Inspection on 10/06/09 for Combe House

This is the latest available inspection report for this service, carried out on 10th June 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Combe House 29/01/08

Combe House 24/09/07

Combe House 08/05/06

Combe House 13/10/05

Combe House 09/05/05

Combe House 15/11/04

Combe House 14/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Combe House Central Drive Walney Island Barrow in Furness Cumbria LA14 3HY Lead Inspector Marian Whittam Key Unannounced Inspection 10th June 2009 09:30 DS0000036531.V375793.R01.S.do c 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 homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Combe House DS0000036531.V375793.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 Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Combe House Address Central Drive Walney Island Barrow in Furness Cumbria LA14 3HY 01229 473617 01229 476336 combe.house@cumbriacc.gov.uk www.cumbriacare.org.uk Cumbria Care 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) Mrs Hazel Whiteoak Care Home 40 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (40) of places Combe House DS0000036531.V375793.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 people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Dementia over 65 years of age: Code DE(E) (maximum number of places: 12). Old age, not falling within any other category: Code OP (maximum number of places: 40). The maximum number of people who can be accommodated is: 40. Date of last inspection 2nd June 2008 Brief Description of the Service: Combe House is a purpose built residential care home, which is owned by Cumbria County Council and operated by Cumbria Care, an internal business unit of the Councils Contract services group. The home is registered to accommodate forty people, including up to ten people with dementia and a person with a mental disorder. The home is single storey and divided into four distinct living units, with all the units being fully accessible. They each contain ten bedrooms, bathrooms, toilets, a good size lounge with kitchenette and dining area. The home has been equipped to meet the needs of the people living there. The home is in its own grounds and outside there are pleasant garden and patio areas that are safe and accessible to all people living there. There is car parking available at the front of the building. The home on Walney Island near the town of Barrow-in-Furness and is reached via Walney Bridge. It is in a residential area of the island and is on a main bus route and close to local amenities. The fees range from £363 per week to £422 per week with additional charges for personal sundry expenses. The service user guide and statement of purpose are made available to people thinking of coming to the home and previous inspection reports are also available in the home. Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is a 2 star. This means the people who use this service experience good quality outcomes. We (The Care Quality Commission, CQC) made an unannounced visit to Combe House on 10th June 2009 between 09.30 and 17.00 hrs as part of a key inspection. Before the inspection the registered manager completed a self-assessment questionnaire called an Annual Quality Assurance Assessment (AQAA), which was used as one of the ways we gathered information for this inspection. It provided us with information about how the home is run and the manager’s views on what the home does well and where they need to improve. There is also information about people living in the home and the staff. We also looked at: • The service history, reporting of accidents and incidents to us and how the registered manager has handled complaints or safeguarding issues. • Completed questionnaire survey forms from people living in the home, staff working there and from healthcare professionals and agencies coming into contact with the service. During the visit we spent time with people living in the home and talking to them about their experiences. We looked at care planning documentation and assessments to ensure the level of care provided met the needs of those living in the home and made a tour of the building to inspect the environmental standards. Staff personnel and training files were examined and a selection of the service’s records required by regulation. We also examined staff files and records relating to the maintenance and safety of the home. The pharmacist inspector assessed the handling of medicines through inspection of relevant documents, storage and meeting with the manager, other staff and residents. The views of people living in the home, their relatives, staff and other professionals were used to assess outcomes for people living there and to help make the judgements in this report. What the service does well: People living in the home we talked with spoke well of the manager and staff and the help and support they get from them. Combe House provides a homely and informal atmosphere for the people living there and we saw that Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 6 staff have a good rapport with them and know them well. Comments about the home people made to us included, “I am happy and content at Combe” and “I am very happy with how things are”. The home is kept clean and tidy and many residents have chosen to personalise their bedrooms, to make them more homely with pictures, ornaments and photographs. Care plans and activities are developed with residents to make sure their personal preferences are included and reflect individual needs, interests and expectations. A wide range of social and individual activities are arranged for people living there who are supported to maintain their own interests and outside contacts. People are encouraged and supported to make choices in their daily lives and activities. A comment made by a relative of a person living at Combe House illustrates what they thought the home did well, “The carers are really kind and considerate to my mum. She is well looked after and I have no worries