Inspection on 07/06/06 for Combs Court Residential Home

This inspection was carried out on 7th June 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Combs Court Residential Home 07/11/07

Combs Court Residential Home 07/02/07

Combs Court Residential Home 13/09/05

Combs Court Residential Home 04/04/05

Combs Court Residential Home 12/10/04

Combs Court Residential Home 27/04/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

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 Jane Higham and Deborah Seddon Unannounced Inspection 7th June 2006 10:00 Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 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 Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Combs Court Residential Home Address Edgecomb Road Stowmarket Suffolk IP14 2DN 01449 673006 01449 674203 combcourt@craegmoor.co.uk www.craegmoor.co.uk Parkcare Homes (No. 2) Limited 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 30 Category(ies) of Learning disability (30), Learning disability over registration, with number 65 years of age (8) of places Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 13th September 2005 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 Craegmoor 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 accessed 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 DS0000024362.V298627.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced Key Inspection of Combs Court, a thirty bedded residential home for adults with learning disabilities, situated in the village of Combes Ford. The inspection was carried out on 07 June 2006 by Inspectors Jane Higham and Deborah Seddon over a period of seven hours. The Key Inspection focused on the care standards relating to Care Homes for Adults. The report has been written using accumulated evidence gathered prior to and during the inspection. The National Minimum Standards and Care Homes Regulations 2001 are referred to throughout this report and any non compliance identified. All key standards were assessed as part of this inspection. The manager of the home was not present for the morning period but joined the inspectors later in the day. The Deputy Manager was present and assisted with the inspection process. The Inspectors had the opportunity to talk to both residents and members of staff who were on duty. What the service does well: What has improved since the last inspection? Since the previous inspection, the management team and newly appointed training co-ordinator have worked hard to ensure that staff have received all the necessary elements of training which will enable them to carry out their Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 6 roles in a competent manner. Whilst a few shortfalls remain, all training needs are audited and mapped out in an overall training plan. 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. Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 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 Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 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, 3 and 5 Prospective service users could not necessarily be assured that they would be provided with sufficient information to enable them to make a decision about whether they would like to live at the home, although this information does exist. Prospective service users can expect to receive an assessment of need prior to being offered a placement. Newly placed residents could not necessarily expect to be provided with a contract and a copy of the terms and conditions of placement. EVIDENCE: The home was able to evidence that it had produced a Statement of Purpose, which had recently been updated with the details of the newly appointed manager. It was noted that whilst the Statement of Purpose contained all the information as required under Schedule 1 of the Care Homes Regulations 2001, it did not state the service user group for which it had been registered, nor does it give an age range for which the service is provided. The home’s current registration with the Commission enables them to accommodate eight service users who have a diagnosed learning disability built are over the age of 65. The list of residents seen at the time of the inspection indicated that in fact the home was accommodating eleven residents who fall into this category. Whilst the owning organisation had made an application to the Commission to vary their registration to include an additional three people over the age of 65, this was returned to the Responsible Individual as it did not contain all the required information and required amendment. To date the Commission has Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 9 not received the amended application back and therefore the home is currently accommodating service users who are outside its registration. The home was able to evidence that it had produced a Service User Guide in a format which was appropriate to the needs and abilities of the service user group. This was seen at the time of the inspection and was produced in a well presented pictorial format. For the purposes of the inspection, the inspector examined the admission documentation and assessments carried out in relation to four service users. In the case of two of the four service users selected for the purposes of care tracking, the home was unable to evidence that a placement contract had been provided and in all four cases a terms and conditions document had not been provided. The home was able to evidence in three of the four cases that residents had been provided with a full assessment of need before being offered a placement. Concern was expressed by the Inspector as to the transfer of one resident from one of the supported flats to Bungalow 2 which is a resource for people with challenging behaviour. The service user was unhappy and felt isolated living in the flat but the decision to transfer to Bungalow 2 was a resource led one and not based on an assessment of need. The service user functions at a much higher level than others within the house and is not able to be supported to fulfil their potential within this setting as staff have to focus on the challenging behaviour exhibited by other service users. Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 10 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, 8 and 9 Residents can expect to have care plans, which reflect their needs, however they cannot expect to have individualised procedures in place to manage challenging behaviour, which will protect them from injury EVIDENCE: The care plans of four residents were inspected to track their care and the level of support they required. Care plans consisted of four sections, assessment, planning, implementation and evaluation. These provided detailed information about the resident’s needs relating to all aspects of their health, personal and social care. Evidence was seen that long and short-term goals had been identified and recorded for each resident. These ranged from booking a holiday, maintaining contact with family and friends and more practical tasks such as encouraging one resident to maintain a degree of independence by managing their own personal hygiene and day-to-day tasks, for example changing their sheets on their bed and help to prepare and cook simple meals. Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 11 A requirement was made at the previous random inspection in March 2006 for care plans to have established individualised procedures for residents likely to have challenging behaviour. It stated that staff must be clear as what they are permitted to do in each circumstance, for how long and how frequently to repeat, especially where physical restraint is required. Evidence was seen that a management of challenging behaviour plan for one resident had been partially completed. The plan consisted of known triggers, a proactive plan to ensure staff are consistent in their approach to avoid situations which trigger their behaviour. A reactive plan detailed the approach and support staff should take when the resident’s behaviour became challenging to others. A strategy was being developed for each scenario that triggered changes in their behaviour, however only one scenario had been started. Care plans and risk assessments are updated and reviewed monthly, a summary of behaviour is recorded by the resident’s key worker who identifies where changes, if any need to be amended in the care plan to reflect the residents current needs. Risk assessments are in place for nutritional and moving and handling needs and other specific issues related to the individual. For example one resident likes to investigate and dismantle appliances and other pieces of equipment, a risk assessment had been completed to prevent the risk of hurting themselves from possible electric shocks. The communication needs of individual residents had been identified. One resident has received support from the speech and language therapist to improve their method of communication. They have good verbal understanding and uses makaton sign language to communicate. They also have an electronic communication aid (liberator), however the manager informed the inspector that this was currently broken. Residents are kept informed and encouraged to participate in the running of the home. The minutes of the last meeting on the 16th May 2006 were seen where issues were discussed about changes in the staff team, residents were consulted on accessing the Stowmarket resource centre, future outings and quality and choice of food. Residents are supported to make choices. Evidence was seen where a resident with limited verbal communication wanted to change their shirt. They led the carer to their wardrobe and pointed to the shirt they wanted to wear, the carer suggested that they wait until they had had their lunch, but the resident took the shirt out of the wardrobe and handed to the carer, who proceeded to help them change. Where possible residents are supported to look after their own money. They each have a wallet with personal monies held in the office, which they have access to through the administrator. A personal money record sheet is kept Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 12 which details all transactions. The wallet of one resident was checked against their personal record sheet and was found to be accurate. The home has good measures in place to protect residents from financial abuse, two staff are required to complete any transaction and weekly audits are undertaken which the manager verifies. Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14, 15 16 and 17 Service Users can expect to be provided with opportunities for activity and to access local community resources, although this is mainly dependent on the time available to care staff. Residents can expect to make choices from a planned menu of meals, although the variety of meals available can be somewhat limited. EVIDENCE: The home has its own day centre which is for the use of residents and overseen by the Activities Co-ordinator. This resource was not open on the day of the inspection as this member of staff had taken some residents out swimming and then for lunch accompanied by the Manager. Evidence was seen in care plans that residents are supported to access day care services; gateway and target clubs and have regular visits to and from family members and friends. One resident attends a drop in café in Stowmarket. Another resident informed the inspector they attended church alternate Sundays in Thurston, where they met old friends. Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 14 Three residents are funded by social services to receive one to one support. One residents care plan seen reflected that they have a day care programme in place which enables them to access social activities of their choice, for example attending gateway, target club and going to the pub to play snooker, swimming, bowling, listening to music and watching football on the television. Residents are supported to access the community by means of public transport. One residents care plan contained a Suffolk saver bus pass to access local transport and Mid Suffolk key card, which enabled them to travel free and obtain useful discounts at shops, restaurants and other attractions. In each of the bungalows and the house there is a notice board displaying items of interest for the residents. There are plans in place for a fete to celebrate 10 years that the home has been open; they are planning to have a BBQ. An amenities committee has raised money to purchase a new BBQ and gazebos. Two residents were observed sitting in the garden under one of the gazebos, knitting, they were happy to chat with the inspector telling them of the places they had recently visited which included Bressingham steam museum, the Zoo, bowling, tombola and gateway club. The inspector was invited to join residents in the house during their midday meal. Residents were observed enjoying the social occasion whilst eating a snack lunch of hot dogs, followed by cake and fruit. They informed the inspector they would be having roast chicken and trimmings for their supper. Concerns were raised at the April 2006 inspection that mealtimes in the house could be rather overcrowded and that residents in the flats were not getting the support they required to prepare their own meals. There was no dedicated member of staff on duty in the flats on the day of the inspection therefore two of the residents from the flats had joined those in the house for their snack, however three residents, two from the house and one from the flats were at day care centres, leaving six people having their lunch in the house. Staff in each of the bungalows and the house are responsible for purchasing food. The inspector was informed that residents discuss and decide on the menu for the week and can accompany staff to the local supermarket if they choose too. Evidence was seen that residents are offered a choice of suitable menus, which included the specific dietary requirements of a resident with diabetes. A range of diabetic foods was seen stocked in the fridge and cupboards. One resident’s care plan reflected that they were supported to access a dietician who had been issued with a healthy diet book and a record made that there was no need to introduce supplements at this time. The Inspector spent some time on Bungalow 2 where residents exhibit challenging behaviour. Apart from input from the activities co-ordinator staff are required to provide residents with day to day activities within the home. The Inspector looked at the day care plan for one resident accommodated on bungalow 2. Whilst this plan confirmed that a timetable of activities had been Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 15 produced this was very much dependent on the time available to staff. Staff are also required to prepare meals for residents, shops for provisions, attend to domestic chores which includes the laundering of residents clothes. It was clear from discussions with the resident concerned that they were not receiving the range and scope of the activities as identified on their day care plan. Prior to writing this report five service user survey feedback forms were received by the Commission. Three our of the five respondents stated that there were never activities arranged by the home which they could take part in. The home was able to evidence that residents’ rights to privacy are protected and that all bedrooms doors are fitted with appropriate privacy locks. Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 16 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, 19, 20 and 21 The home has detailed care plans in place, which identify residents physical and emotional health needs. Residents can expect to be supported to access health professionals and be protected by the home’s procedure for dealing with medication. EVIDENCE: The resident group at Combs Court have diverse needs, which are recognised in their individual care plans. Evidence was seen that residents are supported to access routine healthcare appointments, such as the dentist, doctors and other specialist healthcare providers. One resident spoken with told the inspector that they had arthritis; this was confirmed in the physical and psychological well being section of their care plan. The resident had visited a pain relief clinic where they had been prescribed regular medication to manage their pain and discomfort. The resident had been issued with a bed, which raised and lowered to enable them to get in and out of bed. They had also been provided with a specialist mattress, for the prevention of reoccurrence of pressure sores. A community physiotherapist had visited the resident at the home and devised a set of exercises to help the resident maintain their mobility. Staff assisted the resident to complete gentle exercises, which manipulated the feet and ankles. Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 17 The resident has been issued with other equipment to help them maintain their independence, they use a walking frame whilst moving around the home and a battery operated wheelchair to access the community, this was supported in the individuals moving and handling assessment. The care plans provided good evidence of dates of GP and other professional visits with the outcomes of the visits recorded providing a good account of the residents general state of health and well being. Evidence was seen that a medication change sheet was completed following visits by the general practitioner were they had made changes to the residents medication. A GP comment card received by the Commission indicated that although there had been one medication administration error, in general the respondent was satisfied with the service delivered to residents. The procedure for administering medication was looked at in bungalow 2. Due to the complex needs of the residents none of them self medicate. The medication is kept locked in a cupboard in the dining area. A record of the temperature is kept to ensure that medication is stored correctly. The readings indicated that the cupboards were within the recommended temperature. The team leader is responsible for the ordering, storage, administration and returns of medication. Medication is ordered monthly, checked and signed in by two people. The