Inspection on 31/10/05 for Combe House

This inspection was carried out on 31st 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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Combe House 03/07/07

Combe House 12/07/06

Combe House 23/06/05

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Combe House Castle Road Horsell Woking Surrey GU21 4ET Lead Inspector Pauline Long Unannounced Inspection 31st October 2005 10:00 Combe House DS0000062711.V262475.R01.S.doc Version 5.0 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 DS0000062711.V262475.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 Adults 18-65. 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 DS0000062711.V262475.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Combe House Address Castle Road Horsell Woking Surrey GU21 4ET 01483 755997 01483 773681 val.coomber@brookhurstcare.co,uk 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) Brookhurst Care Limited Valerie Jean Coomber Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The age/age range of the persons to be accommodated will be: 18-45 YEARS One named service user who is between the ages of 17 and a half &18 years with prior written agreement with C.S.C.I may be accommodated at Combe House 23rd June 2005 Date of last inspection Brief Description of the Service: Combe House is suitated in a quiet residential area of Horsell Village, a short distance by car from Woking town centre. It is a new property which is tastefully developed and blends in well with the surrounding properties. This home provides care and accommodation for young adults with a learning disability. The accommodation consists of six individual en suite bedrooms, five of these being on the first floor and one on the ground floor. There is no lift access to the first floor. Communal areas consist of two bathrooms, a dining room, sitting room and easily accessible kitchen and laundry room. The dining room, kitchen and sitting room have doors leading directly onto a large terrace and medium sized secure back garden. The home has a good sized area for parking at the front of the building. Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second Inspection of this home under the Care Standards Act 2000 and the CSCI year April 2005- March 2006 and was unannounced. The inspection was carried out by one inspector and lasted for three and half hours. CSCI would like to thank the resident, provider, manager and staff or their hospitality and co-operation during the inspection. The service had a welcoming atmosphere. On the day of inspection three of the six rooms were occupied. One resident was at home and the others were out at day service activities. One resident and all of staff on duty were involved in the inspection process and were keen to talk about life in the home. Discussions were had with the provider, manager and care staff on duty. Documents sampled, included service users files, care plans, staff records, policies and procedures. A full tour of the home took place, it was pleasing to note that the home had been decorated to reflect the Halloween celebrations. Feedback from the resident at home on the day was limited, in view of the resident’s communication difficulties. What the service does well: This home presents a homely environment and atmosphere for the residents. The manager’s approach was open. The care staff demonstrated a good understanding of the residents care needs and this was reflected in the wellbeing of the resident who was at the home on the day. The home is committed to ensuring that the residents maintain contact with family/friends and the local community. There are various activities offered both in and outside the home. On the day, two of the three residents had planned activities out side the home. Thank you cards from relatives commented that the staff are very caring and that they have been very impressed with the professional way the carers work. Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: 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 DS0000062711.V262475.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2. Arrangements are in place to ensure a full needs assessment takes place before any new admission. The arrangements in place for prospective residents to “ test drive” the home are good. EVIDENCE: Two of the resident’s files were sampled, and contained a comprehensive assessment of needs, which, in the first instance was carried out by the registered provider and the manager at the home. The registered provider indicated that future referrals to the home would be assessed by the manager All aspects of daily living needs were assessed, indicating that the manager and care staff would be fully aware of individual residents care needs. Each prospective resident was offered the opportunity for several visits to the home prior to a trial assessment period. These periods range from a lunchtime visit, to a weekend stay. Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 The manager and staff had a good understanding of the resident’s needs and choices, these were well met. On the day the resident was involved in decisions, and was supported to take responsible risks. Information was stored appropriately and securely and confidentially. EVIDENCE: The care plans sampled had detailed needs assessment. On the day of inspection a resident was observed being enabled to make choices safely. Risk assessments were in place and had been reviewed, it was pleasing to note that the home had reviewed the risk assessment tools they were using and following this review were using one risk assessment format. Care plans included all aspects of personal support and health care needs. The relationships between the residents and staff at the home enabled help and support with some tasks the resident found challenging. A resident was asked if he wished to help to prepare the lunch, he smiled, indicating that he was happy as he followed the member of staff into the kitchen. Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 10 Through out the inspection, staff were observed accessing residents files. This information was stored confidentially. Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,13,14 The Manager and staff enable the residents to maintain fulfilling lifestyles in and outside the home. The home promotes contact with family, friends and the local community. EVIDENCE: The residents at Combe House are not in paid employment. They do however go to individual day activities. This enables them to have a degree of independence, and the opportunity to meet with other day service users. One resident has recently been enrolled at college, which he attends three days a week. The staff commented that on the days he goes to college, he is up and ready from the early hours. The home is committed to ensuring that the residents maintain their relationships with their family and friends. The residents receive regular visitors. Families keep contact by phone. There were various flyers posted on a notice boards, relating to possible future outings. One resident had recently gone to see Concord, he had tickets for a Buddy Holly and the Cricketers Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 12 music concert. As discussed earlier in this report the home was decorated to reflect Halloween celebrations and the staff stated that the residents were going to have a Halloween party, and they were very excited about it. Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 20. The manager and staff have a good understanding of the residents support needs. This was evident from the positive interactions and relationships observed. The health needs of the residents are well met. Residents are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Care plans included clear guidelines on any support each resident required with personal and health care. Physical and emotional needs of the residents were also detailed in the care plans and daily records, which included visits to the doctor, dietician, dentist and reviews of care. The home has a clear medication policies and procedures. None of the residents in the home administers their own medication. All of the care staff on duty were aware of the policies and procedures regarding medication. A new member of staff explained that she would not be permitted to administer medication until she had received medication training. All of the medication record sheets were checked, and were found to be properly completed. The home has recently admitted a resident who requires controlled medication. The manager explained that they had requested a Controlled Drugs Register from the chemist, who provides the homes medication, but to date this had not arrived. Discussions were had with the manager around covert administering of medication. The manager had documented discussions the home had with Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 14 the resident’s General Practitioner, she was advised that the General Practitioner should put the instructions regarding administering covert medication in writing to the home. A requirement has been made with regard to medication. Please refer to pages 26 and 27 of this report. Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. The home has satisfactory policies and procedures in place for dealing with concerns, complaints and the protection of the residents. EVIDENCE: CSCI has received one complaint about this home since the last inspection. The provider investigated the complaint which was upheld. The home has a folder in which they record complaints and compliments. There were several compliment cards with comments such as: we are very impressed with the way the care staff work and our son has benefited from your care. The manager and staff were aware of and have attended the Surrey Multi Agency Abuse training. Discussions with a new member of staff included scenarios around abusive situations. It was very pleasing to note that she had a good understanding of the procedures. Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,28,30. The standard of the environment within this home is good and meets the needs of the residents, providing an attractive and homely place to live. EVIDENCE: As discussed earlier in this report, only three of the six bedrooms were occupied. Two of the resident’s bedrooms were somewhat personalised. They were clean bright and tidy. One bedroom, whilst clean and tidy was observed as being impersonal. This was discussed with the manager, who stated that the resident was admitted to the home with very few possessions, and that they were in the process of buying some items to make the bedroom more homely. The main sitting room was bright and airy and uncluttered. The carpet has been removed as the colour was found to be difficult to keep clean. The lack of pictures and photographs was discussed with the manager, who stated that she was going to have a discussion with the residents around wall decoration. The standard of decoration in the hallways and communal rooms was satisfactory, but would need to be redecorated in due course. The provider and manager are considering a more appropriate type of flooring for the hall, which again was difficult to keep clean. On the day the overall cleanliness of the home was good and no malodours were noted. Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 17 Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 The home employs an efficient staff team in sufficient numbers, who provide a good quality of care to the residents. Recruitment and selection practices were much improved. There is a formal staff supervision process in the home. EVIDENCE: The home has clear policies and procedures for staff recruitment. Staff files seen on the day demonstrated that recruitment and selection practice had improved. All staff files sampled contained the necessary documentation. All staff had satisfactory Criminal Records Bureau and POVA (The protection of Vulnerable Adults) checks. There were 2 care staff, and the manager on duty on the morning shift. The dependency levels of the residents on the day indicated that the present staffing ratio was adequate. Training in the home is given a high priority, in particular non-verbal communication skills. Staff talked about their job roles, there was clarity and awareness of the different roles and responsibilities within the home. Since the last inspection the following training has been provided: • • Manual handling. First Aid. DS0000062711.V262475.R01.S.doc Version 5.0 Page 19 Combe House • • • • • • • Health and Safety. Fire Awareness. Food Hygiene. NVQ 2/3. Child protection Epilepsy awareness. LDAF. A training day on report writing has been booked for 7/11/05. The manager and deputy are at present undertaking the Registered Managers Award. There is a staff supervision programme in the home. The manager and deputy manager carry out the staff one to one formal supervisions. To date staff have received formal supervision with a manager on a six weekly basis. The whole staff team also meet as group on a twice-monthly basis. Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38,39,42,43 Resident’s benefit from the ethos and management approach of the home. Health safety and welfare of Residents is promoted, and resident’s views are listened to. Resident’s personal monies are safeguarded. EVIDENCE: The manager had a very open style and inclusive style of management. From observation of her interactions with a resident and the staff, it was clear that there was an atmosphere of openness and respect. The staff expressed confidence that they could take any issue to the manager. All staff appeared confident in her presence and professional in their work. It is pleasing to note that, the manager and provider have developed a quality audit process for the home, which includes for example, a residents questionnaire both in written and pictorial format, a questionnaire for other care professionals and one for relatives and visitors. To date none of the questionnaires had been sent to service users. Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 21 Health and safety checks are routinely carried out at the home. All equipment in use on the day of inspection was properly maintained, it was noted that the fire extinguishers were due to be safety checked on the 1/11/05. Water temperatures were checked and found to be satisfactory. The standard of recordkeeping at the home is good, it must be noted that the providers have reviewed and re-developed the homes procedures regarding resident’s monies and petty cash records. It was pleasing to note that resident’s accounts sampled were found to be in good order. Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 X X 3 X 3 LIFESTYLES Standard No Score 11 3 12 X 13 3 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Combe House Score 3 X 2 X Standard No 37 38 39 40 41 42 43 Score X 3 3 X X 3 3 DS0000062711.V262475.R01.S.doc Version 5.0 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 12(1)(a) 13(2) 12(1)(a) 13(2) Requirement The registered person(s) must ensure that a Controlled Drugs Register is purchased for the home. The registered person(s) must ensure that written instructions regarding the covert administration of medications is obtained from residents General Practitioner. Timescale for action 14/11/05 2 YA20 14/11/05 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 YA28 Good Practice Recommendations The manager following consultation with the residents should consider how best to make the communal areas of the home more homely. Combe House DS0000062711.V262475.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 DS0000062711.V262475.R01.S.doc Version 5.0 Page 25 - 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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