Care Home: The Coach House

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What the care home does well The Coach House is a small homely comfortable home, which continues to provide an established safe environment for the people that live there. The staffing group are stable providing a continuity of care. The staff have a good knowledge and understanding of the residents needs and capabilities. People are enabled to make decisions and take some risks, so the quality of their daily lives is better. Individuals enjoy a range of activities in and out of the home, which meet their different interests. They are helped to keep in touch with their families and friends, thus have supportive or long-standing relationships that enrich their lives. People have a balanced diet that promotes their health as well as meeting their preferences. People are supported by sufficient numbers of staff who are caring. They have a comfortable, clean, homely environment to live in. What has improved since the last inspection? Nine of the fifteen recommendations identified at the previous inspection have been addressed. The Home`s Statement of Purpose and Service User Guide has been updated. Potential clients are properly assessed prior to admission. Care plans are regularly reviewed. Activities are varied and available to all. Handwashing facilities have been provided in the laundry. A quality assurance programme has been implemented. Staff are receiving supervision. What the care home could do better: The home can do more to ensure that prospective residents and existing residents are given the information they need, in a format suited to their capabilities. More can be done to ensure a consistent level of information and direction is provided in care plans. More can be done to show that choice at meals is promoted and choices made recorded Care should be taken with medicine administration recording. Staff training, specifically with regard to NVQ/LDQ, could be improved. Alternative communication tools could be used more to involve residents in making decisions about their lives. More could be done to ensure the safety and comfort of the staff when carrying meals between the home and Trevaylor Manor. A review of the office and its use would be of benefit to the people using it. Key inspection report Care homes for adults (18-65 years) Name: Address: The Coach House Trevaylor Manor Newmill Road Nr Gulval Penzance Cornwall TR20 8UR     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: Alan Pitts     Date: 0 6 1 0 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 Adults (18-65 years) Page 2 of 28 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) 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 Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: The Coach House Trevaylor Manor Newmill Road Nr Gulval Penzance Cornwall TR20 8UR 01736332133 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: coachhouse@swallowcourt.com Swallowcourt Limited care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home The Coach House is a care home offering personal care and accommodation for up to 9 adults with physical and complex needs, who have a learning disability. The aim of the home is to provide specialist support in a homely environment where people can experience a quality of life with the support and care of the staff. Nursing care is not provided, apart from that which can be provided or overseen by the local community or district nursing team. Swallowcourt, the registered provider, is an organisation that provides specialist care for people with special needs and which also owns three nursing homes. The Coach House has its own entrance drive from the Newmill Road, but is in the grounds of and adjacent to Trevaylor Manor, one of the company?s nursing homes. Penzance town is two miles away, and a bus service passes the home twice a day. Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 9 0 4 1 1 2 0 0 8 Brief description of the care home There is a parking area, and walled gardens for people living at the home to use. The home has recently acquired its own car transport, with occasional use of staff cars or a minibus shared with the other homes, for leisure outings, to get people to health appointments, etc. Accommodation is on two floors, with a shaft lift between floors for those who cannot use the stairs. One bedroom is registered for double occupancy, should two people wish to share. Each bedroom has an en suite toilet, with special door locks fitted on the bedroom doors to give greater privacy if wished. There is a bathroom upstairs, and a level access shower room/wet room on the ground floor, as well as separate toilets. The kitchen off the lounge is used for some food preparation, although the main meal of the day is usually sent from the kitchen of the adjacent nursing home. The dining area is in the conservatory, which looks out over the walled gardens. Weekly fees were from 902.00 - 1400.00 pounds per week, at the time of our visit. These did not include items for personal use such as toiletries and clothing. Care Homes for Adults (18-65 years) Page 5 of 28 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: This inspection took place on the 7th October 2009, over a period of approximately 6 hours. The inspection included: discussion with staff, a tour of the premises, examination of relevant documentation, and the inspector met with some of the people that live there. We also looked at self-assessment information provided by the home. The staff have a good understanding of the care needs of the people that live at The Coach House, and the overall rating reflects the staffs continued hard work to meet the needs of the residents. A prospective manager is in post, and it is hoped that this position will be confirmed as that of the registered manager in