what they can expect when they move in to the home. Evidence: The last key inspection rated these standards as good. We looked at three peoples pre admission assessments. The assessments provided sufficient information for the home to develop a care plan to provide guidance for the staff delivering the care. People using the service and relatives confirmed that the manager had visited and assessed their relative prior to them being admitted to the home. The home provides written information in the form of a Service User Guide to help people decide whether they wish to live at The Coach House. One resident told us that they had received the information prior to moving into the home. We saw copies of the Service Users Guide in the reception area of the home. Care Homes for Older People Page 10 of 25 Evidence: We received four completed surveys from people using the service who confirmed that they had received enough information about the service. Comments received included: the home is outstanding and the staff have gone out of their way to help X settle, and we appreciate this very much Care Homes for Older People Page 11 of 25 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. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: The last inspection report rated these standards as adequate, and gave a requirement for the home to improve their care plan records and risk assessments for people. At this inspection we looked at three peoples care records in detail and these showed that each person had an individual plan of care. They showed that peoples healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each persons records. We found that the quality of information had improved and people were being consulted about their care. However, the need for the care records to be more person centred was discussed with the manager during the inspection. For example the daily records for one person stated skin break, which had healed, but no plan of how this was achieved was in place. The home has good procedures in place for the management of medication. Care Homes for Older People Page 12 of 25 Evidence: Medication is stored safely, and accurate record keeping enables the home to know which medications have been given and at what times. We looked at three peoples medication records and they had been completed by the nurse who administered the medication. The home completes a monthly audit of the medication system and these records were looked at and support that the nurses are adhering to the homes medication policy. Peoples privacy was seen to be maintained by the staff, they were knocking on doors before entering and speaking to people courteously. Residents and relatives confirmed that all staff respect their privacy and dignity. Staff meet the individual needs of the residents well, dignity and privacy are always maintained. Everyone appeared contented during the inspection and were seen in various parts of the home. Some people were outdoors as it was a warm day, people were enjoying visits from family, watching television and reading newspapers. There was a friendly relaxed atmosphere throughout the home, and all staff were polite and courteous with people. Staff told us that they were provided with sufficient information about the residents care needs to enable them to look after them. They also confirmed that they were given time to look at the residents care records for additional information about the individual. A range of specialist equipment is available to assist staff in meeting the health and personal care needs of the people. A good range of pressure relieving equipment is recorded in the health care needs assessment. Staff told us that the home had sufficient pressure relieving equipment to care for the residents prone to skin pressure damage. Care Homes for Older People Page 13 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have the opportunities to be involved and stimulated by a wide range of interesting activities and access the gardens. The dietary needs of the residents are well catered for with a balanced diet and a varied selection of foods. Evidence: The last key inspection report rated these standards as adequate. It gave a recommendation to review the activities in the home, which are appropriate for the needs of all the people living in the home. One of the carers has taken over the responsibility for activities for the People living in the home. She is allocated 18 hours a week for activities and the carers cover when they are not on duty. We were shown the activities folder which has been developed. This shows photographs of some of the residents participating in various events. To assist in finding out what the residents like to do a record of their life historys has been developed. Activities include exercise to music once a week, external entertainment, planned outings and walks in the grounds of the home. It is recommended that the home further develop activities for the more dependant residents and those with short term memory problems. Care Homes for Older People Page 14 of 25 Evidence: There is an open visiting policy which means that people can see their visitors as they choose and maintain relationships that are important to them. We saw visitors coming and going during the inspection. The home provides varied well balanced meals for the residents and caters for cultural and dietary needs. Currently, meals are based on a four-week rotational menu. The chef told us that the menus are reviewed taking into consideration peoples likes and dislikes. Mealtimes and meal options are flexible, breakfast provides a range of choices from full cooked breakfast, toast and cereals. Lunch is a cooked meal or individuals own choice. Tea time is soup, sandwiches or a hot choice of food. The comments received included: the food is excellent and we can have what we like. Care Homes for Older People Page 15 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service