Inspection on 09/05/05 for Combe House

This inspection was carried out on 9th May 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 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 08/05/06

Combe House 13/10/05

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 09 May 2005 08:00 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 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 F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Combe House Address Central Drive Walney Island Barrow in Furness Cumbria LA14 3HY 01229 473617 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Cumbria Care Alan Kent Care Home 40 Category(ies) of 39 OP - Old Age registration, with number 11 DE(E) - Dementia over 65 of places 1 MD - Mental Disorder Combe House F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service must employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2. A maximum of 39 older people (39 OP) may be accommodated including 11 older people with demential (11 DE(E)). 3. The staffing levels for the home must meet the Residential Forum Care Staffing Formula for Older Adults by 1 April 2004. 4. When a single room of less than 12 sqm usable floor space becomes 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. 5. To include one named person in the category of mental disorder excluding learning disability or dementia (1 MD) Date of last inspection 15 November 2004 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 thirty nine 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 kithenette and dining area. It is situated on Walney Island near the town of Barrow-in-Furness. It is in a residential area of the island and is on a main bus route and close to local amenities. The home has been designed and equipped to meet the needs of the residents. It is in its own grounds with gardens to the front and rear and off road parking is available. Combe House F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 8am and 5.30pm on 9th May 05. Since the last inspection in November 04 the home has been visited once regarding a complaint. This had been fully investigated by the home and resolved satisfactorily for the complainant. The inspector met with many of the forty residents during the day and visited all the units and communal areas within the home and grounds but not all the resident’s bedrooms. Time was also spent with the manager and formal interviews held with one senior and three care staff. The inspector was also able to meet with a district nurse and resident’s relatives who were visiting the home. What the service does well: What has improved since the last inspection? The home has developed new medication policies and procedures and provided training to relevant staff. The level of training in the home had improved and personal development records had been introduced for all staff, to record and monitor training activity and identify training needs. New furniture had been purchased which was good quality and suitable for the needs of residents. Further repairs and renewals were also planned. It was evident having a permanent manager in post has given the home some stability and residents and staff felt well supported and they could raise any concerns. Combe House F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 Page 6 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 F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Combe House F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 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 standard(s) 2, 3, 4. The home has good systems in place to ensure people can make an informed choice about living in the home. EVIDENCE: The majority of referrals to the home are as a result of social work assessments. The home also completes their own assessment to ensure they are able to meet individual needs. There was evidence of the home working closely with families and significant others to develop detailed care plans based on the assessments. Through visits or short stays people were able to make an informed choice about choosing to live in the home. Clear contracts have been developed ensuring people had all the relevant information relating to their stay. These were signed by relevant parties and held on file. Combe House F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10. Health and personal care needs were well documented, with individual and specialist needs being responded to appropriately. EVIDENCE: The care plans examined contained comprehensive information regarding individual needs and preferences. These had been developed from a range of assessments completed at admission and on an ongoing basis. Personal profiles were completed, which “bring the plan to life” making them a personalised record and giving staff a better understanding of individuals needs. There was evidence of input from family and representatives, in addition to various health professionals, who advise and guide practice in specialist aspects of care. The care plans were kept under review as required with additional information or changes recorded, which helps to maintain a continuity of care. The inspector met with the visiting District nurse, she described how the home liaises with the community nursing service in an appropriate manner and will seek advice, guidance or training when needs are recognised. A good example of this occurred during the inspection. Staff raised concerns with the nurse Combe House F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 Page 10 about pressure care for a resident, as a result equipment was recommended, which was in place by the afternoon. The home also enjoys good links with other support services including the mental health unit at the local hospital who have also provided training for staff, ensuring staff have the skills and knowledge to respond to individual needs. The manager and Supervisors take responsibility for the management and administration of medication in the home. They have all completed training in the management of medication and were familiar with the home’s new policies and procedures. However when examining the medication trolley and medical record sheet it was evident some morning medication had been signed for but not administered. Care plans were securely stored in the main office, with a copy also kept on the relevant unit. Not all units had secure storage for these, however the manager was aware of the need for this and was in the process of creating secure storage. Combe House F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15. On the whole the residents of Combe House enjoy a safe and fulfilling lifestyle. However the service for people with high dependency needs could be improved. EVIDENCE: The foyer of the home has seated areas and is used for group activities. There is a notice board which had a list of regular weekly activities provided by staff in the afternoons. Also one off events that had been planned and were advertised there, an example being a clothes show, which was planned for the next month. There were a number of residents who were regularly accessing the local community independently. Opportunities for residents who required staff support were obviously more limited, however the home does arrange regular bus trips in the summer months. In addition to activities outside the home they also arrange in-house activities with a visiting musical duet and the mobile library being two popular choices. Residents meetings were held on a regular basis the last one including discussions about activities provided and the menus for the home. Activities available for people with dementia and the more elderly/frail residents were discussed with the manager. As the grounds and gardens are not secure at the back of the home, staff must support people with dementia at all times. This severely limits the opportunities for people to have a walk or Combe House F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 Page 12 just enjoy the garden, something that is beneficial to people with this condition and provides opportunities to exercise choice and control