Inspection on 29/01/08 for Combe House

This inspection was carried out on 29th January 2008.

CSCI found this care home to be providing an Adequate 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 02/06/08

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 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 29th January 2008 08:15 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.V358218.R01.S.doc Version 5.2 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.V358218.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) Vacant 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.V358218.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 24th September 2007 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. The monthly 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 prospective new residents and previous inspection reports are displayed on the notice board in the foyer. Combe House DS0000036531.V358218.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 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place over two days and included a visit by the pharmacy inspector, which took place on 24th January 2008 and a key inspection visit on the 29th January by an inspector and Regulation Manager. We (the Commission for Social Care Inspection, CSCI) met with people living in the home and their relatives and representatives. We also spoke to other professionals involved with the home, care staff and the manager. Prior to this visit we had received an Annual Quality Assurance Assessment (AQAA), which is a self-assessment against the National Minimum Standards (NMS), stating what the home does well, what has improved and future plans. It also provides information about the running of the home, the staff and the people living there. We looked at records relating to the running of the home that are required by regulation and also at information about the people living there and how they like to be supported to live their lives. What the service does well: People who are considering moving into the home are encouraged to visit the home or have short stay before making a decision to move in. Everyone in the home now has a care plan and there was evidence these are being kept under review with updates being signed and dated, thus ensuring changing needs were being responded to, which is good practice. The home liaise with a number of agencies to make sure people’s healthcare needs are being met, with diet and nutrition now being closely monitored. The home keeps good records of doctors’ visits and medication changes, and implements these promptly. Medication reviews have been requested to make sure that people’s medicines are up-to-date. Protocols are in place for “when required” medicines to make sure that people receive them when they need them. Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 6 The home is accessible clean and on the whole well maintained. A monthly health and safety checklist is completed and routine maintenance completed. The homes kitchen was recently assessed as 4 stars by the Environmental Health department. Induction training is generally good and staff have the opportunity to complete their NVQ. Meetings are taking place with the care staff and supervisory team to make sure good communication is in place between the staff team. What has improved since the last inspection? What they could do better: Medication records, including Controlled Drugs records, need to be improved to protect the health of residents and to show that medicines are handled properly. Staff must follow safe medicines administration procedures to include a check of each medication as it is given to prevent errors being made. The admission procedure should be reviewed to ensure contracts of terms and conditions are issued to people, signed and agreed with them or their representative at the time of admission to the home. The manager should ensure the home has the skills and resources available to respond to people’s complex needs before admitting any new people to the dementia unit. The content of care plans including daily records should be reviewed to make sure they are accurate and sufficiently detailed Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 7 The role and responsibilities of the “checker” during medicines administration should be reviewed to make sure the role is effective in maintaining good practice. Staff should have regard to the privacy of residents during the administration of medicines respecting their privacy and dignity at all times. The Controlled Drugs cabinet should be bolted to a fixed wall in accordance with the law, to ensure the safe storage of all medication. The tarmac paths are covered in moss, which is a slip hazard and should be removed, before people start to use the gardens in the summer months. Infection Control procedures in the home should be reviewed to ensure staff are aware of their role and responsibilities and follow good practice guidelines to maintain good hygiene standards. The new staff rota should be introduced at the earliest opportunity to improve the staffing levels in each unit. The manager should audit the training records of staff and develop a programme of training that will meet the needs of the staff team. All staff should receive regular formal supervision in line with the requirements of the NMS to ensure they have the support and guidance they require. 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. The summary of this inspection report can be made available in other formats on request. Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 8 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.V358218.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Good systems are in place to assess people’s individual needs prior to admission. However the manager must ensure the home has the resources to meet individual needs. EVIDENCE: We examined the personal files of four different people, two of whom had recently moved into the home. One person had not had a contract of terms and conditions issued to them and another person had been issued a contract but this was not signed by the person or the home’s representative. It is recommended the admission procedure be reviewed to ensure contracts of terms and conditions are issued to people, signed and agreed with them or their representative at the time of admission to the home. This will ensure they are making an informed decision about moving in and are aware of their rights. Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 10 All the referrals to the home are arranged by the Social Work team, they complete a thorough needs assessment that identifies all personal and healthcare needs including specialist services required. The home also complete their own admission assessment and care plan to guide staff when a person first moves into the home. Based on this information an informative care plan is developed. Currently the home is not taking any new admissions to the dementia unit due to recent difficulties in managing people with complex and challenging needs. Based on discussions with staff and the new manager and the concerns regarding previous placements, the new manager should ensure the home has the skills and resources available to respond to people’s complex needs before admitting any new people to this unit. We met with some people who had recently been admitted to the home who talked to us about their experience. One person described how they had stayed in the home for short respite stays before deciding to move in permanently, which they said had “helped to ease my worries”. The home also encourages visits if people are not famililiar with the home, which also helps the assessment process. Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The content of care plans are improving with reviews taking place. However some recordings and care practice are still not appropriate to ensure a good and consistent quality of care is maintained. EVIDENCE: As a result of the last random inspection visit the previous manager produced an improvement plan in response to the serious concerns and requirements made, relating to poor care practice and recording of care plan information. The new manager has continued to implement the improvement plan and is in the process of reviewing all the care plans in the home. In addition meetings have been held with the supervisory team and care staff ensuring they are aware of their roles and responsibilities in identifying, responding to and recording people’s individual needs. The care plans that have been reviewed are more detailed and contain an informative pen picture or personal profile, which provides valuable information about a person’s life and what is important Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 12 to them, giving staff a better understanding of the individual. In addition a nutritional assessment/screening tool is completed for all the people in the home, which has improved the monitoring and management of people’s diet and nutrition and identified concerns at an early stage. Care plans are being agreed with and signed by the person or their representative ensuring the plan is person centred and reflects their needs and preferences. There was evidence of staff making alterations to the plans, which were signed and dated, thus ensuring changing needs were being responded to. A good example of this was one person who was refusing food. This was recorded in the daily notes and a food monitoring chart was introduced and their GP contacted to visit them. Although these improvements have been noted there are still some care plans and diary recordings that need to be improved. The way things were written in some care plans was not clear or sufficiently detailed. New guidance has been issued to staff at joint supervisions on the content of daily notes on care plans, emergency plans and pressure care. A more robust handover for staff is also now in place. On the whole both routine and specialist healthcare needs are regularly monitored and recorded in the care plan. The home currently does not use a formal pressure care assessment, although when pressure care needs are identified they are recorded in the care plan and a District Nurse informed. We met with the District Nurse who was visiting the home who confirmed that the home make “appropriate referrals and seek and follow any advice or guidance relating to individuals healthcare”. The introduction of a formal pressure care assessment would strengthen the monitoring and assessment process and make sure concerns were responded to appropriately. A new monthly review format has been introduced, which will encourage a more objective and detailed review to take place, including any changes in need. As part of this key inspection process the CSCI Pharmacy inspector also visited the home. Medication records need to be improved to protect the health of the people who live there and to show that medicines are handled properly. Records did not always say why medicines had not been given. Other records were damaged so that it was not possible to read the names of some of the medicines. This is hazardous and can lead to errors when medicines are given. Records for medicines that are liable to misuse, called Controlled Drugs, were not managed well. We watched the administration of medicines. One person prepared medication whilst a second person called a “checker” checked this to keep mistakes to a minimum. However, the role of the “checker” should be reviewed. Not only did they check medicines as they were prepared but also took part in administering them by taking them to the residents. This is a task that should be done by the person who takes responsibility for administration and signs the record. The “checker” said that in six months she hadn’t seen any mistakes despite a number of medication errors being reported to us. Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 13 Medicines were mostly packed into weekly cassettes that had a list of the contents on the back. The staff administering them “popped out” the tablets but did not refer to the list of contents to make sure they were the right ones. This could lead to errors that could harm residents. A sample of medicines was counted and checked against records. Medicines were mostly given in the right dosage, however, one resident did not have their medication for a number of days. Sometimes the privacy of residents was not maintained when medicines were administered. For example, eye drops were given at the dinner table although one resident said she didn’t mind this. Residents were also asked aloud and in the presence of other people if they needed pain-killers. There were good records of doctors’ visits and prescribed treatment that was started promptly. Residents’ doctors had been contacted to check that all medication was up-to-date. Protocols were in place for medicines to be given “when required” so that residents received them when they were needed. Storage of medicines was good but the Controlled Drugs cabinet should be bolted to a fixed wall in accordance with the law. Although the majority of interactions observed during this visit were positive some poor practice was also observed. When good interaction took place staff were attentive and sensitive to people’s individual needs and gave them time and space to make choices and decisions. However the poor examples were humiliating for the person and did not respect their dignity and rights as an individual. Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is aware of the shortfall in relation to the range of activities provided and some improvements have been made. EVIDENCE: Social and cultural needs and preferences are recorded in the care plan and more detailed information about social and leisure activities is being recorded in the personal profiles and pen pictures. However the current range of activities provided by the home are very limited. The activities programme in place has two bingo sessions and four hairdressing sessions each week and two church services held in the home each month, which includes two different faiths. Some people are able to pursue their own hobbies and interests and are supported and encouraged by staff to do this. In addition staff provide more informal activities such as a sing-a-long, reminiscence, reading the paper to them or just chatting with people, which is equally important and valued by people. During the SOFI observation some good practice was observed in relation to engaging people with complex needs in activities. The people observed were singing old time songs with staff, and having games with a sponge ball and skittles. People were asked if they would like to join in and Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 15 their wishes were respected. Staff picked up on non-verbal cues and were aware of the level of each person’s ability. One person wandered in and out of the room and was enabled to join when she wished. Some very good individual work on reminiscence was also observed between staff and people living in the home on a one to one basis. There were however also some examples of some staff not having the same insight and understanding who did not pick up on the more subtle cues, which resulted in misunderstandings and some frustration for the service users. The planned Dementia awareness training will help staff in the unit to work more consistently and will improve their understanding of people’s needs and how they communicate. The manager has asked staff to develop an activity list for each of the four units based on people’s preferences, which will be beneficial to them and guide staff in providing a suitable service. Since the staff meeting about increasing the activities provided, some staff have planned for a small group to go out for lunch, which some staff are supporting outside of the normal hours. This shows a commitment to develop the service and is appreciated by the people who use the service. There are two volunteers who visit the home at least twice a week who may support staff with a group activity or just spend time socialising with people around the home. We joined two different groups of people for lunch, which was served on the different units. The meals were delivered in a hot trolley and served at the table, with people being given the choice of two hot meals and a selection of vegetables. The food was freshly prepared and well presented and provided a balanced and nutritious meal. Lunch was relaxed, people were given choices and shown alternatives and helped appropriately and sensitively where necessary. They chose where they wanted to sit and when they wished to leave the tables. One person refused lunch but had a fortisip food supplement drink instead. On checking their file and they had eaten a good breakfast and their weight and food intake were noted, which is good practice. There is a three-week rolling menu based on personal preferences, with suitable alternatives and special diets catered for on request. Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recording systems and practice are improving to make sure people are safeguarded and their concerns listened to. Further training is needed to support and guide good practice. EVIDENCE: There have been three recent complaints, one of which is related to an ongoing Adult Protection investigation. The other two complaints have been recorded and investigated and responses sent to the complainant in line with the home’s policy and procedure. One is now resolved and the other has been passed onto the Adult Services Team to investigate. All the complaints have been handled and responded to appropriately and in a timely manner. Referrals have been made to other agencies when required. Feedback from people living in the home and their relatives suggest they are aware of the complaints procedure and how to raise a concern. There have also been three Adult Protection concerns raised recently which were all appropriately referred. Two of these have now been resolved and were related to incidents between two people with complex needs who were living in the home. Due to the serious concerns raised, admissions to the Dementia unit were voluntarily suspended by the home until the concerns are addressed. As a result of this investigation and its findings a recommendation has been made to ensure the manager assess that the home Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 17 has the skills and resources to meet individual needs prior to people moving into the home. The other Adult Protection investigation is ongoing. Staff training in relation to Adult protection policy and procedure needs to be strengthened to ensure staff are aware of their role and responsibilities in identifying and reporting incidents. Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. On the whole Combe House provides a safe and comfortable home that meets the needs of the people living there. EVIDENCE: On the whole the home was found to be in a good state of repair, clean and hygienic throughout. There are a suitable number of domestic staff to maintain the cleanliness of the home and there were no malodours in the home on the day of the inspection. People are able to personalise their rooms making them more homely with some people choosing to bring their own possessions and furniture. The furniture in communal areas of the home was good quality and suitable for the people living there. Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 19 Toilets and bathrooms were clean with appropriate aids and adaptations in place. The home liaise with other services such as the Occupational therpy service for advice and guidance regarding appropriate aids and adaptations when needs are identified. The grounds and gardens provide a lot of enjoyment for some people and on the whole they are well maintained, however the tarmac paths are covered in moss, which is a slip hazard and should be removed before people start to use the gardens in the summer months. The “winter vomiting virus” recently affected the home. They reported the incident to the Health Protection Agency as required and followed their guidance. However it was felt by the manager that lessons could be learned and a review of procedures with the staff would be beneficial. Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers of staff on duty in the home are now adequate, however the introduction of the new rota will improve the deployment of staff and improve the quality of the service provided. EVIDENCE: It was evident the home has experienced some staff shortages, which has impacted on the quality of the service provided. Feedback from people living in the home, relatives, other professionals involved with the home and staff all confirmed that they had experienced inadequate staffing levels. The new manager has also identified problems with the deployment of staff across the week also contributing to difficulties with staff cover. The rota since Christmas showed an improvement with all shifts being covered. The manager has developed a new two week rota to replace the previous one, which will improve the spread of staff across the week and should therefore improve the consistency of the service. It is recommended the new rota is introduced at the earliest opportunity. The organisation has sound recruitment policies and procedures in line with current good practice and legislation. All necessary checks are completed to maintain the safety of people living in the home. Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 21 Based on the examination of individual training records there was evidence of only short and basic in-house training sessions taking place, which does not meet the requirements of the National Minimum Standards (NMS). The manager should audit the training records of staff and develop a programme of training that will meet the needs of the staff team. Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new manager is implementing the improvement plan and some improvements have been made, however further improvements are required to provide a consistent and reliable service. EVIDENCE: The Registered Manager Mrs Melanie Williamson has recently resigned her post, which is now being covered by an acting manager, Rachel Martin. Mrs Martin has previous experience in the management role including some time in Combe House supporting Mrs Williamson. Mrs Martin is aware of the improvement plan in place and the previous shortfalls and requirements made at the last inspection visit. There was evidence she is continuing to implement the improvement plan, which has resulted in some positive changes. Meetings Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 23 have been held with care staff and supervisory staff to address the concerns and to improve the communication. People living in the home have good relationships with the staff and feel they can “talk to them about anything they need to”. Each person living in the home has a ‘named carer’ who works closely with them to ensure their individual needs are recorded and responded to. The three supervisors are responsible for the support and supervision of a group of staff including the monitoring and review of care plans they are responsible for. An annual quality assurance survey is issued to all the people living in the home and their representatives. This provides information that is incorporated into the homes business plan an annual basis. People’s personal finances are safeguarded by the homes policies and procedures with the home only holding small amounts of personal finances on request. All transactions are recorded and signed by staff leaving a clear audit trail that is monitored by the supervisory team. We examined staff files and on the whole those were in order. Supervision records were inconsistent and did not reflect a regular amount of formal supervision as required, although there have been some group supervisions. Staff talked about the constant changes to the supervisory team being a problem and “very disruptive”. The manager acknowledged this and is working towards bringing some stability to the team and improving communication both written and verbal. The formal supervision of staff should take place on a regular basis in line with the requirements of the NMS. The importance of recording the daily notes and what should be recorded has been addressed in staff meetings. On the whole the policies, procedures and recording systems in the home maintain a safe environment and safeguard the people living and working there. Risk assessments safeguard people whilst promoting their independence. Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 24 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 X 2 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 2 X 2 Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 25 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 Medication records, including Controlled Drugs records, need to be improved to protect the health of residents and to show that medicines are handled properly. Staff must follow safe medicines administration procedures to include a check of each medication as it is given to prevent errors being made. The manager must ensure at all times there are sufficient staff who are appropriately trained and experienced, to meet the needs of the people living in the home. Timescale for action 01/04/08 2. OP9 13(2) 14/02/08 3. OP27 18 01/04/08 Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer Good Practice Recommendations to Stan dard OP2 The admission procedure should be reviewed to ensure contracts of terms and conditions are issued to people, signed and agreed with them or their representative at the time of admission to the home. OP3 The manager should ensure the home has the skills and resources available to respond to people’s complex needs before admitting any new people to the dementia unit. OP7 The content of care plans including daily records should be reviewed to make sure they are accurate and sufficiently detailed. OP9 The role and responsibilities of the “checker” during medicines administration should be reviewed. OP9 Staff should have regard to the privacy of residents during the administration of medicines. OP9 The Controlled Drugs cabinet should be bolted to a fixed wall in accordance with the law. OP19 The tarmac paths are covered in moss, which is a slip hazard and should be removed before people start to use the gardens in the summer months. OP26 Infection Control procedures in the home should be reviewed to ensure staff are aware of their role and responsibilities. OP27 The new staff rota should be introduced at the earliest opportunity to improve the staffing levels in each unit. OP30 The manager should audit the training records of staff and develop a programme of training that will meet the needs of the staff team. OP36 All staff should receive regular formal supervision in line with the requirements of the NMS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Combe House DS0000036531.V358218.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V358218.R01.S.doc Version 5.2 Page 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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