the next few weeks. Care Homes for Adults (18-65 years) Page 6 of 28 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 Adults (18-65 years) Page 7 of 28 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 8 of 28 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. The home does have a current statement of purpose and service users guide that provides information about the home, and is provided to all clients or their representatives. A thorough assessment is always carried out for all prospective residents. Evidence: The inspector looked at the statement of purpose and service users guide, which is provided to all residents and/or their representatives. There are clients unable to use the written word though, and consideration should be given to alternative means of providing the information (e.g. video/audio). The homes self-assessment states that alternative formats are available on request, but consideration should be given to being more proactive in this respect. The staff assist the people that live at The Coach House to maintain good links with families and people important to them. There have been two new admissions since the last inspection. The homes selfassessment states: We have a detailed assessment process that evidences how we can meet individual needs. Trial visits are offered, and details fully documented. We Care Homes for Adults (18-65 years) Page 9 of 28 Evidence: understand the importance to people of having sufficient information available in order to make a choice; a member of staff is assigned to give perspective residents special attention to ensure that they feel comfortable and able to ask any questions. The care documentation inspected confirmed that a thorough pre-admission assessment was carried out, and one client visited no less than 9 times prior to moving in. Each client (or their representative) has a written and costed statement of terms and conditions, and a contract. Care Homes for Adults (18-65 years) Page 10 of 28 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. The home is run in the best interests of residents, who are involved to the best of their capabilities in decision-making and self-determination. Evidence: The manager demonstrated a detailed understanding of the complex range of needs that are presented by residents and the records inspected generally show how the relevant support is provided. The homes self-assessment states: All residents now have person centred plans, which are clear, detailed and individual to them, full of photographs, and include a goal plan. Residents are as actively involved in this as is possible. They also have detailed Care Plans with a full range of risk assessments completed. Care Plans are reviewed monthly, and full review meetings take place annually. The plans of care involved health care issues, and residents aims and aspirations in educational or social interactions. The plans of care are developed with input from other agencies, such health or the Department for Adult Care and Support (DACS). There is a plethora Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: of supporting information from a comprehensive set of assessments and riskassessments. The pertinent information from these does not always find its way into the actual care plan (person centred plan) in order to give direction to staff how to meet the care needs of the resident. The relevant information is generally there, but locating it can mean searching through a large file of information. In one instance the care plan gave conflicting information to that provided in the assessment. Care should be taken to ensure that the care plan results from review and analysis of the asessments, and provides clear instruction and direction (avoiding generic phrases such as needs assistance). Care plans are reviewed at the frequency stated in the national minimum standards and with the involvement of the resident and/or their representative. Daily records were seen to be detailed and informative of the residents day and lifestyle, including choices made. The residents have key staff to assist them. The manager was aware of capacity issues, though training for staff about the Mental Capacity Act has yet to be arranged. The staff do liaise with other professionals to ensure the rights of the residents are safeguarded, and their right to self-determination is not compromised. Residents were seen to be assisted discreetly and sensitively. The manager and staff have liaised with other agencies in Best Interests meetings where lifestyle choices made by clients may impact on their wellbeing. Advocacy services are also used as appropriate. Risk assessments are completed for various aspects of residents needs, capabilities, and activities, and include instruction how the identified risk is to be managed. Records are stored securely and staff are fully aware of their responsibilities in respect of confidentiality. Care Homes for Adults (18-65 years) Page 12 of 28 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. A range of social and recreational opportunity is provided in keeping with known preferences and capabilities. Residents engage with the local community, and all have appropriate contact with people important to them. Residents rights and capacity as adults is recognised. A balanced diet is provided. Evidence: The homes self-assessment states: Residents are fully involved in planning and discussing what they wish to do. The staff, and care records confirm that residents are involved in a range of appropriate leisure activities and maintain contact with people important to them. The range of activities has improved since the last inspection, and includes college attendance, walks, swimming, and outings. There is a flexible time table of activities, and the person centred Plans include photographs and lists of