Inspection on 04/04/05 for Combs Court Residential Home

This inspection was carried out on 4th April 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

Combs Court Residential Home 07/11/07

Combs Court Residential Home 07/02/07

Combs Court Residential Home 07/06/06

Combs Court Residential Home 13/09/05

Combs Court Residential Home 12/10/04

Combs Court Residential Home 27/04/04

Similar services:

Coopers Mill Ltd

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Paradise Lodge

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Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Combs Court Residential Home Edgecomb Road Stowmarket Suffolk IP14 2DN Lead Inspector Claire Hutton Unannounced 4 April 2005 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Combs Court Residential Home Address Edgecomb Road Stowmarket Suffolk IP14 2DN 01449 673006 01449 674203 combs.court@creagmoor.co.uk Parkcare Homes (no. 2) Limited 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) Mrs Joanna Woodhead Care Home 30 Category(ies) of Learning disability (30) registration, with number Learning disability over 65 years of age (8) of places Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Combs Court Residential Home can accomodate eight people with Learning Disability over the age of 65. Date of last inspection 12th October 2004 Brief Description of the Service: Combs Court is a care home providing personal care and accommodation to 30 adults with a learning disability, eight of whom can be over the age of 65. It is owned by Parkcare Homes Ltd and is a member of the Creagmoor Group Ltd. Combs Court is situated in the small village of Combs Ford. It is close to the village centre and within walking distance of several shops and a bus link to Ipswich & Bury St Edmunds. The establishment comprises of two eight bedded bungalows, one eight bedded house and one double and four single flats for more independent people. There is also an office block with an attached day care centre. Combs Court is along by a short drive with a gate that is kept shut. There is parking beyond for visitors and the homes transport. Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over an evening in April 2005. The Registered Manager met with the inspector at the beginning and at the end of the inspection. The inspector arrived at 5.10pm and left at 9.45pm. the inspector spoke with 5 staff on duty and met and spoke with 7 residents of the home. All of whom worked or lived in either the house or bungalow 2. Bungalow 1 and the flats were not visited. What the service does well: What has improved since the last inspection? What they could do better: There are two things they could do better, firstly ensure all the outstanding requirements from the previous report are promptly dealt with, primarily ensuring everyone has terms and conditions agreed with a contract. Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 Page 6 Secondly, the home currently is using a lot of agency staff and requesting existing staff to work extra. The home had 4.5 whole time equivalent care vacancies and a long term vacancy for a maintenance person. Adverts had been placed, but the standard of applicant was low and not what the home wanted. The rate of pay was thought to influence this. Finally, any member of staff who is asked to work with people who are likely to have challenging behaviour, must be trained before being put in that situation. 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. Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 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 standard(s) 2 and 5 People who use this service have yet to have their contact or statement of terms and conditions fully defined, but it was clear that the home continues to assess the needs of the residents. EVIDENCE: There have been no admissions to the home since the last inspection. However it is clear from care plans and talking to staff that residents needs are continually monitored and plans reviewed and updated. There was evidence from the last statutory reviews held in December 2004 that placements remain appropriate. A requirement from the last inspection was that contracts/statement of terms and conditions between the home and residents are confusing. The manager explained that terms & conditions were all in place but not all agreed. The manager had supplied information to the Social Care expenditure and assessment team, but due to this being lost had to send a second copy, hence the delay. Most people had a standard Social Care contract therefore the manager was confident that she would be able to resolve this matter by 30th April 2005. Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 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 standard(s) 6, 7 and 9 The majority of care plans and risk assessments in place accurately reflect residents needs, however, one plan requires more detail to ensure as an individual the needs are being met and that all involved are not placed at risk of injury. EVIDENCE: Residents spoken with were aware that they had a care plan and that it was reviewed. Individual signatures of residents were seen on their care plans. Two residents knew who their key worker was and that they were ‘their person to talk to’. In the care plans seen it included the role of the key worker. Care plans were based upon elements of daily living and went on the state what the individual could do for themselves and what support was needed by staff. Risk assessments included nutritional needs, moving and handling as well as those around individuals such as smoking in bed, when going out unaccompanied and loosing room keys. One resident has joined a local advocacy group and was very enthusiastic about his participation. Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 Page 10 One plan did not contain sufficient information on the individualised procedures to manage aggressive behaviour. Staff spoken with were not clear as to what they would do in each circumstance, but would do the best they could as they believed each circumstance would be different. Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 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 standard(s) 11, 12, 13, 14, 15, 16, 17 Residents at Combs Court are supported to lead ordinary lives that allow them to participate in the community and therefore lifestyle is individualised. However, more could be done for those residents in the flats to develop independence, especially around meals. EVIDENCE: Recent college courses run at the home were well attended. The process of consultation of what new courses residents would like was well underway and possible tutors would be found. One individual was having a birthday party with friends attending, five residents were preparing for a night out and one other resident was out with a relative. Care plans showed access to luncheon clubs, day centres, pubs, restaurants etc – each was individual on a programme that covered seven days a week. Staff spoken with had a good understanding of personal and sexual relationships, ensuring privacy and confidentiality was observed – perhaps too much so as no mention of this need and therefore no instruction for staff was made in a care plan. Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 Page 12 An example of self determination and respecting resident choice was that staff made appointments for one individual for eye tests, chiropody and dentist. On occasions attendance was refused and staff respected this decision and documented the information. Another positive example was that one resident had purchased two Siamese cats. The rights and responsibilities in this purchase were well thought through and appropriate support put in place to enable a positive choice to purchase and care for the cats. Mealtimes in the house can be rather overcrowded with residents from the flats coming over as there are no dedicated staff in the flats. At a weekend staff in the house produce a full Sunday Roast and 2 other meals a day from the small kitchen to feed eleven people. The dining room would be very cosy to fit everyone plus staff in. Six residents were asked about the food, all felt the food was very good and that there was enough of it. Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 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 standard(s) 18, 19 Promotion of health is clearly taken seriously with health care monitored. Referral to other specialist services and good working relationships are maintained. EVIDENCE: Two residents expressed their positive view about staff in the way that staff help and support them. Six residents are registered at the local surgery in Combs and support of the District Nurse comes from here. One resident had recently had an accident and had to go into hospital for treatment. The appropriate health care services had been accessed promptly and the person was making a good recovery. Two other residents had been referred to Walker Close, a Health Authority Resource in Ipswich for people with learning disability. A detailed assessment and treatment for those individuals was underway. The manager had a letter from Community Nurses praising recent staff communication. The referral to a dietician that was a requirement at the last inspection had been actioned and the associated resident was now doing well A light had been installed in the drug cupboard in the lounge. Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 Page 14 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 standard(s) 23 The home has a good understanding of what to do in the case of dealing with allegations or suspicious abuse. EVIDENCE: The policy and procedure for reporting a suspicion of abuse had recently been activated in respect of a concern raised by the home. A POVA (Protection of Vulnerable Adults) investigation is continuing. All relevant parties had been informed and agreements with the home were in place, thus protecting the resident as far as possible. The manager and staff spoken with all had a good understanding of their duty if they suspected abuse. Staff confirmed attendance at training. Local agreed policies were in place. Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 Page 15 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 standard(s) 24, 25, 26, 28, 30 The environment at Combs Court suits the people who live there. Maintenance is planned, but lack of a person on site may eventually lead to minor matters not being attended to. The use of communal areas should be monitored to the ensure the people who’s home it is are not taken advantage of. EVIDENCE: At the last inspection two maintenance issues were required, these had both been actioned. The kitchen in the home looks good and staff were pleased with the refurbishment. The kitchen does need painting and a new blind. It fell when the inspector touched it. In the coming year the manager confirmed a replacement plan for many of the homes carpets as these were looking tired and worn and many were originals when the home opened. Residents bedrooms were comfortable, had the appropriate furniture for the individual resident and were personalised. Residents spoken with liker their rooms and were proud of the décor. Due to not having a maintenance person in post since last November the homes plan to decorate rooms had fallen behind schedule. The lounge areas in bungalow one of the house were homely and had enough arm chairs of Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 Page 16 differing designs to meet the needs. As earlier stated the house could be rather cosy due to so many people trying to share the available communal space. This was evident as people gathered to go out for the evening and people from the flats came into both the house and bungalow for the evening. Laundry area in the house was clean and with good equipment. All areas seen were clean and without any odours. The manager explained that a new washing machine was due to be installed in the bungalow so that any foul laundry could be appropriately laundered. Evidence of the order for a HW94 machine was seen. The grounds and gardens were beautifully maintained. One member of staff believed that kitchen equipment had moved from the flats to replace that in bungalow one. This was not confirmed as the resident of the flat had gone out for the evening. Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36 People who use this service can be assured that staffing levels are being maintained. But they cannot be assured that all staff are competent and qualified to the same level. EVIDENCE: Staff spoken with in the house were all friendly and keen to demonstrate their competence through interaction and support of the residents, training that had been planned, qualifications they had obtained and the care plans they were responsible for. These staff sought comment and asked questions of the inspector and confirmed they were adequately supervised. Staff in bungalow one were not of the same calibre. One person lacked training in how to deal with challenging behaviour, even though they were placed in a potential situation. One person was defensive with the inspector and abrupt with the residents. One person did not appear confident in the role they had and sought guidance from fellow workers who quickly gave support. All staff spoken with stated they were working additional hours at the home and wanted to give consistency to the resident group. When this was discussed with the manager and recent timesheets were examined, additional hours had been worked, but not in the quantity described by staff. The manager had worked many care hours in the last month, including night shifts. Staff and manager confirmed that hours to support residents in the flats had to be used from existing hours in the house and bungalows. No separate hours Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 Page 18 existed. Staffing levels currently are two care staff at all times during the day for each of the bungalows and house. There were four waking night staff for the whole establishment at night. There was also a manager on call if needed. The rota was very complex, but it did show high usage of agency/additional hours worked to cover the current 4.5 whole time equivalent vacancies in care staff. Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 42, 43 People who use this service can be assured that the home is well run and that their welfare and safety is promoted & protected. EVIDENCE: The Registered Manager Mrs Joanne Woodhead is competent and enthusiastic in her management of Combs Court. She is well qualified in NVQ 4 and NVQ 3 in care. The manager , Mrs Woodhead also manages the domiciliary care service run from Combs Court, so her time is split between the two, but is well supported with the back up of deputies in each service. When these arrangements were confirmed the manager stated that the back up of deputy was supernummary in the care home had now been withdrawn from the budget. Currently this had no effect on practice as individuals were employed to those jobs. Residents and staff spoken with were all positive about managers in the home and found them all approachable and said they were listened to. Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 Page 20 Staff training to ensure the health and safety of residents is ongoing. Training currently included COSHH (chemicals) training last week along with Health & Safety training. On the day staff had attended Moving & Handling training and food hygiene training was planned. Some staff spoken with confirmed that they had undertaken 2 days training Non-violent Crisis Intervention. Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 Page 21 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 x 3 x x 2 Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 x 3 x 3 Standard No 11 12 13 14 15 16 17 2 3 3 3 2 3 3 Standard No 31 32 33 34 35 36 Score 3 2 2 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Combs Court Residential Home Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x 3 3 I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 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. Standard 5 Regulation 5(3) Requirement evidence of costed contracts statement of terms and conditions between the home and resident must be available for inspection. This is a repeat requirement from 12/10/04 Care plans must establish individualised procedures for residents likely to have have challenging behaviour. Staff must be clear as to what they are permitted to do in each circumstance, for how long & how frequently to repeat. This is especially requred in using physical restraint. Residents in the flats must have more opportunities given to them to develop independent living skills. Care plans must inlcude information and specialist guidance for residents who wish to develop and maintain intimate relationships. All staff who are asked to work with residents who are potentially challenging must have the appropriate training before being placed in a potential harmful setting. Timescale for action 31/05/05 2. 6 15 13 (7)(8) Immediate 3. 11 16 (2)(h) 31/05/05 4. 15 15 (1) 31/05/05 5. 32 18(1) (c) (i) Immediate Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 Page 23 6. 33 18(1) (a) With reference to the flats in particular - the ratio of care staff to residents must be reviewed according to assessed need by using the residential forum Guidance published by the Department of Health. Immediate 7. 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. 3. Refer to Standard 1 20 28 Good Practice Recommendations The next time the Statement of Purpose is reviewed it should include reference to the condition of the home to accommodate 8 people over 65. The PRN (as and when required) drug sheet should include symptoms to be observed by staff prior to administration of medication. The use of shared space in the house and bungalows should only accommodate people fom other parts of the home when invited by residents - not as a regular way to manage meals and social interaction due to lack of staff. The policy & procedure produced by Creagmoor on laundering linnen should be made more relevant for staff at Combs Court. The manager should use supervision to discuss matters with staff about confidence and translation of the homes philosophy and aims into work with individuals e.g. approach to residents. 4. 5. 30 36.4 Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 Page 24 Commission for Social Care Inspection St Vincents House Cutler Street Ipswich IP1 1UQ 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 Combs Court Residential Home I54-I04 S24362 CombsCourt V226155 050404 Stage4.doc Version 1.30 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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