Inspection on 13/10/05 for Combe House

This inspection was carried out on 13th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Combe House 02/06/08

Combe House 29/01/08

Combe House 24/09/07

Combe House 08/05/06

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Combe House Central Drive Walney Island Barrow in Furness Cumbria LA14 3HY Lead Inspector Ray Mowat Unannounced Inspection 13 October 2005 07:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Combe House Address Central Drive Walney Island Barrow in Furness Cumbria LA14 3HY 01229 473617 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) Cumbria Care Mr Alan Kent Care Home 40 Category(ies) of Dementia - over 65 years of age (11), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Old age, not falling within any other category (39) Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The staffing levels for the home must meet The Residential Forum Care Staffing Formula for Older Adults by 1st April 2004. The service must employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection A maximum of thirty nine older people (OP39) may be accommodated including eleven older people with dementia (DE(E)11). When a single room of less than 12 sqm usable floor space become available they must not be used to accommodate wheelchair users, and where existing wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a larger room when one becomes available. To include one named person in the category of mental disorder, excluding learning difficulty or dementia (MD1) 9th May 2005 5. Date of last inspection 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 over sixty-five years of age, 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. It is situated on Walney Island near the town of Barrow-in-Furness. It is in a residential area of the island and is on a main bus route and close to local amenities. The home has been designed and equipped to meet the needs of the residents. It is in its own grounds with gardens to the front and rear and off road parking is available. Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place at 7.40 am to enable the inspector to observe the morning routines of the home. Many of the residents were spoken to during the course of the inspection and six residents files were examined. The inspector formally interviewed four care staff and spent time in each of the units, talking informally with residents, visitors, a visiting nurse and care staff, including the supervisor on duty, in addition to meeting the manager of the home. What the service does well: What has improved since the last inspection? What they could do better: There were two issues relating to the environment of the home that must be addressed and are subject to a requirement. The kitchen cupboards and worktop in the Invincible unit must be replaced and the moss must be removed from the paths and patios, as it is now a slip hazard when wet. The manager must ensure regular formal supervision of staff is taking place in the required timescales. The content of care plans should be reviewed, to ensure they reflect the interests and hobbies of individuals and pertinent information relating to people’s social history is recorded. In particular the plans of people with dementia need more detail to guide staff and maintain consistency. The changes to the allocation of laundry work should be monitored to ensure it is effective. Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 6 When maintenance reports highlight a defect any action taken should be recorded. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 7 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.V259011.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 5. The home provides good support, ensuring the admission process is effective and meets the needs of residents. EVIDENCE: Many of the residents spoken to were familiar with the home or had been supplied with appropriate information and supported by a relative or representative, through the admission process. This includes the home completing an assessment, in addition to a social work assessment or any other professional assessment required. Depending on the individual circumstances, prospective residents and their family or representative may visit the home or a short stay is arranged, to enable people to make an informed choice. Residents spoken to said the home had been “supportive and sensitive to their needs” during this process. One person described how their room had been prepared for them, including furnishing it with their own furniture, which had helped with the adjustment to their new surroundings. Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10. The content of the care plans examined was inconsistent, with some lacking the detailed information required to guide staff and ensure a continuity of care is maintained. EVIDENCE: The care plans examined were inconsistent regarding the level of information they contained. In all except one of the six care plans examined, people’s health and personal care needs were well documented. However the other care plan was for a resident with dementia, this did not contain adequate information to support and guide the staff in delivering a consistent and personalised service. Although areas of concern were recognised, there were no programmes or strategies in place, explaining how staff should respond. Another aspect of the care plan that needs to be strengthened is information relating to interests and hobbies. The resident’s questionnaires identified lack of activities as being an issue. If the home is not recording individual interests and preferences, residents are not going to feel their needs are being acknowledged and responded to. There was one care plan out of the six examined that contained information relating to “occupational abilities”, which recorded a persons interests and what assistance they required. In addition Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 10 there was very little information available relating to people’s social history, this would be particularly beneficial for people with dementia or people who are unable to articulate about their past. People have lived very rich lives and had valued social roles in society, which if staff were more knowledgeable about, it