Care Home: The Coach House

What the care home does well The Coach House is providing a welcoming, friendly and homely setting that is clean and comfortable for elderly people so that people are unhurried and feel at home. Residents are encouraged to use their own rooms or the communal rooms without regimentation or control. Staff are smiling, communicative and kind. `They`re very good when I need them.` The residents respond well to staff contact and express appreciation of their support. There were appropriate numbers of staff on duty to support the needs of the residents. The meals are home cooked and well presented, `good and tasty` we were told. `Very nice, would you like some?` The manager has taken up the recommendation made in the last report to enhance the service by involving specialist training in dementia and has found this to be motivating and positive. Some improvements have been made to the care planning process. What the care home could do better: The drug records are not always accurate concerning the medicine that has been administered by staff. The manager must ensure that every member of staff who administers medication is competent to do so, and that they correctly record when medication is given or the reason when it is not administered. There is an absence of written guidance for the staff on giving prescribed medication when it is not given routinely but `as and when needed`. The manager must ensure clear instruction is in place for each resident so that it is not left to the individual judgement of the member of staff on duty. Care plans are in place and are reviewed regularly. However, the master copies that staff will use are not updated with any significant changes as they occur in residents` needs, so the right level of care by all the staff is not assured. We left two immediate requirements for the manager to attend to. They are the updating of all the care plans and providing daily monitoring of the drug administration. She was told that enforcement action may be considered as these issues were raised at the last inspection and are still not fully met. The manager needs to ensure that staff practices are monitored regularly to ensure all the regulations and standards are met. Inspecting for better lives Random inspection report Care homes for older people Name: Address: The Coach House 67 Keyhaven Road Milford-on-Sea Lymington Hampshire SO41 0QX one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Joyce Bingham Date: 1 1 0 2 2 0 0 9 Information about the care home Name of care home: Address: The Coach House 67 Keyhaven Road Milford-on-Sea Lymington Hampshire SO41 0QX 01590642581 Telephone number: Fax number: Email address: Provider web address: donnalynfry@tiscali.com Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs D L Fry care home 17 Number of places (if applicable): Under 65 Over 65 17 0 17 0 17 dementia dementia mental disorder, excluding learning disability or dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 0 17 0 17 0 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) The maximum number of service users to be accommodated is 17 Care Homes for Older People Page 2 of 9 Date of last inspection Brief description of the care home The Coach House is a care home providing personal care and accommodation for up to seventeen older people with or without dementia or mental ill health. The home is owned and managed by Mrs Donna Fry and is situated in a quiet residential area of Milford-on- Sea. Local amenities are a short walk from the home. The Coach House consists of a three storey building with thirteen bedrooms, nine are single and three of the four double bedrooms are en-suite. There is a dining room and lounge with conservatory overlooking the homes enclosed garden. A stair lift provides access to the first floor only. The provider makes information available about the service, including a statement of purpose and service user guide and the Commissions report, to prospective residents on request. Copies of these documents are available at the home and may be sent out by post on request. The home states that the fees range from 385.21 pounds to 446.00 pounds a week for residential care. There are additional charges for hairdressing, chiropody, newspapers and toiletries. Care Homes for Older People Page 3 of 9 What we found: We spent four hours at the home starting from 10:20 am. We looked at relevant records, inspected the drug storage and its methodology, spoke with six residents, and several staff including the manager, and looked at a limited number of rooms. We followed up five requirements made at the last inspection. Two have been fully met. Some work has been completed in relation to the other requirements but there are aspects that remain outstanding. We learned the Coach House is currently accommodating ten residents. They have rooms on the ground and first floor. We were told the only people who access the second floor are the live-in staff members, and so the bathroom and kitchen facilities on this floor are currently designated for their sole use. This has resolved one of the matters of concern from the previous inspection, that residents on the second floor had no access to a bathroom or toilet facility on the same floor. The manager told us that, not only are no residents accommodated on this floor, but she is also progressing architects plans and planning permission to increase accommodation on the ground floor by building a single storey extension. We looked at one of the rooms on the first floor that had previously been highlighted as potentially unsafe for use by elderly persons. The room has three steps down into it from the corridor. This room