about her being in Combe House” The home works with other healthcare agencies and gets specialist help for residents when this is needed. This includes the local GPs and District nursing teams as well as specialist services. People living there are protected by good systems for handling medication to include safe administration, good record keeping including medicines administration and consultations with health care professionals. Protocols for administration of ‘when required’ medicines are in place to ensure safe and effective treatment. People living at Combe House are able to look after and take their own medication if they wish and this helps them remain independent. Training and staff development is being given a high priority in the home. A high percentage of staff have achieved their NVQ in care at level 2 and above. This helps make sure that staff have the knowledge and skills they need to support people in a way that meets their needs and expectations. The service has robust recruitment systems to ensure they get the right staff and promote the safety and wellbeing of people living there. There is an open and inclusive atmosphere where staff are encouraged to reflect on their practices and learn when things go wrong so they cannot happen again. The home is well managed and people living there are regularly consulted about what they want in their home. What has improved since the last inspection? It was evident to us that there is a good team spirit in the home and staff comments and surveys indicate they feel they are valued by the manager and their opinions are listened to. People living in the home commented on the positive changes in the home especially the opportunities for them to have more varied social and recreational activities. The activities on offer to them are now more tailored to their individual preferences, interests and abilities and therefore more person Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 7 centred. This way all people have the opportunity to take part in things they want to do whether that be going for a walk to the beach, gardening, shopping, going to a tea dance or making a trip to London. People’s aspirations are being recognised and their personal goals. This is a significant improvement that the manager and staff need to keep developing. The admission procedure has been reviewed and contracts of terms and conditions are issued to people. We saw that these were signed and agreed with them or their representative at the time of admission to the home so they know and understand the conditions of their stay in the home. The care planning documentation has been improved and is still being developed with use of the person centred care plans. These put the individual at the centre of care planning and it was evident speaking to people living in the home that they were consulted about what they wanted from their care and in their daily lives. The manager has a clear training programme in place now and all staff have an individual continuous professional development file and all mandatory training including in recognising abuse and safeguarding adults has been given. Records are clear and a skills analysis with staff has highlighted gaps in training that have been acknowledged and addressed by the manager so people living there can be confident that staff are being given the training and supervision they need to work effectively. Staff supervision is being done and recorded to support staff and identify their learning needs. All staff now have a designated supervisor who is responsible for their appraisal and supervision and for making sure staff get positive and constructive feedback on their work. Improvements continue to be made to the environment as budgets allow and by using space available to best advantage for people living there. The outside patio area has been refurbished with garden furniture making it a pleasant and safe area for people. People living there are able to grow plants and tend them and one person said the patio was a “good bonus”. Several bedrooms have been redecorated and toilets and a new bath installed that better meets people’s needs and safety. There is a full compliment of domestic staff now to make sure the home is kept clean and tidy for those living there. Risk assessments have been reviewed and fire risk assessments in place in line with new fire regulations. We received several positive comments about the changes and improvements made in the home from people living there, their families and from staff working there. One relative noted what they thought had improved in the home, “They have made the service better in the last six months by having more activities which the residents are enjoying, so I think the service is excellent at the moment”. Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 8 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. Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 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): NMS 1, 2, 3, 4, 5 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 admission process ensures an assessment is done of a persons needs before they come to live at Combe House and that they have information about the home to help them in their decision. EVIDENCE: Information is available about Combe House for people thinking of coming to live there and their families in the combined statement of purpose/ service users guide. This information, which can be provided in different formats and the opportunity to visit the home and spend time there and ask questions, can help them make an informed choice about whether they think the home will suit them. A copy of the latest inspection report is included in the information given to people. People do not have their own personal copy of the guide given for them to keep on admission and refer to but it is in the foyer and easily Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 11 accessible. Survey responses and conversations with people living in the home indicated that they felt that generally they had enough