goals set. The staff Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: recognise the residents right to determine their own waking day within the parameters of meeting their health care needs, and this is reflected in the daily care notes. Residents are able to choose when to be alone or in company, and when not to join an activity. Contact with family members and friends is encouraged and assisted where necessary. Social/recreational activities are recorded in individual plans and the home provides appropriate staff to support these activities. The parent organisation has its own vehicles to assist residents attend appointments, events, or meet with people important to them. Some residents make use of the local bus service to access local facilities. The residents at home at the time of the inspection interacted freely with the staff and the inspector. Interactions between staff and residents were seen to be adult, friendly, and professional. All staff have a responsibility for meal preparation and relevant training has been undertaken. The kitchen is domestic, well equipped and clean. Lunch meals are prepared in the adjacent care home, Trevaylor Manor, kept in a hot trolley and transported across to the kitchen by staff. The route between the two homes is open to the weather. Although advised that there is a choice available at meals and there is documentary evidence of client involvement in determining the menu, it is not clear how individuals are enabled to choose on a day to day basis. There is no record of the choices made at meals. The inspector was shown a pictorial menu tool, which is used to aid choice. The kitchen was inspected by an Environmental Health Officer (EHO) in January of this year. The home has implemented the Making Food Safely programme. Care Homes for Adults (18-65 years) Page 14 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of residents are met with evidence of promoting privacy, dignity and good multi-disciplinary working taking place. Evidence: The homes self-assessment states: All residents are registered with A GP, optician, dentist and chiropodist, and other health professionals as required, and have regular appointments. The health & personal care that people receive is based on their individual needs. All residents receive specialist health care if they need or wish to do so, including dementia specialist nurse, learning disability nurse, neurologist, epilepsy specialist nurse, speech and language therapist, occupational therapist and physiotherapist. All staff have received training in personal care and principles of care, and ensure that care given is person-led way with respect for their privacy and dignity. Person centred plans contain details of how people prefer to be supported, included any gender preference. All senior care staff who administer medication (and over half of our total team) have received medication training. 14 of 20 staff have received epilepsy training, and the remaining 6 members all have training dates in the near future. 3 of the people we support have a Traffic Lights Hospital document in place, and the remainder will have this document completed within a short time. Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: The staff ensure that the residents receive health care services as required, and in accordance with the residents known preferences. Daily records and correspondence document the monitoring and addressing of residents healthcare needs and referral to appropriate healthcare professionals and specialist workers. A number of residents have regular contacts with consultants and other clinical specialists for specific health issues. The care plans include health care needs and how these are met. These records evidence that residents healthcare needs are monitored and addressed. All residents are registered with local GPs. The manager confirmed that listening devices are used for monitoring people prone to seizures. There is now a policy or procedure setting out the parameters of proper use for these devices. Minor amendments to this were discussed with the manager at the time of the inspection. The medication records, procedures and storage facilities are appropriately maintained. Medicine Administration Records were seen to be in order, though there were some gaps where staff had not signed to indicate the medicine had been administered, and care needs to be taken to ensure the administration instruction matches staff understanding of the dosage (e.g. prn or regular prescription). The home uses the Monitored Dosage system for medicines. The policy and procedure was seen at the previous inspection and covers the required areas. Records of administration included a photo of the respective resident. Staff who administer medicines have completed a course in the safe handling of medicines. There is a record kept of any medication errors. Care Homes for Adults (18-65 years) Page 16 of 28 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. Residents were seen to interact with staff in a relaxed manner. The staff have a clear understanding of safeguarding issues and procedures that will protect service users from abuse. Evidence: The people that live at The Coach House are enabled to maintain contact with relatives and friends, and external agencies through visits and telephone calls. The homes complaints procedure is available in the Service User Guide and is provided to residents or their representatives. The Commission has not received any complaints since the last inspection, though the manager and documentation confirm the home has had one complaint, which was properly actioned. Advice regarding various forms of potential abusive situations and procedure are available to staff and are raised during induction training. The home has a written policy and procedure for protecting