Care Home: Cote House

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What the care home does well Cote House provides nursing and care for younger adults who have complex disability needs, in a homely setting, aiming to work with the service user and supporters to enable them to live the lift that they would like to lead. This is supported by detailed and comprehensive support plans, which are service user focused and developed together with the service user and their supporters. Staff know their residents in detail and are enthusiastic about providing nursing and care to the service users in the way that they prefer, and need. Staff are supported by a clear management structure which enables them to perform their role. People commented in surveys and during the inspection about what they considered the home does well. One agency staff reported "Cote House is the best establishment that I have worked in". People commented on the care provision. One person reported "the care is always good", another that they "listen and act on what is discussed" and a service user commented that they appreciated being "allowed own independence". People commented on the staff. One person reported "I have always found the staff most helpful", another on the "good communication" and an external professional reported on the "excellent working relationships". A resident summed up their commented by stating that Cote House "is like a family not just a home". What has improved since the last inspection? The new manager has performed a full review of staff training needs and has put in an action plan to ensure that staff have received training in all mandatory areas, including food hygiene, health and safety and abuse awareness. Medication procedures have been audited and registered nurses now all follow the provider`s policies and procedures on medication administration and documentation. Where a resident is assessed as needing bed rails, documentation to ensure assessment and consent is in place, this fully complies with guidelines from external agencies such as the health and Safety Executive. What the care home could do better: There were no requirements identified as a result of this inspection. Some good practice recommendations were made. The home should ensure prompt documentation relating to changes in support needed to individual service users. To prevent risk of communal use of topical creams, they should be re-named if the name on the jar or tube has faded. Audits of the laundry should be part of monthly visits by the provider as some practice could have presented risk of infection on the first site visit. The provider should consider modernising its beds provision, by providing more profiling beds. The manager should perform a review of current resident conditions and develop a training plan to ensure that staff are trained in such areas as management of a service user with epilepsy. The manager should also, as part of their quality audit process, record all informal concerns, to identify any trends. Key inspection report Care homes for adults (18-65 years) Name: Address: Cote House Rowden Hill Chippenham Wiltshire SN15 2AG     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: Susie Stratton     Date: 1 8 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 Adults (18-65 years) Page 2 of 31 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 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 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 Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Cote House Rowden Hill Chippenham Wiltshire SN15 2AG 01249653760 01249653888 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.voyagecare.com Milbury Care Services Ltd Name of registered manager (if applicable) Susan Jane Worthy Type of registration: Number of places registered: care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is 11 The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Physical Disability (Code PD) Learning Disability (Code LD) Date of last inspection Brief description of the care home Cote House provides care with nursing for up to eleven people with physical disability. The home offers long-term, short-term, and convalescent care. There are also up to four day-care places per day. Cote House is situated in a residential area, within easy reach of the centre of Chippenham. Accommodation is offered on the ground and first floors. Bedrooms are available to accommodate wheelchair users and there is a passenger lift. Because the home is registered to provide nursing care, a qualified Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 0 11 11 Brief description of the care home nurse is on duty at all times, supported by a team of carers. The service is operated by Milbury Care Services. This is a national private sector organisation. Fees are negotiable but the current lowest fee is a thousand and ten pounds per week. Care Homes for Adults (18-65 years) Page 5 of 31 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: As part of this inspection, the homes file was reviewed and information obtained since the previous inspection considered. The home also submitted an Annual Quality Assessment Audit (AQAA). This is their assessment of the quality of their service provision. It also provided numerical information on services provided. Surveys were sent out to residents, their relatives, staff and external professionals who visit the home, and twenty one were returned. Comments made by people in the surveys and to us during the inspection process have been included when drawing up the report. We looked at the AQAA, the surveys and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what areas we should focus on when doing the inspection. The home refers to the people who use their service as service users, so this is how they will be referred to throughout this report. The site visits took place over two days. This was because the manager was away on a Care Homes for Adults (18-65 years) Page 6 of 31 training course on the first day and the deputy manager was working their first week in the home, and so was not aware of certain matters relating to service provision. Both site visits were performed by a regulatory inspector. This person is referred to as we throughout the report, as the report is made on behalf of the Care Quality commission (CQC). The first visit took place on Tuesday 27th April 2010, between 9:40am and 2:20pm. The second