information about the home before they came in. The notice boards in the foyer of the home also had useful information about what is going on in the home. There were a variety of information leaflets and booklets with information on, safeguarding adults, making a complaint, the Mental capacity Act, deprivation of liberty, advocacy services and support organisations as well as general information about Cumbria Care. There was a large notice board with photographs of staff members and who was on duty that day in the home so people living there and visitors knew who was working that day. We looked at individual care plans on all the units in the home. These showed that before coming to live in the home people had their personal, health and social needs assessed. We looked at four people’s care plans and the pre admission assessments that had been done to make sure the home was able to meet an individual’s needs before they came to live there. The pre admission assessments we looked at contained the relevant information from which to develop a basic individual care plan. Specific healthcare needs are identified during the assessment so they can be met when the person comes in. This information ensures the staff are aware of the level of care required to meet people’s different needs. Assessments are done by social workers under care management arrangements and by the home manager or senior staff to try to ensure they are able to meet people’s individual needs. Where the assessment has been done by social services a copy is retained on file. Where appropriate other care agencies and professionals have been involved in providing information before admission and advice after admission. The home has an introductory/trial period followed by a full care review to make sure needs are being met and the home suits the resident. Residents are given a statement of terms and conditions of residency setting out the rights and obligations of the individual. We examined these as a copy is retained on file. The service does not provide intermediate care. Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 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): NMS 7, 8, 9, 10 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 health and personal care that people living at Combe House receive are based on their individual needs so they receive personal care in the way they prefer and in a way that shows respect for their individuality, privacy and dignity. EVIDENCE: All residents have an individual care plan, based on initial assessments and risk assessments, setting out individual health, social and personal care needs and these are being reviewed and updated. The care plans are clearly set out and easy to follow. The information provided covered areas such as a person’s mobility, diet, health needs, personal care and their social and religious preferences. Appropriate equipment to prevent pressure sores was in use, people’s mental health is monitored and effective nutritional screening is being done and weights recorded. The care plans have continued to be developed and improved and this is seen in the ‘person centred’ documentation that Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 13 underpins care approaches. We looked at four care plans in detail and spoke to the people concerned and found plans reflected what was important to the individual, what they feel they need to support them. There was a ‘personal profile’ on file giving a clear insight into the lives of individuals and what was important to them to help staff support them in the way they want. All the care plans examined were up to date and had been regularly reviewed and updated as changes occurred. Changes were clearly recorded, signed and dated, which is good practice. We received surveys back from GPs who visit the home and these were all We talked to care staff who clearly knew the people living there well and their individual needs and discussed their support role and approaches in a way that reflected people’s individuality. Observations during the visit, including moving and handling practices, the lunch time meal, checking of records of care planning and conversations with residents suggested that people are treated as individuals and their privacy respected. One person told us “The staff are very good and will get you what you want. I am content here”. A visitor we spoke with told us “The staff are brilliant; I have never seen any of them be off hand”. The pharmacist inspector checked the way that medicines were handled through inspection of relevant documents, storage and meeting with staff and residents. Overall, we found that medication was handled well. There were a few concerns that were discussed with the manager who confirmed these would be addressed without delay. We received a detailed action plan from the manager within days of our visit outlining their investigation into the errors and the actions they had taken to prevent any reoccurrence and the way the changes were to be monitored for effectiveness. This prompt response to the weaknesses found indicated to us that where weaknesses emerge, and are recognised, the manager and staff learn from them, act quickly to manage them and to make the necessary changes to help protect people living in the home. We looked at records of receipt, administration and disposal of medication and these were good. They accurately showed the medication received by residents and reasons for omission. There were separate records for external medicines such as creams and these were kept with additional directions for use. However, some of these directions lacked detail and did not specify when they should be used. Some of the administration records listed medicines that had been stopped some time previously. Staff had been careful to ensure that these were crossed off and said that they had addressed this matter with the pharmacy. The manager should address this again as this is a potential source of error. The home kept good records of consultations with health care professionals