residents against abuse and supplementary guidance on the nature of abuse. The home has a copy of the Cornwall Multi-Agency Code of Practice on the Protection of Vulnerable Adults, and staff have undertaken relevant in-house safeguarding training. Senior staff may benefit from attendance on the local authority safeguarding training. The parent organisation, Swallowcourt Ltd, are fully aware of the need for prompt reporting of any concerns. As discussed with the manager, none of the staff have received any training about the Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: Mental capacity Act, though the inspector was advised that this is in hand. The manager has had training about the Mental capacity Act and Deprivation of Liberties. Residents are protected by the homes adherence to a robust recruitment procedure, recorded staff supervision, and regular recorded inspections by the registered provider. Care Homes for Adults (18-65 years) Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of furnishings and fittings is good and residents live in a safe, clean, and homely environment. Evidence: The homes self-assessment states: The Coach House is a beautiful listed building which was specially adapted to meet the needs of the people we support. The company has its own team to ensure maintenance is attended to. The house is homely, comfortable and safe. We have a housekeeper who ensures that it is kept tidy and hygienic. All bedrooms are single (the Coach House has 8 residents, but is registered for 9 should 2 people ever request to share). All rooms have ensuite toilet and washing facilities, and are of a generous size. There is a well stocked and maintained walled garden, including fruit trees and herbs. Everywhere was tidy, pleasantly decorated and furnished in a homely way. The bedrooms seen were personalised, reflecting individuals interests and preferences. Rooms are well furnished and comfortable and have been personalised by the occupants. There is a communal bathroom on the first floor. Three of the bedrooms are on the first floor and two on the ground floor. There is a platform lift to assist residents using the first floor. Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: The home looked well maintained, and there was documentary evidence of maintenance and safety checks. The home was clean throughout. Blinds are fitted to the roof of the sun lounge so that the room does not get unbearably hot for those using it. There is easy access to the garden from the sun lounge. Staff are required to carry meals between the adjacent Trevaylor manor and The Coach House. Whilst this is only a short distance the journey is open to the elements. Visiting professionals may carry out their duties in the lounge, or in the residents own room. The lounge is subject to the passing of staff, residents, and visitors so is not ideally suited to private consultation. The office is an internal room with one window opening on to the sun lounge. This room can become very warm, and whilst it is recognised that this is a matter of personal preference, the inspector found it to be uncomfortably warm on the day of the inspection. The room would benefit from active ventilation. The office understandably contains materials (e.g. keys) that staff need in order to fulfill their duties. On the day of the inspection discussions with the manager were repeatedly interrupted by staff wanting something out of the office. This may have a significant impact on a private meeting with a resident or their representative, and consideration should be given to how traffic in and out of the office might be reduced to better afford privacy to people using the office for meetings. The laundry room has a washing machine with appropriate programmes for cleaning laundry properly. The home has proper equipment for dealing with soiled items, including use of alginate bags and the sluice cycle. Disposable gloves and aprons were seen available around the home. There was a sink in the laundry with paper towels, and liquid soap for washing hands. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider must do more to encourage and promote NVQ/LDQ training. The home adheres to a robust employment procedure. Staffing levels are sufficient to provide flexible support to the residents. Evidence: The homes self-assessment states: Recruitment procedure is as follows: Residents take an active part in interviews; Application forms, interview formats/scoring, job descriptions, person specifications, equal opportunities monitoring form, equality and diversity policy, CRB, 2 references are taken up. Staff receive very thorough induction training in their first two weeks, including Skills for Care induction. Mandatory training is completed within first 12 weeks. The manager has had training in recruitment and selection. Staffing numbers have been increased, enabling residents to have greater 1:1 interaction and go out more. Staffing ratios comply with Department of Healths Residential Forum calculations. LDQ and NVQ encouraged. The Coach House has a small group of bank staff who work regular shifts as when required; this negates the need for agency staff and ensures greater continuity to the residents. There are 19 care staff, plus a housekeeper. The registered manager position is currently vacant, but the managers application for this position is in process. At the time of the inspection there were 5 care staff on duty with 8 people living at The Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: Coach House. Approximately half of the resident went out on a trip at the time of the inspection. Staff were observed to provide stimulation and interaction with the remaining residents. Only 3 of the 19 care staff have achieved NVQ Level 2 or above, though it is noted that a further 3 staff are booked to commence this