would enable them to respond more effectively to individuals. It is recommended the content of care plans are reviewed, ensuring suitable information is recorded to guide staff in delivering a personalised care package. Each care plan file contained a daily record sheet that is completed at the end of each shift. Some of the information recorded was not detailed enough, with comments such as “fine today”, which does not provide the next shift with sufficient information. It is recommended daily recordings are more detailed to ensure pertinent information is shared between staff. The home has good links with the local health services ensuring residents health care needs are responded to in a timely and appropriate manner. On the day of the inspection the inspector spoke to a practice nurse, who was visiting the home to administer flu vaccinations to residents from their practice. She confirmed that the home provided appropriate support to residents with their health related needs. The inspector observed the medication being administered to residents by the supervisor on duty and a member of the care team, whose role is to double check the process. Both had received training on the home’s policy and administration of medication. Good practice guidelines were observed and the medication was appropriately administered and recorded. Due to the number of medication errors that have occurred in the home, it is recommended the manager formally observe medication administration rounds and assess the competence of staff on a regular basis. Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. On the whole residents were encouraged to lead an independent and active lifestyle of their choosing, a review of leisure activities provided in the home will be beneficial. EVIDENCE: As mentioned previously the feedback from resident’s surveys highlighted a lack of activities as being an issue. After discussions with residents, staff and the manager, it is evident that in the past, low staffing levels have had a negative impact on the variety and frequency of activities provided. However based on the new staffing rota this situation has been improved. In addition, once the home starts to record individual preferences in relation to interest and hobbies and gather more information relating to peoples past experiences, specific needs will become apparent. The manager has taken on board the feedback and two staff have recently completed an in depth (Age Concern) course to enable them to provide chair based exercise sessions. Staff have organised a forthcoming trip to the local theatre for a sing-a-long concert, which has proved very popular with twenty two residents going to attend. Residents spoken to talked about the activities they enjoy, with several maintaining an independent lifestyle both in the home and in the local community. One lady was going out to a local day service, which enabled her Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 12 to keep in touch with friends. Another was going out for a walk to the local post office. A hairdresser who goes to the home on a weekly basis was visiting the home and had several appointments. There were several visitors to the home during the inspection, including family members, who were either visiting relatives or taking them out and a volunteer who visits the home on a weekly basis, supporting activities or talking to residents, which is a valued role appreciated by residents and staff. During discussions with staff best practice for working with people with dementia was discussed including how staff orientate people. The benefits of using of an orientation board, with a record of the day, date, month, weather, etc, were discussed and something the home should consider using. The grounds have been secured with a fence around the garden, creating a safe environment for people to enjoy the gardens. One of the family members visiting the home helps staff with maintaining some flowerbeds, which had brought a lot of enjoyment to residents. Most residents take their meals in the dining area, however some choose to eat in their rooms, which is respected by staff. The inspector observed breakfast being served in each of the units. Resident’s individual preferences were responded to, with one resident telling the inspector “we can have anything we like, even bacon and eggs if we like”. Independence was promoted at meal times with teapots, milk jugs and food provided on tables, for those who were able to help themselves. The inspector also joined a group of residents for lunch, who confirmed that the food was varied, of good quality and that they were given choices. Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. The home’s policies procedures and practice, ensure residents are safeguarded at all times and their rights and choices are respected. EVIDENCE: The complaints procedure was readily available and staff showed a good awareness of their role in supporting residents with a complaint or concern. Mistreatment and abuse training provided by social services had recently been completed by a group of staff, which they had found beneficial. Based on discussions with staff they were knowledgeable about what constitutes abuse and their role in reporting incidents. The home only holds small amounts of personal monies for residents, which were securely stored in the safe. The home’s policy is for two staff to witness and sign all transactions and checks of the monies, which is good practice. The inspector checked the money against the records and found these to be up to date and accurate. Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 25, 26. On the whole Combe House provides a safe and comfortable environment, however outstanding renewals and maintenance identified must be addressed. EVIDENCE: Combe House provides a homely and comfortable living environment that has been designed to meet the needs of residents. The home is single storey and fully accessible with ramped access to the grounds. Aids and adaptations are in place to assist people with specialist needs, with advice and guidance being sought from relevant professionals when needs arise. The way the home is organised with the four distinct units, gives each area a more personalised, homely feel. However residents are still able to move freely around the other parts of the home and socialise with their peers. Residents are consulted about furniture, fittings and décor, with many residents having chosen their own wallpaper and colour schemes and also brought furniture from their own homes. One lady described how when she moved in, she had her own carpet fitted that had been ordered for her own home. The kitchen in one of the units is in need of replacement as there were Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 15 cupboard doors missing and the worktop was damaged. This has been identified in the programme of repairs and renewal for some time but there is no date for completion of work. The home is now required to replace the kitchen units and worktops in the timescale identified. There were no obvious hazards noted within the home, however there was a heavy layer of moss on the rear path and patio area that is a slip hazard and must be removed. This is subject to a requirement. Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 30. The staffing situation in the home has now improved, with experienced and well trained staff supporting residents. EVIDENCE: Since the last inspection the home has had an increase in hours, with what the manager described as a “floating member of staff”, working between the three units, alongside the regular member of staff. At present relief staff are covering this post, as the manager is consulting staff regarding a move from a three week rota to a two week rota. There are also another 42 hours being covered by relief staff, which will also be incorporated into the new rota. In addition the home also has regular domestic hours (65 per week) and a general assistant (22hrs per week). Some staff spoken to felt that they missed having a dedicated laundry assistant, as they were now expected to pick up laundry duties from the units. However the manager felt that when fully staffed this had worked well and it was only when there were staff absences problems occurred. It is recommended the home monitor the laundry duties to assess the effectiveness of the new system. The manager now maintains a new training matrix to monitor all staff training, with information also transferred onto individual continuous professional development files. The home has a sound training infrastructure, with over 50 of staff having obtained their NVQ 2 qualification. Two of the three supervisors have also completed relevant supervisory skills training. Although annual appraisals had been completed for most of the care staff, regular supervision had not been taking place within the required timescales, Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 17 with some staff not having received formal supervision for some considerable time. Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37, 38. There is no doubt the home is run with the best interests of residents in mind, however formal supervision of staff is a key area for improvement. EVIDENCE: The current manager Mr Alan Kent is working towards his NVQ 4 registered manager award, he recently spent time away from the home shadowing an experienced manager, as part of his personal development. Mr Kent has a good awareness of his responsibilities and has a respectful relationship with the residents and staff. He has a person centred approach and recognises the importance of being in touch with residents and staff, an example of this being when he arrives on shift he makes a point of visiting each unit to speak with residents and staff. Quality assurance surveys had been returned by residents, staff, family and other professionals. These were in the process of being compiled into a report Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 19 before the results are fedback to all interested parties. For residents and staff this will be done via a resident and staff meeting respectively. The home must provide regular supervision to support staff and ensure good practice is maintained. Also by providing regular supervision, staff will feel valued and have the opportunity to resolve any practice issues or concerns. This should improve communication, which was an issue some staff raised as being an area for improvement, on their staff questionnaire. A record of routine maintenance and health and safety checks were examined and on the whole were found to be up to date and in order. Maintenance records relating to hoists and other lifting equipment were up to date, however it was not clear when remedial work or defects had been addressed, this should be clearly recorded and records maintained for inspection. Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 20 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 X X X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 2 X 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 2 3 2 Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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. 2. Standard OP19 OP19 Regulation 23(2) b 13(4) a Requirement The kitchen cupboards and worktop identified must be replaced. Moss must be removed from the paths and patios identified. (Previous timescale of 11/06/05 was not met.) The home must provide regular supervision to support staff and ensure good practice is maintained. Timescale for action 01/02/06 28/10/05 3. OP36 18 (2) 01/01/06 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 OP7 Good Practice Recommendations It is recommended the content of care plans are reviewed, ensuring suitable information is recorded to guide staff in delivering a personalised care package. It is recommended daily recordings are more detailed to ensure pertinent information is shared between staff. 2. OP7 Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 22 3 OP9 It is recommended the manager observe medication administration rounds and assess the competence of staff on a regular basis. It is recommended the home monitor the laundry duties to assess the effectiveness of the new system. It is recommended a clear record of remedial work carried out on lifting equipment, in response to a maintenance survey, is retained. 4 5 OP27 OP38 Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Combe House DS0000036531.V259011.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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