inspection day was on Tuesday 18th May 2010 between 9:40am and 10:40am. These people are referred to as we throughout the report, as the report is made on behalf of the Care Quality Commission (CQC). Both visits were unannounced. A registered nurse was in charge of the home on the first day of the inspection, the deputy manager and an operations manager came on duty during the day. The manager was on duty for the second site visit and was available for feedback at the end of the inspection. During the site visits, we met with a range of residents across all parts of the home and also observed their care. We toured all of the home and observed care provided at different times of day. We reviewed care provision and documentation in detail for four residents, including a resident who had recently been admitted to the home for respite care and looked at specific matters relating to a further two residents. As well as meeting with residents, we met with a registered nurse, three carers and the cleaner. We observed a lunchtime meal. We reviewed systems for storage of medicines and observed a medicines administration round. A range of records were reviewed, including staff training records, staff employment records, complaints records and maintenance records. Care Homes for Adults (18-65 years) Page 7 of 31 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 Care Homes for Adults (18-65 years) Page 8 of 31 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 Adults (18-65 years) Page 9 of 31 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 10 of 31 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. People who are admitted to Cote House will have the information that they need about service provision and will have a full assessment of their needs. Evidence: In their AQAA, the home reported that they provide individual service user guides and statement of purpose which contain accurate, factual information about the home and services they provide. New service users are offered introductory visits and respite stays at the service. Pre-admission assessments are completed during this stage. They report that each service user has a residency contract that contains personal information and that they encourage service users to develop daily living skills and to access community activities. During the past twelve months they report they have updated service user guides and the statement of purpose. They have also implemented a new nutritional assessment tool. We observed that information described in the AQAA was available in the entrance area, including the service users guide and statement of purpose. During the inspection we met with a resident who had recently been re-admitted to Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: the home for respite care. They reported that its alright here. They felt comfortable in the home and particularly enjoyed the sunlight coming in through their window. They reported that they had found that staff came quickly if they rang their bell. The person had a daily profile relating to how they preferred to spend their day, which was very clear and individualised to the person. We also observed that the home had contacted the persons family for further information in relation to a change in their care needs since their previous admission. All respite care residents have a formal review of their needs with the person and other relevant parties at every admission and their care plan is up-dated at that time. Care Homes for Adults (18-65 years) Page 12 of 31 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. People living in the home will have their individual needs met and will be able to choose how they spend their lives. Evidence: In their AQAA, the home reported that each service user has an individual support plan, which indicates their preferences and support requirements in areas such as health, personal care, mobility, social, decision making and many other areas. Support plans are written with input from the service user, and these along with risk assessments are reviewed every six months and updated as necessary to reflect any changing needs, choices or aspirations. They report that the plans reflect the information input shared from families/friends, care manager and health care professionals, as agreed by the service user. They report they enable service users to make decisions in all areas of their lives with staff supporting service users to take responsible assessed risks where appropriate. Additionally within the individual support plan, there is evidence of limitations of freedom, choice or facilities. They report that they have improved service provision in the home during the past twelve Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: months by completing a new format for individual support plans, which are more consistent and risk assessments. They have also introduced service user friendly meetings, using accessible formats. People commented about care provision in surveys. One person reported I think the care and support they give is really good, another reported that the home ensures that every one is an individual, another they are constantly being cared for and all their needs met and another on the good relationships with clients. We met with a range of different service users, some of whom were able to converse with us, others of whom had highly complex disability needs. For such people we observed their care and discussed the peoples needs with staff. One resident commented to us on how they appreciated staff flexibility when meeting their needs. Staff working in the home do not wear a uniform, thus reducing barriers between people who use the service and themselves and gives Cote House a more homely atmosphere. We reviewed peoples support plans and noted that they were highly individualised in tone. Service users were consulted at every stage in support plan development. For example one residents care plan documented very clearly about the areas of their nursing and care where they could self-advocate. Their care plan relating to communication was very clear and reflected what we observed. Care plans reflected in full what the resident told us about. All support plans were regularly up-dated. Care Homes for Adults (18-65 years) Page 14 of 31 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. Residents will be supported by the home in continuing how to live their lives as they