Care Home: The Coach House

What the care home does well The Coach House is a friendly home where staff work hard to make sure that residents living there are comfortable and well cared for. Prospective residents are provided with good information to read prior to moving in, and are visited by the manager to assess their individual needs. A care plan of their individual care, mental health needs, social and personal needs is written by the key worker and team leader and monitored regularly by their key worker to ensure that the service can continue to meet their individual needs. Visitors consulted said that they always feel welcomed into the home by the staff and it was clear that the homes welcoming atmosphere encourages people to visit. It was observed that several visitors were seen during the day. People living at the home are offered choices throughout the day especially with their choice of meals and activities which has improved since the last inspection. Any complaints are listened to and acted upon appropriately. There is enough staff on duty to meet the needs of the residents currently living at the home. What has improved since the last inspection? The team and manager at The Coach House have worked hard to improve and develop its service. The requirements from the last inspection have been implemented, these are that care plans are more detailed, prn medicines and variable dose medicines have clear guidelines in place for staff to follow and record. Staff have attended safeguarding training, that there are adequate amounts of staff on duty at all times, and staff undertake dementia care training. Also that the maintenance and improvement of the Coach unit has been discussed with the Commission. What the care home could do better: Care plans constantly need to be improved and reviewed. Advice constantly needs to be obtained in developing standards of care for people with dementia. The staff need plans put in place for reducing the anxiety for people during the refurbishment of the Coach unit. Key inspection report Care homes for older people Name: Address: The Coach House Yarmouth Road Hemsby Great Yarmouth Norfolk NR29 4NJ     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: Hilda Stephenson     Date: 1 7 1 1 2 0 0 9 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 26 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Coach House Yarmouth Road Hemsby Great Yarmouth Norfolk NR29 4NJ 01493730265 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): SBDP1 Ltd Name of registered manager (if applicable) Jackie Drewry Type of registration: Number of places registered: care home 66 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 66. The registered person may provide the following category ies of service only,Care home only - Code PC, to service users of the following gender - Either, whose primary care needs on admission to the home are within the following categories, Old age, not falling within any other category - Code OP (Maximum Number of places 66), Dementia - Code DE (Maximum Number of places 66), Mental Disorder, excluding learning disability or dementia - Code MD (Maximum Number of places- 4) Date of last inspection 66 4 0 Over 65 0 0 66 Care Homes for Older People Page 4 of 26 Brief description of the care home The Coach House is a care home providing personal care and accommodation for up to 62 older people with Dementia. In addition to this it can also provide care and accommodation to up to 4 people with mental health difficulties. The total number of residents must not exceed 66. The accommodation is provided in the original Coach House and in the newly built building known as The Willows. There is also a four bedded bungalow which is part of the overall accommodation. The new building was completed in 2008 and was registered in October 2008. The Home is located in the centre of Hemsby village close to the post office, pub and local amenities. The home is situated within extensive grounds with part of the garden enclosed. There is ample parking at the front of the premises. The current fees are between £425-£500 depending on the level of care to be provided. Hairdressing, chiropody, toiletries and personal newspapers are extra. Care Homes for Older People Page 5 of 26 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: This unannounced visit to the home took place during the day on 17th November 2009. The manager and two team leaders were in attendance during most of the day. During the inspection a tour of the building was undertaken, staff practice was observed, records and files were read and checked, and some residents and visitors were consulted to provide the evidence when compiling this report. Care Homes for Older People Page 6 of 26 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. Care Homes for Older People Page 7 of 26 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 26 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 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New people will be assessed before being offered a place and have written documents for them to be able to make up their minds before moving in. Evidence: The fees were between £425-£500 depending on level of care provided. Since the home opened a new unit to care for people with dementia, the admission procedures have been improved. The manager explained how she visits prospective new residents at their place of referral be it home or hospital to explain to the new person, their family or their social worker the services offered at The Coach House. The manager collects information regarding their personal care needs, social needs and mental health needs to make a decision whether the place is right for them. This information is written in a format called the pre-admission details. Care Homes for Older People Page 10 of 26 Evidence: During the initial admission process she invites the new resident or their family to visit the home to see the room which would be allocated to them as well as looking round the home and gardens. She also leaves the written details about the home, facilities and care that is provided so they can read it at their leisure. This information has a picture format to provide easy read for those who find it difficult to retain information. Before any new resident is admitted the manager would put in place any specialist equipment that is required to care for them. Because this procedure can be quite traumatic for people with dementia the staff allocated to look after them appear to go that extra mile and try to make this as easy by being available for them if they are worried or anxious. Two residents were spoken with about how they came to live at the Coach House. One said my wife helped me move in here. The second said they didnt know. A family visiting a resident spoke how they were involved with the admission procedure and how the staff helped them and the resident throughout offering support