Inspection on 08/05/06 for Combe House

This inspection was carried out on 8th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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 29/01/08

Combe House 24/09/07

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 8th May 2006 07:45 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.V291177.R01.S.doc Version 5.1 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.V291177.R01.S.doc Version 5.1 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) Post Vacant 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 (28) Combe House DS0000036531.V291177.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The service must employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection A maximum of forty older people (OP40) may be accommodated including eleven older people with dementia (DE (E) 11). The staffing levels for the home must meet The Residential Forum Care Staffing Formula for Older Adults. 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) 13th October 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. 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.V291177.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place at 7.45 am which enabled me to see the morning routines in the home. Information for this report was supplied by the home in the pre inspection questionnaire. In addition twelve residents surveys were returned and two surveys from other professionals. I met with many of the residents during the day as I spent time in each area of the home. I also met with the manager and supervisor on duty, in addition to interviewing three care staff and talking to other staff as they went about their work. I spoke to three relatives who were visiting the home on the day of the inspection. What the service does well: What has improved since the last inspection? What they could do better: The home must now ensure all staff get supervision from their senior on a regular basis. This will give guidance and support to staff and help to maintain a good quality of care. Information given to residents must be up to date and accurate and given to them at the right time. This will give them a better understanding about their rights and choices and the rules about living in the home. Information about how people want to be cared for and what they like or dislike must be recorded and agreed with residents or their representative. It must be looked at regularly and kept up to date. All staff must go on training courses to help them understand their role and how they can improve the service for people. The home should look at how staff are giving medication to residents making sure it is done in a safe way at all times. Combe House DS0000036531.V291177.R01.S.doc Version 5.1 Page 6 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.V291177.R01.S.doc Version 5.1 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.V291177.R01.S.doc Version 5.1 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, 2, 3, 4, 5. Quality in this outcome area is adequate. Procedures are followed in an inconsistent manner, which results in some residents not being provided with appropriate information to make an informed choice about moving into the home. Assessments of need are also inconsistent resulting in some residents not receiving a suitable service. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The statement of purpose and service user guide is in need of review and updating. Some residents spoken to on the inspection and who returned resident’s surveys said they did not receive adequate information prior to moving into the home and had not been issued with contracts. Again the issuing of contracts to new residents was inconsistent with two of the files of two new residents not having contracts in place. These should be signed and agreed by the resident or their representitive. Not having contracts and terms of conditions in place will cause confusion and lead to disputes when issues arise. These issues are subject to a requirement. Combe House DS0000036531.V291177.R01.S.doc Version 5.1 Page 9 Although assessments were on file some of these were not fully completed, which could affect the consistency and quality of care. In one case the social work assessment had not been placed on the care plan file, which left minimal information and guidance for staff on the units. Due to the needs of the individual this put them at risk, as they had a history of falls and eating problems that staff would not be aware of. This is subject to a requirement. When the assessment procedure was followed and assessments completed the home was able to make a clear judgement about being able to meet the needs of new residents prior to admission to the home. Some residents had visited the home prior to admisssion, whilst others had stayed in the home on respite care giving them an insight to life in the home. The home has suitable policies and procedures in place to ensure admission to the home is appropriate but there was evidence these are not being consistently applied. An assessment of need is completed but again this is not applied in a consistent manner or in some cases not fully completed. Contracts have been developed in line with NMS but the issuing of these to new residents is inconsiostent Combe House DS0000036531.V291177.R01.S.doc Version 5.1 Page 10 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): 7, 8, 9, 10. Quality in this outcome area is poor. The assessment and care planning process is inconsistent resulting in essential information not being recorded and responded to, which directly impacts on the quality of care received by residents. This judgement has been made using all available evidence including a visit to the service. EVIDENCE: The quality of the care plans examined were poor and in one instance someone who had been in the home since February 06 did not have a care plan in place and only one review of needs had beeen held in March 06. The resident had not agreed a care plan and did not appear to be involved in the review process. A social work assessment had not been transferred onto the care plan file. Despite a history of falls a manual handling risk assessment was not completed. This puts both the resident and staff at risk. The completion of weight charts was adhoc and actions were not recorded as a result of fluctuations in weight, there was no evidence