training. New staff undertake an in-house induction as well as a National Training Organisation core standards induction. There is good evidence of the registered providers commitment to providing training relevant to the role carried out by staff (e.g epilepsy training), though there is room for improvement (e.g. mental capacity act training). There is a stable staff team available that is providing continuity and a consistent approach to care. The staff team are involved in training, which is continuing and the manager is monitoring training needs. The homes commitment to training relevant to the role staff undertake is noted, but further improvement is needed in respect of NVQ/LDQ qualifications. The personnel file inspected showed that the home is adhering to a robust recruitment procedure in order to protect the people that live at The Coach House. The staff were knowledgeable of the residents needs and capabilities, and were observed to exhibit a positive regard and appropriate attitudes in their interactions. Care Homes for Adults (18-65 years) Page 22 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to provide for the safety and welfare of residents. The home does not have a registered manager, but the manager has made application for this position. Evidence: The homes self-assessment states The Coach House appointed a new manager in December 2008, who has applied to be the registered manager. The manager has 24 years experiencing of working with adults with learning disabilities, including 15 years of management experience in residential services. The manager previously managed a service which achieved an Excellent CSCI rating last year. The manager has an NVQ level 4 in Social Care and is currently working towards ILM qualification. She has attended an extensive number of training courses, and is well qualified to manage the home. The number of training courses the manager has attended include all the core training one would expect, as well as NEBs level 1, Equality and Diversity, British Sign Language level 1, Risk Assessments, Recruitment and Selection, etc. The manager provides clear direction to the Coach House staff team. Staff respond to a clear sense of direction and leadership. Management approach promotes an open, positive and Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: inclusive atmosphere. There are quality assurance strategies in place, based on seeking the views of residents, their families, staff and other outside agencies. Policy records demonstrate that every member of staff follows a corporate approach along with a day to day working knowledge of the Coach House. Record keeping policies and procedures prove that residents rights and interests are safeguarded and that health, safety and welfare of residents are promoted and protected. The manager has been in post for approximately 10 months and has made application to the Commission to be the registered manager. The manager is NVQ 4 qualified and has previous extensive experience in care settings. The service continues to meet the needs of the people that live there. There is use of internal quality assurance tools, and residents are consulted as part of everyday normal practice. Quality assurance findings have been summarised and provided in a report. Discussion took place with a view how to best present the findings in an easily understandable way (e.g. pie charts). The quality assurance tools not only indicate how a service is performing, but also allow for comparison with other homes operated by the registered provider. The registered provider, or their representative, is carrying out monthly visits and providing a record of this as required by regulation. The inspector discussed the financial accounting procedures within the home with the manager. Only small amounts of money are held on request and records are kept. The manager confirmed that the home has no involvement with the management of individuals money or accounts. All residents manage their own accounts or have someone outside of the home doing so for them. Staff are being supervised, and this is recorded, though care should be taken to ensure this is done at least six times a year. The registered provider maintains current invoices and records to show ongoing maintenance and safety checks. The insurance cover in place ensures that the home is well able to fully meet any loss or legal liabilities. There is a comprehensive riskassessment tool provided by an external company. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 28 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 1 6 The registered provider should consider the provision of information in alternative formats. The registered provider should ensure that all care plans (person centred plans) provide clear, detailed instruction and direction to staff. The registered provider should ensure that choice at meals is promoted and choices made recorded. The registered provider should monitor medicine administration with a view to reinforcing staff signing MAR sheets, and reviewing medicine prescriptions. The registered provider should consider installing active ventilation in the office as this room can become very warm. The registered provider should consider how traffic in and out of the office might be reduced to better afford privacy to people using the office for meetings. The registered provider should consider providing covered access between the adjacent care homes in the interests of staff safety. Page 26 of 28 3 4 17 20 5 24 6 24 7 24 Care Homes for Adults (18-65 years) 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 8 32 The registered providers should encourage NVQ/LDQ training. Care Homes for Adults (18-65 years) Page 27 of 28 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. 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