in their lives. In addition alternative sedentary activities should be explored to ensure the home is following best practice and providing suitable activities and equipment. Two areas to be explored include the use of reminiscence materials and the need for specialist equipment, to support and maintain independence and dignity at meal times, such as the use of plate guards and adapted cutlery. Visitors to the home were spoken to during the course of the inspection, they felt the home provided a “good and caring service”. One resident described the home as a “cruise ship without water”. Combe House F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18. The home’s policies, procedures and practice safeguard residents from the risk of abuse and protect their legal rights. EVIDENCE: The home has a detailed complaints policy and procedure, which meets the requirements of the care home regulations. The policy was issued to residents or their representatives giving them clear information. The home had investigated one complaint since the last inspection. This had been a thorough investigation following the home’s policy that resulted in action being taken, which resolved the issues for the complainant. Residents and visitors spoken to were aware of how to complain. Information about advocacy services were displayed on the notice board. However advocates were not routinely used. The signing and agreeing of care plans for people with dementia was discussed, with a recommendation that representatives or advocates should be involved in signing and agreeing care plans. Staff were aware of their responsibilities in identifying and reporting abuse and had completed appropriate training. There was refresher training planned for the near future for twelve staff. Combe House F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, 26. The internal environment of the home is decorated and furnished to a good standard, however the external areas of the home need attention. EVIDENCE: The décor and furniture in the home is good quality and provides a safe and homely environment. There is a programme of repairs and renewal identifying work to be completed and a timescale for its completion. New furniture and carpets were evident on two units, which had made a big difference and were appreciated by residents who commented on “how comfortable” the new chairs were. The paths around the home, which fire exits lead onto, were covered in moss, which is slippy when wet and will cause a hazard. These must be cleaned and the moss removed. The garden to the rear of the home, which the dementia unit leads onto, is not secure. This means people can only access it with staff support, which severely limits opportunities to leave the unit. Also people become agitated if they want to walk and are not able to or have to wait for staff to support them. Combe House F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 Page 15 The manager explained that work was planned to make the patio area to the rear of this unit safe. The addition of a short piece of fencing connecting to the existing hedge will make the garden safe and accessible to all residents. There are four distinct units within the home that have ten people living on them, however people move freely between the units to socialise or join in activities. The resident’s rooms were suitable for their individual needs and people had personalised them with their own furniture and belongings. There was evidence of suitable aids and adaptations being provided to encourage and maintain independence. Overall the home provides a safe and clean living environment, which is appreciated and enjoyed by residents. Combe House F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28, 29, 30 There were sufficient numbers of suitably trained and experienced staff on duty to meet the varied needs of residents. EVIDENCE: The manager was working closely with the supervisory team to ensure they were clear about their role and responsibilities. The manager provides formal supervision and support to the supervisors, who in turn supervise the care staff. There were gaps in the previous supervision records, however the manager had noted this and was introducing a system to monitor supervision. The home has introduced continuing professional development records to record and monitor all training. Based on this information the central training unit produces a three-month training plan enabling managers to identify and plan appropriate courses for staff. Also all new staff attended formal induction training and received a thorough in-house induction. Specialist training was also organised, when needs were identified, such as dementia care. Through the regular contact with the community health service other relevant training is provided. Twelve staff have completed the NVQ award. This level of training ensures a skilled workforce is maintained who can meet individual and specialist needs The home has sound recruitment policies and procedures in place, which protects residents and ensures staff, have the ability and values, to respond to residents needs appropriately. Combe House F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 37, 38. The management of the home is good, providing residents and staff with clear leadership and appropriate support. EVIDENCE: The manager of the home has many years experience in the caring profession and also in a supervisory role. Staff spoken to felt management support was “excellent” and the manager and supervisors were “always available to talk”. Some quotes from the most recent satisfaction survey included “The carers are the best you could have” and “the new manager has made a difference”. More widespread consultation was planned for this year with questionnaires in place for residents, their families or representatives and other professionals. Feedback from the questionnaires was being formally responded to with residents getting feedback on the outcome of the consultation. The home is part of an independent business unit of the County Council, which sets annual budgets for the home. This is monitored and managed locally by Combe House F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 Page 18 the manager who receives monthly budget monitoring records from the central finance department. If an excess of expenditure over income occurred the organisation meets the shortfall. All the records examined in relation to the management of the home were up to date apart from the maintenance of hoists. These were found to be overdue and must be inspected as soon as possible. There were no other obvious hazards noted during the inspection, with the home having suitable procedures and risk assessments in place to maintain the health and safety of residents. Regulation 26 management visits had taken place on a regular basis. Combe House F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION 2 2 3 2 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 3 3 2 Combe House F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 Page 20 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. 2. 3. Standard 9 19 19 Regulation 13(2) 13(4)a 13(4)a Requirement Timescale for action 11.5.05 4. 38 13(5) The must ensure medication is safely administered as prescribed. Moss must be removed from the 11.6.05 paths and patios The rear garden must be secured 1.9.05 to ensure all parts of the home are free from hazards to the residents safety. Maintainence of moving and 31.5. 05 handling equipment must take place in the required timescale. 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 14 37 Good Practice Recommendations It is recommended the home investigate current good practice in relation to promoting independence and providing services, to older people with dementia It is recommended the manager ensure supervisors are aware of the reporting procedures related to significant events. Combe House F58 F10 s36531 combe house v220701 090505 ui stage 4.doc Version 1.30 Page 21 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. 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