of nutritional assessments being completed. These issues are subject to requirements. Combe House DS0000036531.V291177.R01.S.doc Version 5.1 Page 11 Daily records were completed by staff at the end of each shift, these record all personal care provided and other significant events ensuring a continuity of care between shifts. Residents spoken to and responses from the resident’s surveys said they felt their care was good with staff listening to them and providing appropriate support that respected their rights and dignity. I met with some visitors to the home during the inspection and all the people I spoke to were complimentary about the level of care in the home with one person saying the staff were kind and helpful There was evidence of appropriate referrals to health services as needs were identified and residents confirmed they got to see their GP or other health professionals as required. Food intake and weight were not recorded consistently and issues relating to diet and nutrition were not being recorded and responded to appropriately. This could have potentially serious consequences on a persons health and well being if such concerns are not responded to. This issue is subject to a requirement. Medication administration was observed and practice had improved, the supervisor on duty took a lead role in the administration process and was observed by a “checker”. Their role is to double-check the person and their prescribed medication prior to admission. The supervisor had completed appropriate training, however not all “checkers” had completed training. Due to the history of errors in the home I agreed with the acting manager to make a referral to the Pharmacy inspector to carry out an inspection. Combe House DS0000036531.V291177.R01.S.doc Version 5.1 Page 12 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. Quality in this outcome area is adequate. When staffing levels are appropriate the home provides suitable activities and supports people with their own hobbies and interests, however there has been regular instances when there have not been adequate numbers of staff to achieve this. This judgement has been made using all available evidence including a site visit. EVIDENCE: Residents were seen to spend their time either in the communal areas of the home including the lounges, foyer, garden or in their own rooms. They were moving freely around the building and socialising with other residents in different units of the home. Independence is encouraged a good example of this was two residents who I spoke to who regularily used the local community amenities. Feedback from the residents surveys suggest that residents would like more activities and outings. The minutes of the residents meeting confirmed this, with discussions recorded about the type of activities people preferred. It was evident that the numbers of staff on duty was crucial, to enable meaningful activities to take place. Subsequently due to shortages of staff activities have not been taking place on a regular basis but only when staffing levels allow, which was aknowledged by residents and staff. There should be a fourth member of staff on duty each shift to support and encourage activities Combe House DS0000036531.V291177.R01.S.doc Version 5.1 Page 13 in the units As one resident described it to me Im bored we dont do enough activities. This issue is subject to a requirement under the staffing section of this report. There were frequent visitors to the home during the inspection some of whom I met with. The residents meeting had also discussed the choice and quality of meals in the home. On the whole feedback from residents was very positive about the food and their ideas and preferences about changes to the menus had been recorded and responded to. I joined a group of residents for lunch, which was served in the unit from a ‘hot trolley’. There was a choice of two cooked meals which had been freshly prepared. The dining area was appropriately set out. The organisation was also recruiting their own relief cook to try and improve the consistency and quality of food when the regular cooks are absent. Combe House DS0000036531.V291177.R01.S.doc Version 5.1 Page 14 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. Quality in this outcome area is good. The home has suitable policies and procedures and staff are aware of how to record and respond to complaints and concerns. Residents are safeguarded by the policies in place and were aware of how to make a complaint. This judgement has been made using all available evidence including a site visit. EVIDENCE: Based on discussions with the manager and staff they are aware of their responsibilities in handling complaints and the homes procedure. There is one outstanding complaint that has been referred to the Ombudsman. Many aspects of this complaint were upheld with subsequent requirements and recommendations being made to address the shortfalls and poor practice identified. Residents surveyed said they knew how to complain and who to complain to. Information regarding support from independent advocacy services was displayed in the units. Not all staff had received suitable adult protection training. Staff spoken to though were aware of their responsibilities and reporting procedures in relation to suspected mistreatment or abuse. Combe House DS0000036531.V291177.R01.S.doc Version 5.1 Page 15 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, 21, 22, 23, 24, 25, 26. Quality in this outcome area is good. Combe House provides a safe, clean and well maintained living environment. This judgement has been made using all available evidence including a site visit. EVIDENCE: The outside paths were clear of hazards and were now safe. The home was found to be in a good state of repair, clean and hygienic throughout. Responses from the resident’s survey confirmed that the the home is well maintained, “clean and fresh”. There were no malodours in the home on the day of the inspection. Residents rooms I visited were homely with some people having their own possessions and furniture around them. Toilets and bathrooms were clean and well maintained with new bath hoists recently fitted. Appropriate aids and adaptations were in place around the home. Furniture in communal areas was being replaced with the new furniture being suitable and good quality. Combe House DS0000036531.V291177.R01.S.doc Version 5.1 Page 