last delivery had been missing medication which the team leader had identified and immediately contacted the dispensing pharmacy. They showed the inspector a copy of the fax sent and a record of the tablets when they were delivered to the home. The front of each medication administration record (MAR) chart had a photograph of the resident for identification and their personal details. All the MAR charts checked were signed and dated appropriately. Medication was either blister packed or provided in boxes with the pharmacy label attached. The team leader explained that they keep a record and ongoing stock check of medication dispensed in boxes, the list was kept at the front of the MAR chart folder, with an ongoing record of the amount of tablets the resident has left. The checklist of one resident tracked during the inspection was seen and was found to be accurate. Evidence was seen in the residents care plans that their wishes in the event of death and dying had been sought and recorded. Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 18 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 and 23 In general, residents can expect to be provided with sufficient information to enable them to raise any concerns they may have or to make a formal complaint. Improvements could be made in relation to the home’s recruitment procedures to ensure that as far as possible no residents are placed at risk. EVIDENCE: The home was able to evidence that it has a clear complaints procedure which is produced by Craegmoor Ltd., and a copy is displayed within the reception area of the building. The complaints procedure is also included as part of the Service User Guide. The home has a complaints book which is available in the reception area, where residents or visitors to the home can log any complaints or concerns they may have. Out of the five service users surveys returned to the Commission, three respondents indicated that they would know how to make a complaint. The one relative /visitor questionnaire received by the Commission indicated that the respondent was unsure of how to make a complaint. The service needs to ensure that residents and their advocates and families are provided with this information. The home was able to evidence that all prospective staff members are subject to a POVA First check before commencing duties and thereafter an Enhanced Disclosure via the Criminal Records Bureau. Concern was expressed at the inspection as to the limited information contained in two references provided in support of a job application, especially as a positive Enhanced Disclosure had also been received. Records in relation to staff training confirmed that staff members are provided with training in relation to the recognition and reporting of abuse. Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 19 Since the previous inspection no complaints have been received by the Commission in relation to this service. Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 20 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, 26, 27, 28, 29, 30 Residents can expect to live in a home that meets their needs in a safe and homely atmosphere, however there needs to be a continued programme of decorating and maintenance of the home and equipment. The home needs to review policies and procedures for infection control. EVIDENCE: Combs Court is situated in the small village of Combs Ford and is close to the village centre. It is within walking distance of several shops and a bus link into Bury St Edmunds and Ipswich. The home is made up of two eight bedded bungalows; one eight bedded house, one double and four single flats. There is also an office block with a day care centre. The inspector made a tour of the building and grounds. The gardens are landscaped and beautifully kept, separating the bungalows, flats and houses and creating private areas for each. An amenities committee have recently raised money to have the patio areas outside the day centre and each unit extended for residents to sit outside in the nicer weather. Bungalow 2 is a special needs unit, with seven residents. They currently have one vacancy. Each of the service users has their own room, which were nicely Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 21 decorated reflecting their personalities with personal items and furniture. Additionally there is a range of communal areas accessible to all residents consisting of a lounge, dining room and kitchen. The bungalow has one bathroom and one walk in shower with a toilet shared between the seven residents. There is an additional toilet available. Each resident’s room with the exception of one has a hand washbasin in their bedroom. The washbasin was removed from one residents room as they were considered at risk, as they have in the past removed it from the wall, they have access to the bathroom directly across the hall from their bedroom. Residents toiletries and personal prescribed creams and soap were being stored in the bathroom and shower room. These were taking up a lot of space and were the personal items of the residents which should be kept in their rooms and not stored or used communally to prevent the risk of the spread of infection. Overall, Combs Court overall provides comfortable and homely accommodation. There has been a programme of redecoration; both bungalows and the house have had the kitchens, bathrooms, hallways and a number of residents bedrooms painted. Some of the existing carpets and lino were rucked in places, which is a tripping hazard. The inspector was informed that the home have obtained several quotes for new flooring in the kitchens, dining areas and lounges, however the quotes were missing and were unavailable for inspection. Some of the furniture in the bungalows and the house could co with replacing, armchairs are looking old and worn, in the house one armchair had no cover and the cover on the sofa was coming apart. The radiator in the room of a resident in the house needs repairing the top was bent which was protruding upwards with sharp edges. The home has now employed a maintenance person, who was spoken with during the