prefer. Evidence: In their AQAA, the home report that they support service users to lead the life they choose and to pursue their hobbies, interests and opportunities to access new activities and experiences. Service users are supported to invite friends and family to visit. Support is provided to maintain relationships with people outside the home and open access supports service users in welcoming visitors. They report that all service users take part in valued and fulfilling roles and activities within the home and local community and that service users are encouraged in a healthy diet to promote healthy lifestyle. They report that during the past twelve months, they have ensured that all food is prepared from fresh ingredients and cooked on the premises. They also now have the ability to offer all service users alternative therapies such as Reiki and Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: Shiatsu. People commented about meals in surveys. One person reported the meals are really good quality and home cooked and another that the home provide freshly cooked meals. However another person felt that the home did not offer a choice for meals and felt that the home should employ a cook, rather than relying on carers to perform this role. We met with the carer who was performing the cooking. They reported that they always gave residents choice about what they liked to eat. They reported that all vegetables were delivered fresh and that there was lots of fresh fruit, including fresh fruit left out for residents so that they could help themselves. They reported that they made all their own soups and gravies, rather than using packet varieties. Service users commented to us on the meals. One person said to us everythings fresh and well cooked, I think its lovely, another we have all sorts of things about the meals and another I enjoy the meals, theyre fairly well balanced. We observed a lunch-time meal and saw that the meals were nicely presented and the meal was clearly hot. We observed that domestic-style crockery and cutlery was used. Relevant aids were provided to support residents in maintain their independence when eating. A care assistant who was thickening a service users drink with thickening agent told us about the importance of correct preparation, to ensure that the agent was fully mixed into the persons drink. We observed that a carer was prompt in noticing when a service user needed support with eating. We observed another carer who was feeding a resident, they were talking to the person, supporting them in engaging in conversation to enhance the meal as a social occasion. We observed another care assistant who was supporting a resident with highly complex disability needs to eat their meal. They were using a teaspoon and only putting small amounts on the persons teaspoon. They checked carefully each time that the service user had swallowed, before going on to give the person more food, taking time to fully support the resident. On the first day we visited, we observed that all liquidised foods were mixed together, giving the meal a brownish appearance. We discussed with the deputy manager that mixing all of the contents of a meal together did not enhance flavour and was institutional in tone. This had been fully addressed by the second day of the inspection. People commented on activities in surveys, many reporting that there were not enough trips out for residents. This was reported to relate to staff shortages during the period when the home had had a high staff turnover (see Staffing below). The Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: manager reported that, now they had more permanent staff in post, they would be able to address this area. One person commented in their questionnaire that the home keeps me occupied and happy. Another commented that Cote House has a wide range of activities e.g. coffee bar, wine bar quizzes etc and outings for the service users. We observed that there were photographs of a range of activities provided to support service users prominently displayed on notice-boards. One resident reported we do all sorts of things, play games and Ive got a lap-top computer, Im not at all bored, another resident reported on how they enjoyed going out into the garden, particularly for barbecues, and that they were fully able to do this independently, using their wheelchair. A resident who had complex disability needs had mobiles and pictures of people significant to them on the celling of their room, where they could see them. Residents reported that they could go out of the home when they wanted. One resident commented particularly on how much they enjoyed going out regularly with their parent. Some residents had extended family support. One such resident had clear records maintained about issues relating to their family life, so that all staff could be informed and up-dated. This was particularly important where residents were frail and had difficulties in communicating such matters, to ensure that their social care needs were met. Care Homes for Adults (18-65 years) Page 17 of 31 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. Service users will be supported by the homes systems which ensure that their personal and health care needs are met. Evidence: In their AQAA, the home reported, that they provide service users with the personal support they require in their preferred way, to meet their physical and health needs. They report that they ensure that service users capabilities are worked with to give them as much control and independence over their support as possible. They report that they are proactive in seeking out the best professional care and ensuring all service users have an annual review with their GP. They report that during the past twelve months, they have implemented a nutritional assessment tool and developed improved methods of recording behaviour. A new system for monitored dose medication has been introduced. People commented about service provision in surveys. One person described nursing care as excellent and another as soon as someone calls out, they are attended to, and even if they cant call they are always being checked that all is well with them. A relative commented on their relatives complex, unstable medical condition and that Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: the home managed this condition well, in contract with other providers. We met with a range of residents