and explaining along the way. They said they were very satisfied, how they had been involved. Each new resident has a written contract detailing the care levels, fees charged and how they could move out if they wished, a sample of contracts were seen and the majority were signed by a family member who was acting as the residents advocate. Care Homes for Older People Page 11 of 26 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. People living at the home will have their care and health needs assessed and reviewed. Evidence: Each resident has a written care plan which is devised by their Key Worker and Senior Carer. Within the first few days after admission this care plan is written in a format to include the activities of daily living needs. This includes personal care needs taking a bath, physical or nursing intervention, toileting needs, dressing in their own clothes and what they would like to eat or where to sit. Their mental health needs which includes how to deal with memory loss, confusion within the environment, time and day and sometimes challenging behaviour. Also their social care needs including their past interests and hobbies, work life and family involvement are taken into account within the care plan to enable each resident live a full and rewarding lifestyle as they can or are able. This needs constant reviewing. Care Homes for Older People Page 12 of 26 Evidence: Three care plans were seen and read and each of the three residents were spoken to. Varying degrees of information was gathered during these discussions and all three residents appeared comfortable and content with there care. The care plans included risk assessments regarding the individual care, such as one resident was going out to the village gym with a member of staff and risks were included of the various pieces of equipment. Another risk highlighted how falls could be reduced for that person to be able to walk around the gardens. Another included their moving and handling needs and the use of the sling to be safely transferred from one area to another. There was evidence of other professional input such as visits from the district nurse, GP and community psychiatric nurse and how hospital appointments were followed through. The care plans that were seen and the staff spoken to showed evidence of them following a clear pathway of individual care. The medication of the three residents was also checked and whether the system was safe. This was observed in the Coach House unit. The two requirements following the last inspection of the use of infrequent medication and variable medication had been completed. Each resident has a medicine recording chart with their prescribed medicines and the charts seen showed no gaps and the amount of medication given or refused by each person. The medicines that were disposed of were recorded. There is a safe system in place for the recording and administration of controlled medication, two members of staff check and sign the required register for this. The medication policy was checked and staff explained that they had medication training and supervision before they were competent in administering these, this was recorded in their files. Care Homes for Older People Page 13 of 26 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 will be offered meaningful activities and be provided with a choice of food. Evidence: During this visit within the Willows unit, several activities were going on in different lounges. A quiz was taking place in the large lounge with several residents and the activities coordinator. Music and dancing was taking place in a smaller lounge with care staff, and groups of families were sitting taking tea with their residents in a third lounge. The home was quite noisy during this period of the morning and one or two residents were quite anxious about the noise, but staff were seen going to these residents to either sit with them or trying a distraction therapy. Several residents were also seen walking in the enclosed garden area. The activities coordinator said that she delivers social activities during the two hours she works in each unit. Each care plan records the activities that residents take part in and staff appear to respect their decision if they do not wish to be included in group activities. Reminiscence and one to one activities are also included with some Care Homes for Older People Page 14 of 26 Evidence: residents who enjoy a quieter interaction. A list of activities was seen displayed including musical entertainers, chair exercises, dancing, crafts, hand and foot massage, and the current competition of making the church crib. Three residents have a gym membership with the local village gym and attend during the afternoon session with a member of staff. One resident continues to go shopping in the town each week, and several enjoy a trip round the village. Visiting both units it was observed that staff attend to residents social needs very well. Several families were visiting during this inspection and five were spoken to who said They are marvellous and take better care of father than we could. This is a happy home, all the residents are treated the same- with love and respect. They and the home are always clean and tidy. The food is superb and the care is outstanding. Offers my nanna a warm and very comfortable home in which she has enjoyed a quality of life that would otherwise have been lacking. Looks after my mother, me and my sisters very well. They are very attentive and I can take any problems to any staff and it will be acted upon. All the staff are helpful. The lunch time meal was observed within the Coach House unit, residents were sitting in the rear lounge with individual tables to have their meal. The dining room and front lounge is currently being redecorated. Residents were offered a choice from the menu of beef stew or sausage, egg and chips or cauliflower cheese with fresh vegetables. The dessert was between sponge pudding and custard or apple and custard or fresh fruit. All the residents spoken to said how much they enjoyed the food. Both kitchens in each unit was clean and tidy and the cooks explained the process of ordering, checking the food supplies and how they obtain residents choices from the menu. Staff said: Cares for people that have been written off by other places. We care for people with varying needs, offering them person centred care. Care Homes for Older People Page 15 of 26 Evidence: We are there for families and help provide a happy, fun environment. We work well as a team and offer each other support where needed. Care Homes for Older People Page 16 of 26 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 will have their views listened to and acted upon. Evidence: The manager explained that the two anonymous complaints had been dealt with. The issues were getting people out of bed too early, tablet found on floor and moving and handling issues. The manager