and changes to medication were accurately recorded on medicines administration records. However, we noted a number of occasions where Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 14 antibiotics were not started on the evening they were received but were left until the next day. This delay in treatment of infection could affect health. We also noted a pain-killer that was not given for four days and was recorded as ‘out-of-stock’. The person required additional painkillers during this time. However, records showed that a new supply had been received in time to continue treatment but was not started until four days later. The manager must make sure that people always receive the treatment as prescribed by the doctor to keep them well. People living at Combe House were able to look after and take their own medication when they wanted to and where this was safe and this helped them to remain independent. We spoke to one person who was pleased to be able to do this as it meant they could take their painkillers promptly when needed. The care plan showed that this had been thoroughly assessed for potential risks to ensure their safety. The home managed the administration of ‘when required’ medication very well. Protocols were in place for each medication that gave clear guidance on appropriate use. This ensured that residents received safe, effective and consistent treatment. We checked the care plans of a resident whose medication was sometimes given mixed in drinks. The records showed that staff consulted with the resident’s doctor and family to ensure this was in their best interests. This is good practice to uphold a person’s individual rights. However, there was little information in the care plan to fully assess and describe how the medication was to be administered to ensure safety, effectiveness and appropriateness. Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above 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): NMS 12, 13, 14, 15. 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. People living at Combe House are able to take part in a wide range of meaningful social and recreational opportunities according to their individual needs and capabilities and are being supported to make choices about their lifestyles. EVIDENCE: Activities and recreational preferences are included in the individual care plans and individual records are kept of what people have taken part in. Care plans include personal profiles that have been developed with residents and /or their families where possible. This provides useful information for those supporting residents with activities that are meaningful to them and suit their capabilities. We looked at records of activities and spoke to people about the things they had been doing. Activities are advertised on the notice board along with local community news and news about what is happening in the home and future events and planned activities. Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 16 We found from speaking to people, looking at records, care plans and from survey responses that a lot of thought and effort has been put into developing and widening the range of social and recreational activities available to people living there that they choose and help to organise. The use and organisation of staff hours have been organised to enable staff to put on and support activities both in the home and in the local community. The manager and staff have been working to improve recreational opportunities for people living there that are more tailored to individual preferences and capabilities as well as providing more group activities group activity such as a quiz, bingo, a craft group or a film club. People told us about the different things they enjoyed doing and comments were generally positive including, “There is a good selection of activities” and one person said, “We never went anywhere before, now we go out and about, it’s definitely a 100 improvement”. People had planted herbs and tomatoes on the refurbished patio and garden areas and told us they enjoyed tending their plants. This activity had resulted from a suggestion made at the resident’s meeting. Some people did not want to take part in as many activities other people living there and did not feel they had to. Some people went out with friends and family and people also appreciated being able to go out with carers shopping in town. We spoke with one person who had always been interested in keeping fit and was about to get a taxi to go the gym with a carer, they also hoped to start swimming again once a week as well. It was important to them to be able to continue to do things they enjoyed doing all their life. There were lots of pictures around the home documenting the various events people had attended outside the home and inside. There were pictures of people attending local shows, charity ‘red nose’ events, Karaoke, tea dances, meals out at local pubs and morning coffee in the garden. Some people told us they went out to the local pubs and some attended a lunch club at another nearby pub. One person had recently attended a conference in London with the manager to discuss her person centred care plan. There are regular visits from the local vicar and priest who offer pastoral support and communion for those who want it. There is a multi denominational service once a month if people want to attend and worship. The home encourages relatives and friends to visit and people living there told us are no restrictions on when people can visit them. We could see from speaking with people, hearing about their participation, examining records of activities and looking at all the different recreational opportunities being developed that the manager and staff were promoting people’s right to live an ordinary and meaningful life. Routines and mealtimes are flexible and staff responded to people’s changing choices and wishes. It was evident that the manager and staff have maintained the improvements in this area found at the last inspection and are building upon them to develop the service in the longer term. They are trying to put person centred care into practice in this outcome area by actively looking for information and ways to support people to follow their faiths and interests and enjoy their social lives. Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 17 There is a four weekly menu in place. Minutes of resident’s meeting show that food and activities are both discussed at their meetings. People we spoke to said that staff asked them what they wanted each day and could have an alternative if they didn’t like the daily choices offered. We spent time with people at lunchtime on Swiftsure unit where people with dementia were living. The meals were given out by staff and well presented with ‘seconds’ offered. Staff spent time with people assisting them with their meals and ensuring they had appropriate aids to help them eat their meal. We saw that staff encouraged people who were reluctant to eat and offered alternatives to tempt them to eat. It was an informal and pleasant occasion with staff interacting in a friendly and supportive way and offering a variety of cold drinks with the meal and hot ones after. People we spoke to were generally positive about the meals in the home. One person told us they very much liked the meat dishes and they discussed the food at their meetings and felt happy to do so. Another comments included that “The cooking is good, on the whole everything is good” and “I like the cooking”. Our surveys indicated that generally people are satisfied with the food provided and the manager has used questionnaires to get feed back on what people would like to see on the menu. We visited the kitchen and spoke with the cook who has worked at the home for many years. The kitchen was clean, well organised and appropriately stocked. The cook kept appropriate records and told us about how they catered for special diets and how new menus were being introduced to include people’s suggestions. People had asked for scampi, rabbit pie and lamb chops and these were being introduced on new menus. The service has a 5 star rating from the Environmental Health officer. Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16, 17, 18. 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. People living at Combe House are aware of the complaints procedures and how to make their concerns known and have confidence that the manager and staff would listen to them and take action to respond to their concerns and safeguard their welfare. EVIDENCE: There are clear procedures in place for dealing with complaints and concerns and records are securely kept to maintain confidentiality. We looked at the complaints log and this was in order with copies of complaints forms, any associated correspondence and details of investigation and if it had been referred to social services under safeguarding procedures. The complaints policy and procedure is in the guide for the people using this service and there is also a copy on display. Since the last inspection the home has made two Safeguarding Adults referrals to protect people’s welfare and these have been investigated and addressed by the home manager in line with multi agency guidance with other relevant agencies. The home has recorded one complaint made to them, which they have investigated and recorded. Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 19 The service has internal policies and procedures for the Protection of Vulnerable Adults (POVA) and a copy of the Local Authority’s procedure was also seen to be available and information on whistle blowing for staff. The service has clear multi agency guidance on actions it needs to take in safeguarding vulnerable adults. Training is being given staff to on adult protection, reporting and preventing abuse to the care staff. We spoke with staff and they were aware of the procedures and what they would need to do if they suspected abuse. Survey responses and comments from people living in the home indicated that they were aware of the complaints process and how to make a complaint and that staff listened to what they had to say. People we spoke with supported this view as well. One person told us “If I was unhappy I would talk to the staff, the girls are wonderful”. The home did not deal with any resident’s personal finances only small amounts of spending money for safekeeping and practices and procedures are in place to protect resident’s financial interests. Care staff we spoke to told us they have had training on recognising abuse and the adult protection procedures and on dementia awareness and training records supported this. The service has procedures in place to help staff deal with aggression by people living there, any missing persons and a policy on restraint. Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 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): NMS 19, 20, 21, 22, 24, 26, 26. 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. People living at Combe House enjoy a comfortable and homely living environment. The premises are being maintained and kept to a good standard of cleanliness. EVIDENCE: The home is being well maintained with an overall good standard of decoration and provides a clean and homely environment for residents with no lingering odours evident. There is an annual programme of maintenance and to date nine bedrooms have been redecorated and also the toilets to make the environment more attractive and up to date. Some bedroom furniture has recently been replaced and lockable cabinets are provided in all bedrooms for people to keep valuable items or if they want to take care of their own Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 21 medicines. People we spoke with said they liked their rooms and that the home was kept clean and fresh. There are ample dining and lounge areas for people in the home and a large comfortable foyer where musical entertainments and film shows take place. There is a large flat screen television here and during the day we saw a group of people having a film show as well as a sing