feel safe with the staff, and they are confident their problems will be listened to and taken seriously. Evidence: People using the service and relatives told us they were aware of the complaints procedure, including how to complain to the Care Quality Commission by way of information provided by the home. The CQC and the home have received no complaints in the last 12 months since the last inspection. Review of the current accident book showed no occurrences, or trends, in the nature and type of reported accidents, which caused us concern. These showed people recorded as having had falls, had all been risk assessed with regard to their mobility and potential for falling. The home operates an open door policy to allow residents and visitors to voice their concerns at any time. Residents and relatives confirmed to us they would have no hesitation in raising concerns if they had any. Policies and Procedures on whistle blowing and advocacy information is available on display for everyone, and all staff receive abuse training. The manager confirmed that she had attended the Deprivation of Liberty training, and had passed the information on to the staff. Care Homes for Older People Page 16 of 25 Evidence: We had discussions with two staff, who were able to describe the action they should take if they were in receipt of a complaint, or observed abuse of a resident. Training records confirmed they had all received relevant adult protection training. Care Homes for Older People Page 17 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a comfortable, small homely environment in which to live. Evidence: The home has been adapted to meet the needs of the people who use the service without losing its character. There are homely touches, such as ornaments, pictures and plants. There are two sitting rooms with comfortable armchairs and a small dining area for people to use. Accommodation for people using the service is available in single and shared bedrooms. The manager told us that currently shared rooms were being used for one person to respect peoples preferences. The home stands in beautiful maintained grounds with access for people to go out when the weather permits. We looked at some peoples bedrooms and these were found to be personalised and reflected individual tastes, gender and preferences. People are encouraged to bring in their own possessions in order to have familiar items around them to make their rooms as homely as possible. All areas of the home were clean and tidy, with no malodours evident in any part of the home. Care Homes for Older People Page 18 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident staff numbers on duty, and skill-mix, are sufficient to meet their assessed care needs, and that recruitment and employment practices are consistent with safeguarding them from abuse Evidence: The duty rotas showed that the home was planning staffing levels proportionate for the number and needs of the residents. The manager told us that they have not used any agency staff in the last twelve months, and shortfalls are covered by staff working additional hours. Residents stated that they felt the staffing levels were good and they never had to wait for long periods when requesting assistance. Staff spoken to also expressed that the staffing levels were sufficient for them in meeting the health and social care needs of the residents. In addition to the nurses and care staff, the service provides catering staff, maintenance, administration cover and gardeners. Three staff files were reviewed during the inspection. The home was following their recruitment procedure and completing the appropriate checks on the applicants. It was recommended that they ensure that the applicants had the month as well as the year on employment history to assist in identifying any employment breaks. We looked at the training records which showed ongoing training for the staff. Staff confirmed that they felt appropriately trained in meeting the health and personal care Care Homes for Older People Page 19 of 25 Evidence: needs for the people living in the home. The home has more than 50 of care staff with an NVQ qualification of two or above. Care Homes for Older People Page 20 of 25 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 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 the management and administration of the home is based on openness and respect. Evidence: The last key inspection rated these standards as good, there has been no change with the management arrangements. The manager has been at the home for many years and is also the registered manager for the residential home, Field House, which is about five minutes away from the Coach House. The manager is registered on a Dementia Care 12 month course, which she is finding helpful and hopes to promote some of the good practice guidance at both homes. We looked at the fire records which show that they are being tested regularly and the records were up to date. The home does not take responsibility for peoples monies but has a system in place for some people to keep small amounts of money for hairdressing. Care Homes for Older People Page 21 of 25 Evidence: The Annual Quality Assurance Assessment received from the home is a clear reflection of the home, and planned changes for the next 12 months. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 To safeguard people from harm, risk assessments and service user plans must be drawn up when new people are admitted to the service. 01/07/2009 Care Homes for Older People Page 23 of 25 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 2 7 12 The home further develops care records for individuals in a more person centred approach. Further develop the activities for the more dependant residents and those with short term memory problems. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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