who had different needs for health care and personal support. Some of the residents we met with had complex nursing and disability needs. We observed that they had clear support plans which directed staff on how their needs were to be met. Support plans included long term and short term goals, with the individuals strengths and supports needed being documented. Where a resident had a complex need, such as a swallowing difficulty, there was a clear risk assessment relating to choking, with a clear care plan about how their individual needs in this respect were to be met. One persons mouth care needs in relation to swallowing difficulties were very clear, including details such as their need to use a low foam toothpaste. We observed that external health care professionals were contacted when relevant. For example one resident was documented as having a slight change to a pressure area. Their records showed that the tissue viability nurse had been contacted, who had given the home advice, which they had followed. We met with a visiting health care professional who reported that some service users needed interventions to support them from staff and that this had been complex to achieve recently, due to a high turnover in staff. They reported that they would like to train the homes staff on how to perform basic exercises for service users, but with a high staff turnover, this had not been possible. We discussed this with the manager, who reported that staff turnover had been higher than usual for a range of reasons (see Staffing above) but that now they had re-established a stable work-force, they anticipated that this could be progressed. We observed that in one instance, the home were not following directives from a speech and language therapist about how the service users meals were to be chopped, observing that all the residents meal had been liquidised together. The directions in their support plan were dated 2009. We discussed this with the deputy manager and they were aware that there had been revisions to the persons care plan. By the second day we visited, the persons current needs in respect of their meals was clearly documented. We met with nursing and care staff and discussed service users needs. A registered nurse we met with showed a very detailed knowledge of individual peoples needs and actions to be taken to meet needs. For example, they were able to inform us about a referral for a further seating assessment made for a resident whose weight had changed and how their current wheelchair no longer met their individual needs. They described how they had been able to work with a resident, who had communication Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: difficulties and who could be aggressive at times, using observation to ensure that they received personal care in a way and at a time of day that the person preferred. We observed a care assistant promptly reporting on a change in a service users condition to the registered nurse. The carer cave a succinct and clear description of the change to the registered nurse, so that they could decide on actions to take to meet the service users changed needs. As reported in their AQAA, the home are trialling a new monitored dosage system for medication at this time. Staff reported on how responsive the new medicines supplying company were being. We observed that registered nurses performed medicines administration in a safe manner, following guidelines in on administration of medicines. All medicines were safely and securely stored, including Controlled Drugs. Records, including those relating to Controlled Drugs were clear and maintained in full. There were clear records relating to administration of topical creams and food supplements which were prescribed for individual residents. Topical creams were named and dated when opened, however as some were kept in bright sunlight, for example window sills, some of these were fading and needed re-naming and dating. A service user had a very clear support plans relating to indicators for a medicine to be given in an emergency and actions to be taken by staff in such an emergency.. Care Homes for Adults (18-65 years) Page 20 of 31 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. Service users will be protected by the homes systems to ensure that they are safeguarded and their complaints and concerns listened to. Evidence: In their AQAA, the home reported that they provide a clear and effective complaints policy and ensure all service users, staff, families and other agencies are aware of its existence and how to use it. They report that complaints are dealt with in a specified time frame and that they provide a robust procedure for responding to any suspicion, allegation or evidence of any type of abuse. They report that clear recording of service users finances following company procedure. They report that staff are encouraged to discuss any concerns they have in supervision and team meetings. Their aim is to provide an open culture for service users to feel comfortable and confident in expressing their views. People commented about this area in surveys. An external professional reported the home are always quick to respond and that the team are always professional, polite and respectful. A relative commented that the home listen to concerns of relatives and try to do something about them. Another person commented Cote House will always listed to any comments that I have suggested. They are always willing to make the life better or improve areas, so that the resident will benefit. We discussed with service users about how they would raise any issues of concern to Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: them. One service user reported that they would go immediately to one of the members of staff and theyd sort and put it in the right direction, another person reported Id see one of the women. We observed in one of the service user meetings that the manager had explained in an approachable manner about how they could complain and raise issues. We looked at the homes complaints folder. The manager reported that they had had no formal complaints during the past year. They did report that they had had a few concerns raised with them but that they had been dealt with informally at the time. We advised her that as part of standard quality audit processes, she should document all such issues, to enable her to identify any trends or issues. The