along later on. The dining and lounge areas on the units were clean and well decorated and used for daily activities and some residents were sitting in them reading their papers, knitting and watching television. There are communal telephone facilities available for residents to use but many people have their own telephones. Bedrooms are all single and those we saw had a satisfactory standard of decoration, furnishings and had locks on the doors if people chose to use them. The rooms we saw had been personalised by people with their own belongings, photographs and ornaments to make the room more homely and their own place. New curtains and blinds have been ordered to further improve the environment for people. Both staff and people living there did comment on the need to “modernise” the building and give it a “general update”. There are separate toilets close by bedrooms and communal area and bathrooms with assisted bathing aids. One bath has been replaced with a newer model that is safer for people and other bath hoists are being refurbished and lap belts added for greater safety. There are suitable adaptations inside the home to promote people’s independence and moving and handling equipment is in place to make people comfortable and safe. If needed specialist equipment such as nursing beds and pressure relieving devices is obtained for people following assessment. Call bells are in resident’s bedrooms, toilets, bathrooms and communal areas. Records show that moving and handling equipment being used, including the lift, is regularly serviced. Outside the grounds were tidy and accessible for people living there. We talked with some people who were sitting outside “getting some fresh air” and enjoying the good weather with staff close by. The refurbished patio area was attractive and had suitable furniture and one person described it as a “bonus”. There are infection control procedures in place in the home and staff were observed using protective aprons and gloves where needed. Staff training records indicate that staff are being given training on infection control and in safe food handling. There is a small laundry on site and the care staff are responsible for doing the laundry and taking it back to residents. The laundry was generally tidy however we saw that there were manual sluice facilities in the laundry area where items may be stored following washing. It is not good infection control practice to have manual sluicing facilities attached to the room where clean laundry is kept and is contrary to The Department of Health’s published professional guidance. We discussed this with the manager and strongly recommended that she carried out an assessment of the potential risks and then find ways to minimise any risks to people living there from cross Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 22 infection. This should be part of their overall infection control procedures for the home given the current layout of the laundry and sluice. Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are 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): NMS 27, 28, 29, 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. There are robust recruitment procedures being followed to safeguard people living at Combe House and appropriately trained staff offering care and support to people living in the home EVIDENCE: We looked at staff rotas, spoke with staff and observed staff levels during the visit. Generally the home has sufficient staff on duty with a range of skills and experience to provide personal care and support for the number of people currently living in the home. The home is now fully staffed and also has two new relief staff and there has been very little staff turnover in the last year. Rotas showed care staff work on a rotation system on the units in the home with two carers always on the EMI unit. The manager is on duty from 9am to 5pm five days a week and there are supervisors on duty from 07.30am until 10.15pm when the two night care staff come on duty and they are given a handover. The manager has carried out a night audit and report after working with night staff to gain insight and be accessible to night staff and their issues. The manager tries to use the staffing available to the best advantage of the people living there and to support their social activities. Generally there are six carers on duty both morning and afternoon shift and where possible seven in Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 24 the busier morning period, although holidays and sickness may affect this. Staff surveys and those we spoke with indicated that usually there are enough staff to make sure people’s individual needs can be met. One staff member commented “We always have plenty of staff to cover the units and for activities plus a floater to help around”. Although staff did comment on how the people they are caring for are often frail when they come to live there and with complex physical needs that do require more time and attention to support them properly. Overall people living there told us and their survey responses also indicated that staff are available when they want them and that “Staff are helpful” and “motivating” and “always help me when I need it”. All staff had continuous professional development plans and these show all training they had attended and development needs. Staff have an initial 5 day induction period. Training is being well supported in the home and is being well planned and organised to make sure mandatory training is up to date and individual training needs are prioritised. The manager has carried out a staff skills analysis in order to highlight any gaps in training so training can be provided when it becomes available. NVQ training courses are well established with a high percentage of staff achieving level 2 or 3 and more staff commencing this vocational training. Staff were positive about their induction and continuing training opportunities. We received comments such as, “I had very good induction training” and “We have a great atmosphere within the team” and “Staff, supervisor and manager were very helpful when I first started”. Staff morale was good with a pride in their home evident and views were expressed to us that “ I really enjoy working at Combe House and am very proud of this home” and “We have grown really well compared to where we were two years ago”. There are clear recruitment and selection procedures being followed and overseen by the manager. Application forms are completed, references taken up and interviews arranged. Records show that new staff are appointed and begin work only after all the required legal checks have been completed and that they have a period of induction training. Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 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): NMS 31, 32, 33, 35, 36, 37, 38. 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. Combe House is well managed with effective systems to promote the interests of people living there and a high level of consultation with people using and working in the service means they can all contribute to the continued development of the home. EVIDENCE: The registered manager, Hazel Whiteoak, is suitably experienced for her role with many years nursing and management experience to draw upon. The registered manager is doing the leadership and management NVQ and is on target to complete as planned. She has also undertaken training relevant to her role to ensure she is up to date with best practice. The manager is clear Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 26 about her role and responsibilities and the ways in which the service can continue to develop and improve for people living there given the budgets she works within. This was clear and evidenced in the service’s annual quality assurance assessment that the manager completed and sent to us. It was evident speaking to people living there and staff that the manager provides supportive leadership, is approachable and promotes a strong ethos of being open and transparent in all areas of running the home. More than one person living there told us how much the home had improved with the current manager. Comments included, “The manager is very good, I can talk to her or the staff and they listen” and “She’s very good, the best manager we’ve had”. There are effective quality monitoring systems in place to monitor the home’s performance against its aims. People living there are consulted about what they want in their home at regular ‘residents meetings’. This is organised to include people living there in a social evening as well and the minutes are put on display for anyone to read. Satisfaction surveys are also used with people living there, their families and visiting professionals to get feed back. Recently a survey was used to get people’s opinions and ideas on the meals and menus and the ideas raised are being addressed. Results of surveys go in the Statement of Purpose. There are also supervisor and staff meetings for discussion of work issues and practices. From what staff told us and said in their surveys these meetings allow them to make suggestions and raise ideas for making the service better. Policies and procedures are reviewed at team meetings and supervisions so staff have up to date knowledge of any changes that have occurred due to changes in good practice or legislation. Records indicate that staff have regular supervisions and staff confirmed in surveys and in their comments to us. Comments included, “Our manager gives us all the support we need” and “I feel I have support and help from both my allocated supervisor and home manager and I feel I can go to them for help with any work related problem”. The manager does regular audits and spot checks on care plans and medications. There are also internal audits by the organisation on Health and Safety and a recent one on moving and handling. There is also an annual finance audit and this is due shortly. The home has a policy for the safe handling of people’s spending money and all financial dealings are witnessed and recorded, spot checked periodically and audited annually. We checked some of the individual money files and these were in order. On the whole the records required for the operation of the home that were examined on this occasion were up to date and accurate to help ensure the home is a safe and comfortable place to live. Records of hoist and emergency equipment checks and servicing contracts indicate that the home has systems and practices to promote resident health and safety. Fire training for staff is being given and recorded. Moving and handling training and required mandatory training is being done with staff and is up to date. Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 27 Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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. 1. Standard OP9 Regulation 13 (2) Requirement The manager must make sure that residents always receive medicines as prescribed by the doctor, in particular antibiotics should be started promptly and medicines must not be allowed to run out. Timescale for action 01/08/09 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. Refer to Standard OP9 Good Practice Recommendations It is recommended that care plans, for example for the application of topical medicines, are more detailed to ensure safety, effectiveness and appropriateness of medicinal treatment Given the layout of the sluice and laundry area we strongly recommend that the manager should carry out a thorough risk assessment on the use of the sluicing facilities adjoining to the laundry and when cleaning commode pots in proximity to the laundry area and find ways to minimise DS0000036531.V375793.R01.S.doc Version 5.2 Page 30 2. OP26 Combe House any cross infection risk for people living there Combe House DS0000036531.V375793.R01.S.doc Version 5.2 Page 31 Care Quality Commission North West Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 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. 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