explained how these had been investigated and resolved with the required action taken as not to happen again. One adult protection issue had arisen with a member of staff and had also been resolved. The new complaints policy was displayed on the noticeboard in each unit and both have their own complaints log. Relatives were satisfied and confident that any complaints they had would be investigated by the manager. Two comments returned from surveys received prior to this inspection had been dealt with. Need to make sure the right clothes are returned to the rightful owner. Make sure there are clean towels in the rooms. Evidence of staff training in adult protection were seen in staff files and by speaking to individual staff during the visit. The majority of staff were aware of the whistle blowing policy in speaking up against bad practice. Care Homes for Older People Page 17 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be provided with a clean comfortable home to live in. Evidence: The home consists of three units. The Coach House unit accommodates up to twenty residents in the older style building. This was currently being updated and redecorated and is currently an adequate standard. The new Willows unit accommodates up to forty four residents who have dementia and the bungalow can accommodate up to four residents with a mental disorder. The bungalow currently has no residents. There were fifty seven residents living at the Coach House at the time of this inspection. A tour of both units was undertaken and the Willows was clean, tidy and had ample space for residents to walk around. The Coach unit was being refurbished to improve the building for the current residents. The dining room and front lounge was being updated. All of the bedrooms in this unit was also being redecorated during the next few months with rooms available for residents to use when there bedroom was being refurbished. Care Homes for Older People Page 18 of 26 Evidence: Both units had separate enclosed gardens although there was adjoining areas for residents to visit either unit. The Willows showed evidence of good practice for residents with dementia on how signs and colours are important for people to reduce their confusion. There were no obstacles in the way for those who wished to walk around the building and a sensory garden with furniture was available for those who enjoy being outside. Signs and colours were also being transferred to the Coach unit. A sample of the regular maintenance of the home was seen and how repairs are recorded and undertaken to ensure the safety of people who live there. Care Homes for Older People Page 19 of 26 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. People will be supported by sufficient numbers and well trained staff. Evidence: Both units are staffed separately with the manager spending her time between them both. Each unit is run by the team leader who is supported by senior care staff. Both staff rotas were seen and the units have adequate amounts of staff on duty. The manager said that she occasionally uses agency staff, although the permanent staff usually cover sickness and holidays. The Willows have one staff in charge and five care staff, one cook and kitchen assistant, two laundry assistants, two domestic staff and a maintenance man during the week. The Coach unit has four care staff, one cook and one kitchen assistant who also covers tea time. Both units have the minimum amount of waking care staff at night with a senior or manager on call. The recruitment of new staff follows clear guidelines and this was seen within the staff records. All staff are vetted and the required references in place before commencing Care Homes for Older People Page 20 of 26 Evidence: work. Two staff files showed this to be in place. New care staff follow the homes induction training programme which includes the skills for care knowledge base, with supervision by the manager or team leader. The manager provided details of the staff training matrix which includes health and safety, dementia awareness, moving and handling, medicines, nutrition undertaken over the past three months. Staff records showed that the majority of staff have been supported with their training needs. Supervision of staff is in place where staff meet up with one of the management team to discuss issues and training needs to be put in place for them. Staff comments received from the surveys prior to the inspection like: We could do more team building activities. Could do with more staff and more time for activities. Have a good manager. The manager has employed an activities coordinator who now organises activities to reduce the time spent by care staff, and team building activities are included outside the home as well as during the staff meetings. Care Homes for Older People Page 21 of 26 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 are able to live in a safe and well run home. Evidence: The home is managed by a competent, experienced manager who has worked at the home for several years and has overseen the expansion to treble the size of accommodation for people with dementia. She is supported by two team leaders who run both units. The provider visits the home on a weekly basis, who, also undertakes a monthly audit of the service. The manager organises staff meetings, relatives and residents meetings with the results displayed on the various noticeboards. She also obtains feedback from other people which goes towards the results of the quality assurance of the service. The manager does not keep finances for any of the residents. Care Homes for Older People Page 22 of 26 Evidence: A sample of the health and safety records were checked, fire training and up to date equipment was in place, water temperature and legionella checks had been carried out. Adequate infection control measures were in place. The equipment and staff training for moving and handling was seen, although night staff required this update. The home was made secure and windows had restrictors attached to reduce the risk of falls. The insurance certificate was up to date and displayed. The registration certificate required some minor alteration and this information was taken back to the registration team. Overall, the home is a safe place for people with dementia to live, with various sociable activities in place for them to achieve a fulfilling lifestyle as they are able. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 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 3 7 12 19 Care plans constantly need to be improved and reviewed. Advice constantly needs to be obtained in developing standards of care for people with dementia. The staff need plans put in place for reducing the anxiety for people during the refurbishment of the Coach unit. Care Homes for Older People Page 25 of 26 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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