inspection. They informed the inspector they are contracted to work 20 hours a week and that they are working through a programme of decorating to complete the dining rooms and lounges in each of the bungalows, flats and house. The home has used the assistance of a relief maintenance person to help with the decorating programme and employ a separate gardener. Two requirements were made at the inspection on the 28th April 2006, with regards to infection control. Terry hand towels have been replaced with paper towel dispensers in all bathrooms and toilets. An agreed and written procedure has been implemented for the cleaning of commodes. Staff informed the inspector they were disinfecting commodes, however evidence was seen in bungalow 2 that a commode pan was still being stored on the floor in the bathroom, thus compromising dignity and hygiene. Protective equipment such as gloves and aprons were available in all bathrooms. Some of the toilet brush holders seen were dirty and needed cleaning or replacing. Buckets with mops Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 22 left in were seen left in bathrooms, the mop heads looked dirty and needed replacing. Mops need to be stored properly to prevent contamination. The procedure for dealing with soiled linen was being managed well; the home has purchased and installed a washing machine in Bungalow 2 with a sluicing programme. Staff were seen using red dissolvable bags, which were put directly into the washing machine on the sluicing cycle. Generally the premises were found to be clean and tidy, however there were two rooms in bungalow 2 which had an unpleasant odour, there needs to be better systems in place to ensure thorough cleaning and management of continence. As a result of an immediate requirement left at the inspection in April 2006, bungalow 2 has had the bath fitted and the bathroom decorated. The bathroom door however has a whole in the door where the door lock should have been. The maintenance person had tried to obtain a lock, which was compatible with the master set of keys. A lock must be fitted to provide privacy and dignity for residents using the bathroom. Residents have a key to access their room. Residents in bungalow 2 have decided to keep their doors locked as one resident has a tendency to enter their rooms with out permission. The inspector discussed with the team leader how the resident with physical disabilities and limited communication was able to gain access to their room. They informed the inspector that the resident will gently grab hold of a member of staff and gesture that they wish to go to their room by leading the member of staff. The resident was observed entering their room in this way. Residents who live in the house only have a stairway as a means of accessing the first floor, as residents are getting older they are finding it more difficult to manage the stairs. The inspector was informed that there had been some discussion about fitting a lift between the two floors. One resident whom is a wheelchair user has a bedroom situated in the house at the end of the corridor which is next to a fire exit, however the fire exit had three steps leading to the pavement. The inspector was advised that quotes had been obtained to build ramps. These were not available for inspection. Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 23 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, 33, 34 and 35 Residents living at the home can expect to be supported by staff members who are qualified, competent and knowledgeable about their needs. EVIDENCE: On the day of the inspection, the home was being staffed by the Manager, although he had taken some residents out swimming, the Deputy Manager, who was about to relinquish her post to concentrate on her responsibility for homecare services and an administrative assistant. The staffing rota confirmed that the house and Bungalows 1 and 2 were provided with two members of care staff. Three staff were also providing one to one support for service users. The staff allocated to each house and bungalow were also expected to provide support to the four residents who were accommodated in the flats. The staffing rota indicated that there was one member of staff who was allocated to providing support to the residents who were accommodated in the flats, although that person had been unable to fulfil their duties as they had been required to cover a vacant night shift. Whilst the level of staffing provided on each house could be viewed to be adequate to provide direct care to residents, the responsibilities of the staff are so varied and include so many domestic tasks that the provision of social care, support in activities of daily living and leisure activities has suffered. The Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 24 provider organisation needs to review the levels of staffing provided to ensure that the individual needs of service users, both social and personal are met. Staff members spoken to felt that they were under pressure and not able to provide appropriate activities for service users as they were involved in so many domestic tasks. As part of the inspection process, the Inspector examined the personnel files of the two most recently employed staff members. The home was able to evidence that required documentation in relation to the employment of staff was retained in compliance with Schedule 2 of the Care Homes Regulations 2001. Issues in relation to the quality of written references has been addressed under the Complaints and Protection section of this report. Since the previous inspection an overall training record has been produced which confirms which members of staff have undertaken certain areas of training. Training plans confirmed that staff had undertaken mandatory training. Care staff who were allocated to work in Bungalow 2 had been provided with training in Control and Restraint techniques and others had undertaken training in Non-aggressive Intervention. Since the previous inspection all staff had undertaken training in infection control via a Craegmoor Ltd. learning pack. Some training shortfalls still existed ie basic food hygiene and health and safety and these need to be addressed without delay. Newly employed staff were provided with an Induction Training Package. Since the previous inspection, staff have all been provided with medication training. The home employs a staff group of 53 of which 17 have obtained NVQ qualifications. One team leader has achieved an NVQ Level 4 in care. Another seventeen staff are working towards NVQ qualifications at Levels 2 and 3. Of the five service user surveys submitted to the Commission , four respondents confirmed that staff were always available when they were needed. Whilst staff personnel files confirmed that some staff members had been provided with formal supervision, this appeared to be on a sporadic basis. Two of the four staff members selected for the purposes of tracking had not received any formal supervision since their employment. Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 25 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): 37, 38, 39, 42, 43 People living in the home cannot be assured that the present management systems ensure their protection, health, safety and welfare. EVIDENCE: The manager is currently not registered with the Commission for Social Care Inspection (CSCI). They are in the process of obtaining an application to become the registered manager. The home has suffered from an inconsistent management structure in recent years and it is now a priority to ensure that the provider organisation proposes a manager for registration with the Commission. The Manager is currently working towards a National Vocational Qualification (NVQ) level 4 in care and are waiting to be registered and to commence the Registered Managers Award (RMA). Feedback from staff and residents indicated that they found the new manager to be helpful and approachable, however, the manager needs to be aware of their role and that they provide a clear sense of direction and leadership to the staff and residents. Currently the manager has been covering night and day Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 26 shifts on the rota as well as trying to manage the home and the domiciliary care agency. The manager was out on the day of the inspection accompanying residents swimming, they retuned early in the afternoon to meet with the inspectors. The frequency of the Responsible Individual visiting the home to conduct monthly unannounced visits to comply with Regulation 26 of the Care Home Regulations 2001 were discussed with the deputy manager and the administrator. These visits are to inspect the home, and interviews with staff and residents should take place. A written report must then be forwarded to the manager and the Commission for Social Care Inspection (CSCI.) the last copy of the regulation 26 was received by the CSCI in December 2005. The administrator provided evidence at the inspection that these visits had occurred in January and February 2006. The homes business plan for 2006-2007 was seen, which reflects six objectives with targets and the action and support required to achieve the objectives set out in the plan. The objectives covered areas leading the business forward, financial management, customer focus, team excellence, compliance and control and a marketing plan. The Commission for Social Care Inspection (CSCI) certificate of registration was seen displayed in the entrance hall along with insurance certificates for motor insurance and employers liability insurance, covering property, damage business interruption and residents effects. During a tour of the home the fridges and freezers in both bungalows and the house were checked. They contained a good range of food, however a records showed that fridges temperatures were to high and above the recommended temperature of 1-5 degrees centigrade. Readings were consistently ranging between 6.6 – 10.8 degrees centigrade. Weekly health and safety checks were being carried out to monitor hot water temperatures, however it was noted that hot water delivered to the handbasin in the toilet sited in the reception area, which is not only used by visitors but also day service users was of an excessive temperature and constituted a health and safety risk. One service user advised the inspector that they had suffered a recent fall which was confirmed by the care staff. However it was noted that this accident had not been recorded on the appropriate record. It was identified that when an accident occurs an Incident Report is completed by the responsible staff member and then passed to the Management team, a member of whom completes the accident record. Best practice would suggest that the member of staff who has witnessed the accident or found the service user following any accident should complete the accident record to ensure that it does not contain “second-hand” information. Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 27 The Inspector also examined the system for the recording of any control and restraint interventions employed. At the present time these are recorded on an incident report form. These reports were found to be limited in their content and should include the timing of the Control and Restraint intervention, the staff members involved in the restraint and the part of the service users body held by each. Records maintained for the testing of fire alarm and detections systems were examined on bungalow 2. It was noted that whilst there was evidence to confirm that fire alarm systems were tested this was often not on a weekly basis in compliance with the recommended test frequencies as issued by the Suffolk Fire Service. Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 28 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 Standard No Score 1 1 2 2 3 2 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 x 32 3 33 1 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x LIFESTYLES Standard No Score 11 2 12 x 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 2 x x 2 3 Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 29 YES 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 YA1 Regulation Sch. 1 Requirement The Registered Persons must ensure that the Statement of Purpose includes the range of needs and the age range of service users for whom it intends to provide a service. The Registered Persons must ensure that the home does not accommodate residents who are outside of the agreed category of registration. The Registered Persons must ensure that placements within the home are on a needs led, rather than a resource led basis. The Registered Persons must ensure that evidence of placement contracts and terms and conditions must be available for inspection. (This is a repeat requirement from 12/10/04 04/04/05, 13/09/05 and 02/03/06) The Registered Persons must ensure that resident Care Plans establish individualised procedures for residents likely to have challenging behaviour. DS0000024362.V298627.R01.S.doc Timescale for action 20/07/06 2 YA1 Section 24 of the Care Standards Act 2000 14(1)&(2) 07/06/06 3 YA2 07/06/06 4. YA5 5(3) 30/07/06 5. YA6 1513 (7)(8) 30/07/06 Combs Court Residential Home Version 5.2 Page 30 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 required in using physical restraint. (This is a repeat requirement from 04/04/05, 13/09/05 and 02/03/06.) 6. YA11 16 (2)(h) The Registered Persons must ensure that the residents accommodated in the flats have more opportunities given to them to develop independent living skills. (This is a repeat requirement from 04/04/05, 13/09/05 and 02/03/06) 17/08/06 7. YA14 16(2)(n) 8. YA24 The Registered Persons must 17/08/06 ensure that service users are offered a range of leisure activities which are appropriate to their needs and abilities. 23(2)(e)(f)(i) The Registered Persons must 17/08/06 ensure that internally the premises are kept in a good state of repair and a programme for maintenance and renewal,for decoration and furniture within the home is maintained, therefore: * Quotes obtained for the replacement of carpets must be submitted to the CSCI as evidence that work is in progress. * A privacy lock (with an override device) must be fitted in the bathroom of Bungalow 2. Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 31 * The radiator in the room of a resident in the house requires fixing. The top is bent and protruding upwards and therefore presents a health and safety hazard. * Furnishings must be in good condition and good quality and appropriate for use within a learning disability service. 9. YA30 13 (3)23 (2)(d) The Registered Person must ensure that the premises are kept clean and hygienic throughout and systems are in place to control the spread of infection. Therefore: * toilet brush holders require thorough cleaning. * Systems are in place for the management of continence * The current systems for the storage of mop heads and buckets must be reviewed including infection control measures. * Storage of commode pots when not in use, including infection control measures. 10 YA33 18(1)(a) The Registered Persons must undertake an urgent review of the current level of staffing provided and ensure that it is sufficient to meet the personal and social care needs of individual residents. The registered persons must ensure that the staffing level is sufficient to ensure the cleanliness of resident DS0000024362.V298627.R01.S.doc 07/07/06 20/07/06 Combs Court Residential Home Version 5.2 Page 32 11 YA34 19(4)(c) 12 YA35 18(1)(c)(i) 13 14 YA36 YA39 18(2) 26 15 YA42 16(2)(g) 16 YA42 13(4)(a)&(c) 17 YA42 Sch.4.12(a) 18 YA42 13(8) accommodation and that residents are provided with meals which are nutritious and varied. The Responsible Person must provide the Commission with evidence that the current staffing level is appropriate. The Registered Persons must ensure that prior to any prospective staff commencing duties that two satisfactory references are received. The Registered Persons must ensure that staff working at the care receive all areas of mandatory training. The Registered Persons must ensure that all staff receive formal supervision sessions. The Registered Persons must ensure that where the Responsible Individual conducts regular monthly visits to the home under Regulation 26 of the Care Homes Regulations 2001, a written report must be produced and a copy submitted to the Commission. The Registered Persons must ensure that fridges are maintained at the recommended temperature range of 1 – 5 degrees. The Registered Persons must ensure that hot water delivered to the hand – basin sited in the reception and day centre area remains at a safe temperature of approximately 43c. The Registered Persons must ensure that all accidents occurring in the home are documented. The Registered Persons must ensure that all incidents where restraint is used are recorded DS0000024362.V298627.R01.S.doc 07/06/06 17/08/06 20/07/06 06/07/06 06/07/06 07/06/06 07/06/06 07/06/06 Combs Court Residential Home Version 5.2 Page 33 19 YA42 23(4)(c)(v) and include details of the duration of the restraint, the staff members involved and the body parts held. The Registered Person must ensure that fire detection systems within the home are tested on a weekly basis (in line with guidance issued by the Suffolk Fire Service) and that these tests are documented. 07/06/06 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 Refer to Standard YA24 Good Practice Recommendations The Registered Persons should ensure that residents should be supported to maintain their personal possessions and equipment in working order; the communication aid of one resident needs to be repaired. The Registered Persons should ensure that armchairs and sofas have spare covers, when existing covers required repeated laundering and repair. The Registered Persons should ensure that accident records are completed by the staff member who has at first hand witnessed the accident or was the first person to discover that the accident has occurred. 2 3 YA42 YA42 Combs Court Residential Home DS0000024362.V298627.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk 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 DS0000024362.V298627.R01.S.doc Version 5.2 Page 35 - 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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