was in use and a risk assessment had been completed by the manager to ensure the occupant of this room was mobile and fit enough to both descend the steps, and open and hold open the door in order to exit the room. The resident showed us the room themselves and was able to climb all the stairs easily from the ground to the first floor. They told us, I am happy with this room. I dont have a problem getting in and out. We looked at three care plans and their reviews, and spoke briefly with six of the residents, one in private. The manager has developed the care plans covering residents mobility occupational/leisure/social interaction, personal care, health, risks, speech, emotional/psychological needs, domestic arrangements, medication, continence, and finance. A clear photograph and typed personal profile giving some life history, work, family relationships and significant events is now included and we felt that real progress has been made here and communicated this to the manager. We learned that since the last inspection she has attended a four day training course organised through the Alzheimer Society in dementia care and found this stimulating and inspiring. We found that the care plans had been reviewed on a monthly basis and they were dated but not always signed. We found that in the case of two out of three of the residents their care plan did not reflect all their current needs, providing only limited written strategy or guidance for staff in the management of particular behaviour, not being up-to-date in relation to their current medication, and being too general and non specific in relation to personal care needs e.g dressing and undressing-support is required, and a care plan that stated may have the odd accident when the review notes refer to incontinent and wearing pads 24/7. There were two care plan reviews that identified issues and proposed a review of medication, but we could not find any evidence of further action being taken eleven days later, and the manager could not account for this. Care Homes for Older People Page 4 of 9 We inspected records of medication and the new drug storage that had been placed in the cool walk-in larder off the dining room. The cupboard was of good proportions and contained an inner controlled drug cupboard. A monitored dosage system was in use. We expressed concern to the manager on finding errors in the medication records. Some medicines were presumed to have been given, as they were not still located in the blister pack, but not recorded in the drug chart as having been given/refused/discarded. We found an instance of prescribed medication which the home was treating as as and when needed without any documentary medical evidence for the adjustment. There was insufficient guidance for staff on as and when needed medication. Under our statutory powers we took copies of the relevant care plans and records of administration of medicines, and made an immediate requirement that the manager attend to these matters and provide daily monitoring of the drug administration. The home was found to be very warm and clean and odour free. The majority of the residents were in the lounge and enjoying the music and companionship of each other and the staff. One resident was engaging with the staff member in the kitchen and was readily compliant to leave his activity there when requested kindly by the staff member. Other residents were remaining by choice in the own rooms but came to the dining room for lunch. The home-cooked meal was observed and residents said that it was good and tasty. What the care home does well: What they could do better: The drug records are not always accurate concerning the medicine that has been administered by staff. The manager must ensure that every member of staff who administers medication is competent to do so, and that they correctly record when medication is given or the reason when it is not administered. There is an absence of written guidance for the staff on giving prescribed medication when it is not given routinely but as and when needed. The manager must ensure clear instruction is in place for each resident so that it is not left to the individual judgement of the member of staff on duty. Care plans are in place and are reviewed regularly. However, the master copies that staff will use are not updated with any significant changes as they occur in residents Care Homes for Older People Page 5 of 9 needs, so the right level of care by all the staff is not assured. We left two immediate requirements for the manager to attend to. They are the updating of all the care plans and providing daily monitoring of the drug administration. She was told that enforcement action may be considered as these issues were raised at the last inspection and are still not fully met. The manager needs to ensure that staff practices are monitored regularly to ensure all the regulations and standards are met. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 9 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 9 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 1 9 15 Care plans must cover all the 19/03/2009 personal care needs of each resident and be kept up-todate to ensure all the assessed needs are fully recognised and met by the staff 2 9 13 The manager must ensure that all medication is administered safely and regularly monitor and keep under review the staffs adherence to the recording and handling of medication to ensure there is no mishandling. 19/03/2009 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 Care Homes for Older People Page 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. 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