Care Home: The Coppice

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• Clover House
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What the care home does well This service supports service users to live everyday ordinary and meaningful lives. Service users are central to how the home is run and the staff team work flexibly to fit around the lifestyles of individuals. When we asked staff members what they felt the service did well we were told it " always puts the needs of service users first". Through looking at staff members records and after direct observation of their practice as they provided support to service users, we think members of staff have the skills, knowledge, understand and meet the needs of service users very well. Though we have received some mixed views from relatives about their opinions of service users daily routines and the provision of activities, one person stated that because of the daily input provided by the service , their relative was able to "lead as normal a life as possible". Comments received from service users, all of whom had assistance from relatives or staff to complete their surveys, stated they were satisfied with the provision of activities and that they received the support they required. Even though there have been no new admissions into the home for a number of years there are good pre admission procedures in place which ensures the needs of service users are assessed and matched to a service within the Elizabeth Fitzroy Service before any introductions are made. Once a home has been identified, a service user then receives a visit from someone from the home to talk through any concerns they have and answer any questions.The CoppiceDS0000005606.V375164.R01.S.docVersion 5.2Moving in procedures are designed to meet the needs and requirements of the individual service user and can be as short or as long as they desire. Each service user is actively involved in the making of their care plan and their families and people who are important to them are also consulted for information. The care plans we looked at were detailed and contained all the required information, this means members of staff had the information they required to know all about the needs of service users, their personal preferences for care and how that should be provided. The environment continues to be well equipped and is a pleasant place to live. It is a bright modern home which is designed to meet the needs of younger adults. All comments received stated positively about the home with one saying they have "a nice home with nice friends". Service users are encourage to share their views and the homes complaints and safeguarding procedures were in place for their protection. Surveys confirmed that complaints procedures were known and information given to us from the manager and staff team tell us that if any complaints or concerns were raised they would be taken seriously, recorded and investigated appropriately. Staff are trained in protection procedures and health and safety of service users is paramount. Health and safety checks were completed regularly, risk assessments were in place and, where risks were evident for service users appropriate risk management plans were in place which had been agreed with the service user. Service users can have confidence that staff at the home have been recruited correctly and that appropriate checks have been completed to make sure staff members are safe people to work with vulnerable adults. When we asked members of staff about their recruitment and training programmes they told us that agency staff are also interviewed and "shadow other experienced members of staff" before they commence long term work. We were able to confirm this during the inspection. There has only been one staff vacancy within the previous twelve months, this means service users continue to be supported by care staff who know them well and with whom the have been able to form lasting relationships and friendships. Generally all comments received from relatives were very positive, which confirmed they were kept informed about important matters and they felt their relative received the care and support they required. Some raised minor issues where they thought the service could be developed more and we would recommend that the manager finds ways to meet with families on a regular and routine basis to get their views and consider any suggestions they make. Although one relative stated they "would like more staff" they also said "We are delighted with the service".The CoppiceDS0000005606.V375164.R01.S.docVersion 5.2Page 9 What has improved since the last inspection? New care plans have been developed. The ones we looked at had extensive information about everything on the service users and recorded what was important to them, their health care needs, personal dreams and aspirations and how they would like to receive care support from members of staff. The management, recording and administration of medication has been reviewed and better recording systems were in place. The manager has made sure that service users always have easy access to the call system within their private rooms, so they can call for support if they require it. A better on call support system has been put into place which means when staffing shortages become apparent at short notice, support to obtain additional staff is provided quickly rather than staff on duty having find members of staff to cover the duty. This means that service users should not experience any undue adverse affects when staff shortages are first identified and that as far as possible they continue to receive the support they require in a timely manner. When we looked at the rota we assessed that there had been appropriate numbers of staff on duty to meet the needs of service users. Though there was some comments from relatives and staff that an increase in staffing levels at weekends would be of great benefit to service users. What the care home could do better: Even though we have assessed this service as excellent, we have still identified aspects where there remains an opportunity for further development. The manager should also be registered with us within the next six month and complete an up to date management qualification. Consideration should be given on how to support service users to develop long term personal sexual relationships and have partners if this is their desire. Systems should be in place to support them to have private times with their partners with regular and routine opportunities to develop long lasting relationships. Because service users are ageing and not all have active family support, the manager should make sure that they are consulted about how they would like to be cared for should they become very ill. Their views should also be sought regarding their last wishes and feelings. This will make sure that as far as possible in the event of their death, plans are in place which have been agreed to and can be followed as they have requested.The CoppiceDS0000005606.V375164.R01.S.doc Version 5.2 0 Key inspection report CARE HOME ADULTS 18-65 The Coppice 51 