manager reported that when they came in post, they had identified that there had been a deficit in training staff in abuse awareness and whistleblowing. She had worked through this deficit to make sure that all staff had been trained in these areas. There were now full records on file and all staff had signed to state that they had undertaken this training. We discussed scenarios with some staff about what actions they should take if they suspected that a vulnerable adult might have been abused and all staff were aware of actions to take, including the domestic. Staff we spoke with were very keen to up-hold individual residents rights. Residents moneys are regularly audited during managers monthly visits to the home and a report made. Where relevant support plans were put in place about residents financial needs. We did observe on the first day of the inspection, that residents moneys were placed in the Controlled Drugs cupboard. We advised that this is contrary to the Medicines Act, which states that only Controlled Drugs may be held in Controlled Drugs cupboards. By the second day of the inspection, full actions had been taken to address this matter and alternative secure storage had been provided. Care Homes for Adults (18-65 years) Page 22 of 31 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. Service users will live in a home environment which is clean, well maintained and meets their diverse needs. Evidence: In their AQAA, the home reported that Cote House is a homely, clean, hygienic, safe and comfortable environment that meets the individual needs of the service users and current legislation. They report that the home is well located to access local facilities and transport networks. They report that they provide service users with their own personalised space in a self contained single room, with suitable furniture and fittings and encourage them to add their own personal belongings that reflect their culture, beliefs and personalities. They also provide comfortable and fully accessible communal facilities that reflect service users needs and preferences, with aids and adaptations where necessary. They report that they provider reviews the environment yearly and also performs a visual review by the Ops Manager monthly. During the past year they have employed a designated cleaner who is able to concentrate on communal areas and deep cleaning. The lower hall has been redecorated and it now has a light airy feel. New fencing has been placed around the back garden. People commented on this area in surveys. One resident reported on how they appreciated the way the staff kept my room tidy and clean. A member of staff Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: reported that they needed better beds for clients, currently only have 2 profiling beds. An agency worker commented in their survey the cleaner is very good at their job. One relative did comment that they felt that their relatives room was too small. We observed that Cote House is a large town house, set back from the road, in its own grounds. Entrances and exits have been made suitable for people with a disability. We observed high levels of equipment to meet service users disability needs, including overhead hoists and a range of bathing facilities to meet residents varying disability. A carer reported to us that weve got all the equipment we need and on the range of baths and showers for service users. Another carer reported that although maintenance is performed regionally that they had quite a quick response to requests for maintenance. We observed that while all the beds were variable height, none were profiling. This means that where safety rails are indicated that non-integral rails were being used. We advise that the provider considers gradually modernising the provision of beds, which have profiling beds, with integral bed rails. We reviewed systems for ensuring safe practice in prevention of spread of infection and observed that a good range of necessary equipment was available. A carer reported to us on the good supply of disposables. We observed practice in the laundry. On the first day, we observed dust and debris behind the machines, that laundry was spilling out of containers on to the floor and that while there were a lot of hoist slings, which were all named, they were left one on top of the other. We discussed this with the deputy manager who ensured that all such matters had been dealt with by the second day of the inspection. We advise that the laundry be considered at each monthly visit to ensure that standards are in place to prevent risk of spread of infection. We met with the cleaner. They knew about their role, the importance of safe storage of chemicals and the systems for daily, weekly and monthly cleaning of different areas in the home. They also reported on the good communication systems between the staff and themselves. For example they reported they were always informed if a resident developed an infection and so particular attention would need to be paid to effective cleaning of their room and disposal of used items. Care Homes for Adults (18-65 years) Page 24 of 31 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. Service users will be supported by staff who have been safely recruited and are supported in their roles. Evidence: In their AQAA, the home states that staff have clear roles and responsibilities and that they are appropriately trained and qualified. They have a robust recruitment policy and practice, which adheres to relevant current standards and legislation. They also report that all staff are supervised and appraised on a regular basis. They report that during the last twelve months, they have used E-learning to support staff. They have also employed a qualified manual handler. During the next twelve months, they plan to continue to ensure that recruitment take places to meet the homes requirements. People commented about this area in surveys. Many reported on the lack of staff and what they considered was low staffing levels. However, this was not echoed by all people. One person reported the staff are friendly and accommodating to clients and work well as a team. The homes data set and discussions with staff indicate that the home has had a quite high staff turnover during the past twelve months. This included the manager and deputy manager, as well as more junior staff. When we considered this with the Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: Operations Manager, it was clear that the staff turnover did not relate to concerns about the home and its management. Exit interviews had been performed and indicated that staff had left for anticipated reasons, such as planned retirement, relocation and military personnel postings. The exit interviews by staff were positive about the home. However the effect has been a higher proportion of newer staff needing support, a higher usage of bank and agency staff that usual. The situation appeared to have begun to ease by this inspection, with new staff becoming more familiar with their roles. We spoke with a new member of staff, who reported that they were working with an experienced member of staff all the time. They reported that they felt supported and that they appreciated this as they had not worked as a carer previously. They reported that if they did not know what to do, they could always ask a more senior member of staff and knew they would be listened to. We looked at the induction training records and observed that they conformed to current guidelines and were being completed in full. All new staff have a named supervisor who reports back to the manager on any issues identified, to ensure that prompt action can be taken to support new members of staff. We observed that agency staff also complete an induction. An agency staff commented to us in their survey that they were always made aware of the fire procedures. The new manager has put a lot of work into analysing staff training needs and putting them in place. Staff reported that they were fully supported in undertaking national Vocational Qualifications and other study sessions. One person reported that the providers were pretty good with training and another that they got lots of study days. Training records showed that the manager had ensured that all staff were upto-date in mandatory training. Other training had included diet and nutrition in health, report-writing for support workers, pressure area care and postural management.We discussed with the manager that now she has ensured all base-line training has been competed, that she needed to develop and action plan to ensure that staff were trained in areas to meet current resident need, including epilepsy and artificial feeding, including use of relevant equipment. We looked at staff recruitment files and observed that safe practice was carried out, including proof of identity, a full working history, two suitable references, police checks and health status checks. All three staff files were consistently maintained to the same standard. The manager has a matrix for staff supervision, with clear records of who was supervising whom. Supervisions are based on job descriptions and follow the providers policies. The manager reviews supervisions and identified trends, taking action as relevant. Care Homes for Adults (18-65 years) Page 26 of 31 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. Service users will be supported by the systems for management of the home. Evidence: In their AQAA, the home report that they provide service users with a well run home. There is an effective manager who respects the individuals rights and ensures that their best interests are safeguarded. Service users views underpin monthly monitoring and annual service reviews, policies and procedures in place to ensure health, safety and welfare of the service users are protected and ensure that record keeping is of a standard required. They report that during the next twelve months, they plan to develop a national service user forum, to facilitate service user contribution to companys policies and procedures. During the first day of the inspection, we met with the deputy manager and operations manager. The operations manager reported that they were supporting a culture of can do and that this was more possible now that they had a stable team of staff in place. They were also planning to look at more supports for staff in their role. We looked at service user meetings and observed that service users views on menus had Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: been sought and also that they had been informed about the staff recruitment campaign, and when new individual members of staff would be commencing their role. We observed that staff meetings were interactive and that discussion was encouraged. Staff had also been advised on accurate record-keeping, avoiding the use of generalistic wording such as normal or usual when making records. A person commented in their survey that the manager is always swift to contact me with important information. We observed that the providers regularly audits a range of areas, as well as seeking stakeholders views. We observed that health and safety and fire safety procedures were regularly audited. There were safe systems for assessment of need for the use of bed rails, which followed principals set out by the Health and Safety Executive. Maintenance systems were regularly reviewed. We observed that standards checks on safety took place, including checks on wheelchairs, hot water temperatures and hoist and sling checks. All residents have individual fire evacuation plans. On the first day of the inspection, we observed that the home were not using British Standard signage for oxygen and that oxygen cylinders were not secured. This had all been addressed by the second day of the inspection. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 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 19 Where an external healthcare professional has changed the detail of an action to take to meet a service users changed needs, this should always be documented. Where named and dates of opening on service users topical creams have faded, the tube or jar should be renamed and dated. A system for the documentation of informal concerns and complaints should be developed. The provider should consider modernising its beds, by providing profiling beds. Consideration should be given to cleanliness and practice in the laundry during monthly visits by managers, to ensure that risk of cross infection is minimised. The manager should perform a training analysis of current residents nursing and care needs and develop training plans to ensure that staff have been trained to meet such needs. 2 20 3 4 5 22 29 30 6 34 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. 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