16 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. Combe House DS0000036531.V291177.R01.S.doc Version 5.1 Page 17 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): Quality in this outcome area is adequate. On the whole feedback from residents and their relatives was that they were happy with the care provided by staff. Staffing levels have been low at times, which has impacted on resident’s quality of life. Also training for staff is below the expected level. This judgement has been made using all available evidence including a site visit. EVIDENCE: On examining the rota and talking the staff, residents and the manager it was evident there have been shortages of staff. I discussed with the manager appropriate staff levels, two staff on the dementia unit, one dedicated staff on each unit with a fourth member of staff who moved between the three units as needs dictate. This is subject to a requirement. The home has recently recruited two staff to cover 45hrs of care staff vacancies and another member of staff for a 16 hr domestic post. Staff training has been at a low level with staff not receiving both mandatory and specialist training and refreshers. Induction training was not taking place in a timely manner. A member of staff who started work in November 05 did not receive their induction training until March06. This is subject to a requirement. Staff records were improving with new systems in place to capture all the relevant information in relation to training and development needs of staff. The NVQ programme is available to staff, who are encouraged and supported to complete the award. Combe House DS0000036531.V291177.R01.S.doc Version 5.1 Page 18 CRB disclosures were up to date for all staff and two references had been taken for all new staff although there was only one reference in place for some staff recruited earlier in the year. Combe House DS0000036531.V291177.R01.S.doc Version 5.1 Page 19 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): Quality in this outcome area is adequate. Taking into account that the manager is new in post and has identified many of the areas of concern noted in this report then the home is operating to an adequate standard, however some areas of poor practice have been highlighted. This judgement has been made using all available evidence including a site visit. EVIDENCE: The new acting manager is knowledgeable and experienced in her role. She is aware of the shortfalls in the home and is in the process of introducung new systems to monitor and guide care practices. She is working closely with the supervisory team to ensure they are aware of their roles and responsibilities. The manager was in the process of completing a formal audit of the service to identify priorities, this is completed on an annual basis and monitored monthly by the operations manager. Regulation 26 visits (monthly visits by the operations manager) are also used to monitor the home. Combe House DS0000036531.V291177.R01.S.doc Version 5.1 Page 20 An annual survey of residents is also used to prioritise targets for the year. The organisation allocates a budget to the home which is monitored by the homes manager and the operations manager. In addition to these formal monitoring systems regular resident’s meetings are held. The minutes of the meeting were displayed on the notice boards in each unit. Discussion points included menus and meals, staffing levels, entertainment and missing laundry, actions had been agreed for each of the issues raised. Supervision of staff was again inconsistent with some staff not receiving appropriate supervision in the required timescales as set out in the NMS. In particular new staff should be supported through regular supervision/mentoring to guide and support good practice. The manager has set up a supervision matrix to help her track when staff supervision has been completed, which should improve this situation. This is an outstanding requirement from the previous inspection. Record keeping in relation to care plans was poor for some residents and must be improved. There were no obvious hazards noted during the inspection and the safety and welfare of residents was being maintained. Combe House DS0000036531.V291177.R01.S.doc Version 5.1 Page 21 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 2 2 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 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 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 1 2 3 Combe House DS0000036531.V291177.R01.S.doc Version 5.1 Page 22 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 2 Standard OP2 OP3 Regulation 4 14 Requirement All residents must be issued with a contract of terms and conditions. The home must not provide accommodation unless a suitably qualified person has assessed the needs of the person. All residents must have a manual handling risk assessment completed on admission, to ensure a safe system for moving and handling them is in place. The home must develop a care plan for all residents that is signed and agreed with them or their representative. All care plans must be kept under review and up to date ensuring any changes are recorded and agreed with residents or their representatives. The home must maintain a record of diet and nutrition including weight gain or loss and what action has been taken. Staff must receive training appropriate to the work they are to perform. DS0000036531.V291177.R01.S.doc Timescale for action 01/07/06 01/07/06 3 OP3 13(5) 01/07/06 3 OP7 15 01/07/06 4 OP7 15 01/07/06 5 OP8 15 01/07/06 6 OP30 18 c 1 01/08/06 Combe House Version 5.1 Page 23 7. OP36 18 (2) The home must provide regular supervision to support staff and ensure good practice is maintained. (Previous timescale of 01/01/06 was not met) 01/07/06 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 2. Refer to Standard OP1 OP7 Good Practice Recommendations It is recommended the statement of purpose and service user guide are reviewed and updated and supplied to prospective residents. It is recommended pen pictures/social histories are included in all care plans. Combe House DS0000036531.V291177.R01.S.doc Version 5.1 Page 24 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.V291177.R01.S.doc Version 5.1 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. 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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