Wellington Road Altrincham Cheshire WA15 7RQ Lead Inspector Sylvia Brown Unannounced Inspection 7th & 15th April 2009 10:00 The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 2 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 The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Coppice Address 51 Wellington Road Altrincham Cheshire WA15 7RQ 0161 929 4178 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) wendy.layfield-cole@efitzroy.org.uk www.efitzroy.org.uk Elizabeth Fitzroy Support Wendy Layfield-Cole ( not registered) Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category 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 is within the following category: Learning Disability - Code LD The maximum number of service users who can be accommodated is: 7 Date of last inspection 13th April 2007 Brief Description of the Service: The Coppice is a detached brick built property and is in keeping with others in the road. The home provides accommodation with personal care for 7 people with a learning disability. It is situated near to a local school and there are traffic calming measures in the area. The house is divided into two properties with an inter-connecting door. The main body of the house provides accommodation for five residents. There is a semi-independent living arrangement for two male residents in the annex. There are large secluded rear gardens and parking. The laundry facilities for the home are situated in the detached garage at the rear of the property. The home has its own minibus, which affords the residents access to day care, local colleges, recreational facilities, and places of interest. Fees are calculated on an individual basis based on individual’s needs. Currently the lowest fee is £1,150 per week and the highest is £1,486. The home has a service users guide and statement of purpose both of which have been adapted to make sure service users can understand them. Both documents are provided to prospective service users and their families upon request and when they first meet with the manager or representative from the home. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 5 The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service would experience Excellent quality outcomes. The inspection report is based on information and evidence gathered by the Care Quality Commission (CQC) since the last key inspection, which was completed in April 2008. This was a key inspection which included two site visits to the service. The first site visit was unannounced which means the manager and staff were not told that we would be visiting. At that time the manager was not on duty. As a consequence we arranged to meet with the manager on the second site visit to complete looking at records which we did not have access to on the first visit. Since the key inspection in 2007 we have completed an annual service review in June 2008. An annual service review (ASR) is a summary of our knowledge of a service that has not had a key inspection in the last year. It is helps us decide if a service is still as good as we thought it was at the last inspection or if we need to alter out inspection programme. The ASR concluded that we did not need to change when the draft of the next inspection. For reporting purposes the preferred term to be used for people living and receiving a service at the Coppice is service users. As part of the inspection process we gathered information from a number of people which included talking with and seeking the views of service users. Prior to the site visit we also sent out surveys to service users, their relatives and members of staff. This gave them an opportunity to tell us about their opinions on the services provided at the home. Comments received are included within the report. There have been no new admissions at the home for some considerable time and we have at past inspections case tracked service users living at the Coppice, this means we have looked in depth at their care support which included looking at their records in detail. For this inspection process we concentrated on any new developments within the service and obtained a general overview of all service users which included looking at a sample of their records and spending some time with them as they went about their daily routines and received support from staff members. This helped us get a better view about how people living at the Coppice are looked after and supported. In March 2009 the manager completed a self assessment form, which is called an Annual Quality Assessment Audit(AQAA).This document should tell us in detail what they and the registered manager have done since the last key inspection to meet and maintain the National Minimum Standards. It should also tell us what the manager and the registered provider felt they were doing well, how they had improved within the past 12 months and plans to develop The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 7 in the next 12 months. The AQAA was completed very well by the manager and provided us with a lot of information about the service. We also gathered information from general contact with the home through their reporting procedures which are called Notifications and information we may have received from other people, such as the general public and professional visitors. We have not received any complaints or allegations of abuse about this service. The service has a proven history of good practice. The last key inspection only issued one requirement which related to the submission of an application for registration with us. After the inspection we received a report from the manager and registered provider which detailed the action taken to comply with the requirement. This report is a public document and should be on display within the home and can be made available for reading upon request. What the service does well: This service supports service users to live everyday ordinary and meaningful lives. Service users are central to how the home is run and the staff team work flexibly to fit around the lifestyles of individuals. When we asked staff members what they felt the service did well we were told it always puts the needs of service users first. Through looking at staff members records and after direct observation of their practice as they provided support to service users, we think members of staff have the skills, knowledge, understand and meet the needs of service users very well. Though we have received some mixed views from relatives about their opinions of service users daily routines and the provision of activities, one person stated that because of the daily input provided by the service , their relative was able to lead as normal a life as possible. Comments received from service users, all of whom had assistance from relatives or staff to complete their surveys, stated they were satisfied with the provision of activities and that they received the support they required. Even though there have been no new admissions into the home for a number of years there are good pre admission procedures in place which ensures the needs of service users are assessed and matched to a service within the Elizabeth Fitzroy Service before any introductions are made. Once a home has been identified, a service user then receives a visit from someone from the home to talk through any concerns they have and answer any questions. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 8 Moving in procedures are designed to meet the needs and requirements of the individual service user and can be as short or as long as they desire. Each service user is actively involved in the making of their care plan and their families and people who are important to them are also consulted for information. The care plans we looked at were detailed and contained all the required information, this means members of staff had the information they required to know all about the needs of service users, their personal preferences for care and how that should be provided. The environment continues to be well equipped and is a pleasant place to live. It is a bright modern home which is designed to meet the needs of younger adults. All comments received stated positively about the home with one saying they have a nice home with nice friends. Service users are encourage to share their views and the homes complaints and safeguarding procedures were in place for their protection. Surveys confirmed that complaints procedures were known and information given to us from the manager and staff team tell us that if any complaints or concerns were raised they would be taken seriously, recorded and investigated appropriately. Staff are trained in protection procedures and health and safety of service users is paramount. Health and safety checks were completed regularly, risk assessments were in place and, where risks were evident for service users appropriate risk management plans were in place which had been agreed with the service user. Service users can have confidence that staff at the home have been recruited correctly and that appropriate checks have been completed to make sure staff members are safe people to work with vulnerable adults. When we asked members of staff about their recruitment and training programmes they told us that agency staff are also interviewed and shadow other experienced members of staff before they commence long term work. We were able to confirm this during the inspection. There has only been one staff vacancy within the previous twelve months, this means service users continue to be supported by care staff who know them well and with whom the have been able to form lasting relationships and friendships. Generally all comments received from relatives were very positive, which confirmed they were kept informed about important matters and they felt their relative received the care and support they required. Some raised minor issues where they thought the service could be developed more and we would recommend that the manager finds ways to meet with families on a regular and routine basis to get their views and consider any suggestions they make. Although one relative stated they would like more staff they also said We are delighted with the service. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 9 What has improved since the last inspection? What they could do better: Even though we have assessed this service as excellent, we have still identified aspects where there remains an opportunity for further development. The manager should also be registered with us within the next six month and complete an up to date management qualification. Consideration should be given on how to support service users to develop long term personal sexual relationships and have partners if this is their desire. Systems should be in place to support them to have private times with their partners with regular and routine opportunities to develop long lasting relationships. Because service users are ageing and not all have active family support, the manager should make sure that they are consulted about how they would like to be cared for should they become very ill. Their views should also be sought regarding their last wishes and feelings. This will make sure that as far as possible in the event of their death, plans are in place which have been agreed to and can be followed as they have requested. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 10 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. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 11 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 12 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are confident that the 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 assessment tells thestaff supporting the service user all about them, what they hope for, what they want to achieve and the support they need. EVIDENCE: There have been no new admissions to the Coppice for a number of years. What we know is from previous inspections and information provided to us by the manager during this inspection, that significant time and effort is spent to make service users admission into the home personal to the them. The pre-admission assessment process includes speaking with the service user, their family and people who are important to them, medical professionals that are involved and any other person who can positively contribute to the development of an accurate assessment. Because of this consultation process extensive information is gathered about all aspects of the service users life, The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 13 needs and aspirations. When we looked at some service users files we saw that the assessments were kept under review and continued to be maintained throughout the service users stay at the home. Once the pre-assessment process has been completed by various professionals and mangers within the organisation, a process for selecting the best home to match the service users needs is completed, though in reality because of the demands on the service, often placements are allocated where there is a vacancy. Once a home has been identified the manager from that service meets with them and plans a visiting programme which is chosen and suitable to the service user and their family. Service users can have a number of day visits and overnight stays until they are confident to make the move into the home. Reactive and carers surveys stated they are provided with enough information about the service. The services provides service users and their family with a statement of purpose and service users guide at the time of the preassessment process. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 14 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users needs and goals are met. They have care plans that they or someone else close to them have been involved in making. They are able to make decisions about their life including their finances with assistance from the service if they need it. Service users have the support they need to take risks to enable them to stay independent. This is because staff members promote service users rights and choices. EVIDENCE: During the site visit we were able to sit and observe the day to day routines of some service users as they received support and interacted with staff members. This helped us to assess what supports were in place for service users and how their independence was promoted. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 15 We saw a number of service users preparing for their midday meal and going out. One service user told us they were attending the dentist within the community that day. The staff member informed us that because of the service users anxiety about dentists and treatments a considerable amount of support had been provided to the service user prior to the appointment. The dentist had visited the service user and had been able to explain the process and staff had provided further explanations and encouragement. Because of this the service user felt able to try and have treatments done. On the second day we were able to confirm that the appointment had gone well and that the service user was pleased with their achievement in overcoming their fear. At the time of the site visit the registered manager was in the process of introducing new and more detailed care plans. Although the ones we read were lengthy documents, they contained a substantial amount of relevant information both past and present on the service user, including their strengths, abilities and personal preferences. It was clearly evident that time and consideration had been given to talking with the service uses about their life, their current desires, health care needs and their aspirations for the future. Family members and important people to the service user had also been able to contribute to the development of the care plans including medical professionals. From reading care plans, talking with staff members, observing service users and talking with the manager it was clear to us that staff were committed in supporting service users to lead meaningful lives. Care plans were individualised and service users decisions about what they wanted was recorded. All care plans were signed by the service user and in an easy read format. They were kept under review and amended when goals had been reach or other issues required recording such has changes in health care. Service users opinions are sought and some belong to various groups that seek their views on everyday matters , ways on developing and improving services for people with a disability. The organisation used various methods as part of their process for gathering the opinions of service users about the quality of the services they receive from the home. Service users are also able to have advocates and independent people to talk with them and act on their behalf. Service users had communication care plans in place which makes sure their communication needs are understood and can be met by members of staff. They also had individualised financial support plans which enabled them to budget and manage their finances and particularly for large expenditures such as holidays and outings. Staff were observed to have the appropriate skills to communicate well with the people using the service and positive relationships continue to be evident. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 16 Because staff members are committed to supporting service users to live the life they want, risk management and assessments were in place, which identify where risk were evident and how they should be managed. Because of this service users are able to go out into the community, continue with their hobbies and interests and take everyday risks the same as other people. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 17 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13,15,16 & 17 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each service user is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability and gender. Service users take part in activities that are appropriate to their age and supports them to follow their personal interests and activities. Service users are as independent as they can be, lead their chosen lifestyles and have the opportunity to make the most of their abilities with their dignity and rights respected in their daily lives. They have healthy, well presented meals and snacks at times and places to suit them. EVIDENCE: Service users at the Coppice live as full a life as they desire and as is reasonable, records identified that they continue to take an active part within their local community and pursue their own hobbies and interests. Some The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 18 service users receive visits from day care support services which enables them to develop their skills and confidence from their own home. Others continue to attend day care services within the community. This is currently being reviewed as consideration is being given as to how much choice a service users actually has about their attendance. Staffing levels are based on the expectation that a number of service users will be away from the home each day therefore there is an expectation that a service user will be going to day care as a matter of routine. Staff members continue to support service users to be active within the local community with a number being a part of focus groups which meet together to share experiences and contribute to the development of the organisation and services as a whole. Some service users are positive role models and advocates for others and have taken part in leading discussion forums which has encouraged them to use their presentation skills to inform others on topical issues which affect them and others with a disability. From the records we looked at and from the information we have received from service users, relatives and others, we know that service users are supported well to pursue their own hobbies and interests. Each service user is afforded an allowance from the organisation towards their annual holiday which they are individually able to choose. Any additional expenses are funded by the service users themselves. The registered manager and staff team are dedicated to promoting the self worth of service users and they have consistently demonstrated to us that they promote service users to retain their individuality and have dreams and aspirations and where possible support them to fulfil them. Service users are able to take everyday and extraordinary risks, because of good risk assessment and management programmes being in place which promote service users to be active rather than restrict them. They are able to meet with others to socialise and are able to make new friendships and relationships. We discussed with the registered manager how service users are supported to maintain and develop personal long lasting relationships and to what extent service users are supported to spend personal and private time with a partner. The manager stated that this area has not been developed sufficiently and that some service users would possibly desire this and have opinions on how they could be supported to find partners. We were told that the manager would arrange to start this discussion with service users and seek the organisations opinion on best practice and how they would be able to support service users to have partners. We observed meals and meal times to be relaxed with service users being able to chose individually what they would like to eat. We saw that they were assisted to make things for themselves and make decisions about what food was bought each week. The manner in which meals are chosen and shopping for food undertaken is more in keeping with that of an ordinary household The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 19 rather than an establishment. We saw service users looking through cupboards and refrigerators to see what they could have for lunch, others without that ability were told what was available and were able to make their own choices. Service users have the opportunity at eating out within the community and enjoy takeaway meals. Those who are at risk of weight loss or have complex eating routines have specific records in place, nutritional advice and services to support them. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 20 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18.19,20 & 21. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive personal support from staff in a way that they prefer and want. Their physical and emotional healthcare needs are met because the home has procedures in place that staff follow. Systems are in place which makes sure service users receives the correct support to take their medication safely. EVIDENCE: The care plans we looked at confirmed that service users are fully involved in making plans of care and have the opportunity to say how they would like to receive personal and healthcare support. Individualised plans clearly recorded peoples personal healthcare needs and how they should be met. The registered manager has made sure that each service user has an action healthcare plan and an annual healthcare check. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 21 Individualised medication profiles were in place which stated what medication was required and how the service user would like it administered and where. Each service user has a medication review completed every six months and their general care plan is routinely evaluated to make sure it is relevant. The service has a sustained record for maintaining compliance with administration, safekeeping and disposal of medication. Care staff receive training and are competent to administer and support service users to take their medication. Service users are encouraged to attend medical health care support services within the community and attend the local health care practices to receive medical checks and advice. We could see from their records that dental, optical and hearing checks are completed as required and additional support services such as chiropodist are carried out as required. In 2007 the AQAA stated that the registered manager after consultation with service users would develop a demise plan which makes sure that service users have end of life plans in place which reflects their personal wishes on how they should be cared for should they become terminally ill. The 2009 AQAA stated the same thing which indicates that they have not been developed since we last inspected. We are recommending that this development takes place to make sure that the wishes and feelings of service users are known. From our observation, through looking at records and from what we have been told, we know that staff continue to provide a service user led support service which is flexible, consistent and meets the changing needs and preferences of service users. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 22 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People using the service experience Good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are able to express their feelings and have confidence that their concerns and complaints will be recognised and taken seriously. Complaints and protection procedures are adapted so service users can understand them. This means that service users know how to raise any concerns and what will happen to make things better. EVIDENCE: A number of service users at the Coppice are involved in various groups which supports them to express their opinions and raise any concerns they may have about any of the services they receive. Everyone is provided with adapted information about the complaints procedure and staff members take time to individually explain the processes for raising complaints with them to make sure they have the confidence to share any concerns. Adult protection procedures are also in place and have been adapted to make sure they can be understood by service users. Staff have received training in adult protection procedures and are aware of their responsibility to keep service users safe. Good recruitment and selection procedures are operated by the manager, who makes sure that appropriate documents are provided by prospective staff The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 23 members and that she carries out statutory checks to ensure new staff are suitable and safe people to support vulnerable adults. We have never received any concerns or allegations about this service. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a safe and well maintained home that has been adapted to meet their individual needs, is homely, clean comfortable and pleasant. EVIDENCE: The home is a well maintained family home and fits well within the community without drawing attention to it being a residential care home. We had the opportunity of spending time with service users during the course of our site visit, because of this we were able to look around the home and see if it was suitable for all service users. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 25 We found that the home continues to be of a good standard with the annual upgrading continuing as planned. Both communal and private areas have been appropriately adapted to make sure service users who require the use of a wheelchair or hoist have enough space to move around and access all parts of the building. Fixtures, fittings and decoration are reflective of a younger generation with many modern features. Each bedroom is individual and reflected the preferences of the service user, there is enough space to ensure they have tables and equipment to support them with their hobbies and interests and if they wish, meals can be taken there. Since the last inspection action has been taken by the manager to make sure all service users have access to a call point within their own rooms and are able to summon assistance if they wish. The home has assessed the long term needs of people living there and has three bathrooms one of which has a specially adapted bath and a shower room. This means that service users have a choice of bathing options and can have as many baths as they desire. Service users have access to Sky television and a music system which we observed them enjoying and listening to. In 2008 infection control procedures were improved by the provision of a sluicing machine and a hand washing sink for staff members. Even though the home is of a good standard there continues to be plans in place for the development of a parking area to the front of the home which will enable an upgrading of the rear garden to make sure it is safe and adapted to meet the needs of people with a disability and promote their interest in gardening and using outdoor areas in fine weather. The AQAA stated that it is the intention of the service to replace thermostatic water valves and purchase another hoist. As we have previously seen at inspections the home continues to be clean and free from unpleasant odours. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34,35 & 36 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive safe and appropriate support from staff who are skilled and competent. Staff receive supervision and training from their manager. This means service users have confidence in the staff because checks have been done to make sure that they are suitable. EVIDENCE: We looked at two weeks rota, various training records, two staff files and observed care staff in practice. We found that the manager maintains robust recruitment and selection procedures. Staff application forms were well detailed ,references applied for and received and statutory checks carried out to make sure that prospective staff members were suitable people to work with vulnerable adults. All prospective staff members completed face-to-face interviews. Service users are invited to meet with prospective members of staff and be part of the interview process. They are provided with records which detail the questions to be asked which include relevant pictures so the The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 27 service user can choose to describe their opinion on what they think about the prospective staff members response to the question. From the records we looked at we could see that once appropriate checks were in place letters of appointment were provided to the new staff member and they commenced work at the home in a supernumery capacity. This means they were additional to the staffing ratio and worked alongside experienced members of staff and got to know service users and their individual support packages . New staff members completed the homes induction programme and the Skills for Care Common Induction programme which is the required standard. We also saw that individual supervision was planned for and training and development programmes were in place. The AQAA stated that each member of staff has received a copy of the General Social Care Councils Code of Conduct and that during their probationary period they receive training in such things as the protection of vulnerable adults, moving and handling, first aid, confidentiality and other related topics which support the service users to be cared for safely. Service users are supported by a small staff team which include both male and female members of staff. 50 of the staff team have completed a National Vocational Qualification at level 2 or above which meets the required standards. There has been minimal changes in the staff team within the last 12 months with only one member of staff leaving within that time. This means that service users continue to be looked after by people who they know, trust and have a friendship with. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 & 43. People using the 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 Coppice is a well run and managed home, this means service users interests, health and wellbeing are put first. EVIDENCE: The Coppice is managed in the best interest of service users with excellent outcomes for them. There have been no changes within the management structure, the manager has been at the home for approximately eleven years. She continues with her training and is in the process of completing appropriate management training. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 29 At the last inspection we required that the manager submits an application for registration with us. Whilst that has been done, we can confirm that there has been a delay in processing her application which means she has yet to fully complete the registration process with us. The service is supported well by other management structures with a deputy/assistant manager in place who has completed NVQ 4 training and the Registered Managers Award. A senior manager from the organisation continues to visit the home each month to complete Regulation 26 visits, which assess how the home is being managed, if service users are getting the support they need and are satisfied and monitors staff members practice and records. Issues and matters arising are discussed with the manager and support and supervision provided. We looked at a number of these records and found that appropriate action is taken to make sure there are good ongoing monitoring systems within the home to measure the quality of the services provided. Health and safety checks are routinely completed and during the inspection we looked at health and safety records and servicing certificates to confirm that equipment and amenities were safe and fit for purposes. An up to date fire risk assessment was in place, health and safety checks were routinely completed to check fire safety equipment. Fire safety records identified that fire alarm tests were carried out, as was practical fire safety drills which included service users involvement. Insurance certificates were up to date and records relating to the personal information of service users were kept securely and away from public view. Food hygiene and infection control training has been provided to all relevant staff and moving and handling training and individual risk assessments were in place. Quality assurance procedures makes sure the views of service users are sought on a regular basis , however there continues to be a lack of formal consultation with other people about the quality of the service. We have not been informed that a full quality audit has been completed and we have not been provided with a public report which relates to the services at the Coppice. The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 4 32 4 33 x 34 4 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 x LIFESTYLES Standard No Score 11 4 12 4 13 4 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 2 4 X 3 X X 3 3 Version 5.2 Page 31 The Coppice DS0000005606.V375164.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA15 YA21 Good Practice Recommendations Ways should be sought to support service users to develop long lasting personal and sexual relationships. Plans should be in place which detail service users preferences for care should they become seriously ill and include their personal wishes and feelings about end of life arrangements. The manager of the home should have training at NVQ 4 or equivalent, successfully achieve the Registered Managers Award and be registered with us. 3 YA37 The Coppice DS0000005606.V375164.R01.S.doc Version 5.2 Page 32 Care Quality Commission Care Quality Commission Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 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. 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