Inspection on 13/07/06 for Coombe

This inspection was carried out on 13th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Coombe 29/06/07

Coombe 10/11/05

Coombe 23/05/05

Coombe 15/01/05

Coombe 13/07/04

Similar services:

Fairfields Country Rest Home

Fairfax House

Claremont Nursing Home

Doveridge Care Home

Dunmore

Chatsworth

Dunraven Lodge

Eastleigh Care Homes, South Molton

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

CARE HOMES FOR OLDER PEOPLE Coombe 321 Canford Lane Westbury-on-Trym Bristol BS9 3PS Lead Inspector Sandra Gibson Key Unannounced Inspection 13th July 2006 2:45pm X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Coombe DS0000035952.V296670.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 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. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coombe Address 321 Canford Lane Westbury-on-Trym Bristol BS9 3PS 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) 0117 3772580 0117 3772581 Bristol City Council Patricia Vera Willis Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th November 2005 Brief Description of the Service: Coombe is operated by the local authority and is registered by the Commission for Social Care Inspection to provide personal care and support for up to 30 people who are over 65 years of age and who have dementia. Coombe is situated in the Westbury Park area of Bristol in a quiet road with parkland behind and delightful views of the surrounding country. The nearest shops are 1/2 mile from the village of Westbury on Trym and the care home is located on a bus route. It is accommodated in a two-storey building with a shaft lift to the top floor. All bedrooms are single but do not have en suite facilities. There is a lounge on both floors and a dining room on the ground floor. There are several toilets near to communal areas. The building itself is based upon a long corridor and does not lend itself to small group living. The garden has a ramp making it accessible to wheelchairs, and is secure. It also has a pergola, garden table and chairs for residents to use in warm weather. The fees are £584 .99 /week and extra charges are made for chiropody, hairdressing etc. Currently this information is provided verbally prior to admission and then confirmed in writing within a new residents contract. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place midweek between the hours of 2:45pm and 8:30 pm. Evidence was gathered from: Examining previous correspondence with the home including Regulation 37 (Death illness, other events notifications) and Regulation 26 monthly reports complied by the nominated responsible individual, inspection reports, information from pre inspection questionnaire, relatives comment cards (3), GP comments cards (1) health professionals comments cards (2) talking to/observing residents, talking to the deputy manager and assistant officer /talking to and observing staff, talking to one visitor, talking to and case tracking four residents, examining records, policies and procedures. What the service does well: Residents’ placements continue to be fully reviewed following their admission to the home . This allows residents and their relatives to make sure that Coombe can meet their individual needs. There are systems in place to ensure that residents recive the appropriate health care at the right time .This ensures that the physical and mental heath needs of residents are well met. Coombe provides residents with good opportunities to experience a stimulating and varied life where various informal activities are regularly made available. Visitors are made very welcome and meals are well managed and provide daily variation, good nutrition and social contact for people. The home has a satisfactory complaints system with evidence that service users feel that their views are listened to and acted upon. The procedures for the recruitment of staff are satisfactory which protects residents from risk of harm. Arrangements for protecting residents from harm are good. These measures ensure that residents are protected as far as possible from risk of harm. The residents and staff team continue to benefit from an experienced manager who has encouraged an open style management approach. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 6 There are satisfactory systems in place to ensure those residents’ financial interests and valuables are safeguarded by the homes record keeping, policies and procedures. The system for accessing records that must be available for an inspection is satisfactory. This ensures residents best interests are maintained. What has improved since the last inspection? What they could do better: The system of providing residents with a written contract /statement of terms and conditions has deteriorated since the last inspection so residents and their representatives are not always informed of their rights when moving to Coombe. The support and training in place to meet residents’ individual mental health needs is very good. However, attention to dementia care training is required to ensure that residents’ specialist needs are fully met. The care planning system in place is only partially satisfactory. Further improvements must be made to ensure that residents individual personal and social care needs can be fully met. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 7 The medication administration system has improved considerably since the last inspection. However further minor attention is needed to ensure that the systems fully protect residents and staff. The care provided to residents at Coombe is of a good standard. Staff ensure that residents’ individual needs are met with privacy, dignity and respect both when they are alive and at the time of their death. However, staff may benefit from specialist training regarding equality and diversity and death and dying to support them in their work. Arrangements for protecting residents from harm are good. These measures ensure that residents are protected as far as possible from risk of harm. Urgent action needs to take place with regards to the cleanliness comfort and safety of the home to ensure that residents live in a safe well maintained environment. Health and safety checks are not wholly satisfactory. Further urgent attention must be given to these checks to ensure that the health, safety and welfare of residents and staff is promoted and protected at all times. Please note that enforcement action may need to take place if ongoing requirements are not met in the timescales laid down 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. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Information and the way it is provided to prospective residents and their representatives has been reviewed and up dated following the last inspection. This information now ensures that prospective residents and their carers have the necessary information to make an informed choice about where they choose to live. The system of providing residents with a written contract /statement of terms and conditions has deteriorated since the last inspection so residents and their representatives are not always informed of their rights when moving to Coombe. The support and training in place to meet residents’ individual mental health needs is very good. However, attention to dementia care training is required to ensure that residents’ specialist needs are fully met. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 10 Residents’ placements continue to be fully reviewed following their admission to the home . This allows residents and their relatives to make sure that Coombe can meet their individual needs. EVIDENCE: The statement of purpose and service users guide were examined. These documents were reviewed in December 2005 following the last inspection. They now contain information on mental health support provided in the home and the training staff have received to carry out this role. Evidence confirmed that there are arrangements in place for prospective residents and their representatives to be provided with a Statement of purpose and Service users guide before viewing the home. A sample of statement of terms and conditions was seen during the course of the inspection. These contracts did not contain information about room number or who was responsible for the fee. Neither were they dated or signed by a representative of the management team or the resident/ representative. There was no evidence of advocacy involvement for residents who do not have a next of kin or representative. There is evidence in place to confirm that dementia care training has taken place in this home in the past but there was no evidence to confirm that dementia care training has taken place since the last inspection or is planned to take place during the next few months. Evidence confirmed that the majority of permanent staff have received dementia care training, but new staff and agency staff have not. The manager has completed training in working with people with mental health and emotional support needs. She is now attending a one-year City and Guilds Community Mental Health Course. There is evidence to indicate that this training has been very beneficial to her management practice at Coombe. The whole staff team and some regular agency staff have received training and support from the Mental Health In reach team. A rolling programme of mental health training provided by Bristol City Council Adult Community Care started in February 2005. At the time of the inspection evidence confirmed that five members of staff had attended this specialist training. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 11 There was written information in place to confirm that all new residents are subject to a four weekly review prior to a placement being made permanent. The resident, resident’s representative, placing social worker, and key worker are all consulted during the review. This review may take place earlier depending on the residents assessed needs and in some cases a temporary placement may be extended to ensure that a residents needs can be fully met in the home and that Coombe is the most suitable placement for each individual. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The care planning system in place is only partially satisfactory. Further improvements must be made to ensure that residents individual personal and social care needs can be fully met. There are systems in place to ensure that residents recive the appropriate health care at the right time .This ensures that the physical and mental heath needs of residents are well met. The medication administration system has improved considerably since the last inspection. However further minor attention is needed to ensure that the systems fully protect residents and staff. The care provided to residents at Coombe is of a good standard. Staff ensure that residents’ individual needs are met with privacy, dignity and respect both when they are alive and at the time of their death. However, staff may benefit from specialist training regarding equality and diversity and death and dying to support them in their work. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 13 EVIDENCE: There was evidence in place to confirm that each resident has a care plan. However from the sample seen the practice of involving residents in the development and review of the care is variable. The social background / pen history has only been completed on some residents. Those seen that have been completed have not been signed by the resident/ representative or the member of staff involved in compiling the information. Records confirmed that health professionals such as General Practitioners, district nurse, community psychiatric nurses and chiropodists are contacted at the appropriate time. There was evidence of multidisciplinary working taking place on a regular basis. Equipment was observed to be in place to prevent pressure sores in residents who were at risk. A District nurse seen during the inspection said, “I love coming here. The staff are so caring. All staff are lovely. They always try to learn from the District nurses team and GP’s. There are some problems with consistency of staff due to agency staff. The staff all work hard and the key carers genuinely care for them”. Another health professional said I think this home is very well run: I have worked at four other local authority homes and none of them was anywhere near the same level of care. The staff are invariably courteous and welcoming as well as helping me with clients.” One of the General Practitioners who visit Coombe also indicated that Coombe provided a good standard of care. One relative comments card said, “Staff at all levels are very caring with Coombe residents. Dementia often robs people of their “self”, but I find that staff are very understanding and sympathetic.” Up to date risk assessments are in place for the protection of residents, and staff. Through out the inspection it was observed how the management team and staff team treat all residents with respect and dignity and how independence is encouraged. One resident was seen throwing a slipper at another resident and then this same resident deliberately poured a warm drink over herself. The two members of staff dealt with the two separate incidents in a very caring non-threatening but urgent way. One relative said that he/she was very happy about the care of his/her relative and if he had any problems he/she would see the boss. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 14 Coombe has Bristol City Council medication policy and procedure in place which are accessible to staff. These documents were updated a couple of years ago. There is currently a working party, reviewing the policy and procedure. A sample of medication records was checked and they were noted to be up to date and accurate. Medication received, administered and disposed of is recorded. However it was observed that black ink is not used consistently and that sometimes staff do not clearly record their initials or signature after administering medication. This poor practice may lead to confusion when medication audits are carried out. The staff at the home understand the need to comply with administration, safekeeping and disposal of controlled medication. Residents’ medication is reviewed by the General Practitioner if somebody is not well. There is however no current system to prompt medication reviews on a regular basis. Records all confirmed that residents were assisted to attend hospital appointments where planned. Equipment was observed to be in place to prevent pressure sores in residents who were at risk. During the course of the inspection four members of staff were consulted and all staff confirmed that they were provided with lots of opportunities in respect of training. However, it was the inspector’s opinion that care staff, in particular those that carry out night duties would benefit from training on death, dying and terminal illness. Evidence also confirmed that one member of staff had requested training on equality and diversity but to date no staff in this care home had received this training. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Coombe provides residents with good opportunities to experience a stimulating and varied life where various informal activities are regularly made available. Visitors are made very welcome and meals are well managed and provide daily variation, good nutrition and social contact for people. EVIDENCE: Evidence seen during the inspection confirmed that a great deal of thought is given to arranging social life with in the home including opportunities to take part in activities. The staff at Coombe work hard to meet the varying needs of its individual residents. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 16 One of the members of the management team said that they had recognised as a staff team that the same groups of residents or individuals had been supported to go out into the community. This was usually as a result of those individuals being more mobile or displaying less challenging behaviour for staff to manage. This member of staff indicated that the staff team had tried to redress this balance when the staffing situation improved after the last inspection. On the day of the inspection a few residents had been out in the community for a few hours with their key worker. One resident had been to Avonmouth to the area where the shipbuilding used to take place. This resident had worked in the ship building industry before he had retired and enjoyed this visit immensely. They had also enjoyed a pub lunch and then visited a former resident from the home. The inspector heard about a recent trip to Weston–super–mare that had been organised by the staff team. One relative who had accompanied his wife on the trip said how much he had enjoyed the day. The inspector was informed that it had been this couples anniversary and that they had got married in Weston. Staff had taken photographs of the couple for their family to enjoy the occasion. Staff seen during the inspection confirmed that a lot of activities take place in the home. They spoke about the designated activities coordinator who is responsible for organising the activities in the home and how other staff supports this worker during the week. They also spoke about the key working system and how they have lots of opportunities to spend one to one time with individual residents. Staff said, “residents have a good life at Coombe. Day Outings are organised on a regular basis throughout the year to places such as Weston, Portishead, and Bristol Zoo We also take residents out at different time of the day. Evening trips are arranged to go to the pub, social clubs or to the theatre. Other one to one time includes trips to the shops, walks in the park and coffee at a café.” There was information in the activities book to confirm that all residents were receiving one to one time with their named carer. Groups of residents are also encouraged to join in with activities such as making egg and cress sandwiches, painting or making pots. The activities coordinator supports these activities. Musical entertainers visit Coombe on a regular basis and the “Pat” a Dog Scheme visitor also visits the home. Coombe have a library of videos that are appropriate for the older age group accommodated in the home. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 17 The home holds an annual summer and winter fetes and members of the local community are invited. Relatives are invited to organised functions where food, drink and entertainment are provided. There is a church service that takes place on a twice-monthly basis. A religious group called The Good News Team also visit this home once a week to lead residents in singing and musical events if they wish to join in. One member of staff regularly takes residents to Church if they wish to attend Reflexology and aromatherapy sessions are held once a week in addition to visits from the hairdresser. Regular residents and separate relative support meetings take place in this home. Tea and coffee are always available either by asking a member of staff who will either make it or provide the provisions for relatives to make a drink themselves. Relatives may also have a meal with the resident they are visiting. A four-week menu is provided and this is on display in the home for the residents to see. A copy is also available for relatives to see. The staff team have organised theme days in the home. These days have included French and Caribbean style days. The staff told the inspector that these days were very successful and included tasting food from these places, staff decorating the home and the appropriate music was played. Comments from residents included, “I am very happy here. I like the staff. I like the food.” Another resident said, “ I am looked after very well. I am impressed with the care I receive”. “ I do not want to join in with the activities but I enjoy going to the village” The inspector observed the communal tea being served. Evidence confirmed that staff is trained to help those residents who need help when eating and are sensitive in their approach. Residents are able to choose if they wish to eat by themselves separate from the dining area. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has a satisfactory complaints system with evidence that service users feel that their views are listened to and acted upon. Arrangements for protecting residents from harm are good. These measures ensure that residents are protected as far as possible from risk of harm. However improvement must be made to protect residents’ legal rights to ensure that individual residents’ rights are fully protected. EVIDENCE: Coombe accesses Bristol City Council complaints procedure, which is clearly written and is easy to understand. It can be made available in a number of formats (including other languages and large print etc) to enable anyone associated with the service to complain or make suggestions for improvement. The complaints procedure is available within the home. Relatives consulted during the inspection confirmed that they were aware of the complaints procedure and how to make a complaint. A sample of residents consulted during the inspection confirmed that they were happy to approach any member of staff. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 19 The complaints and compliments log was examined and it was noted that a recent tour of the home had been completed by one of Bristol City Councillors. There are no current complaints investigations taking place in the home. However, it was noted that there had been three internal staff investigations carried out by Bristol City Council Adult Community Care since the last inspection with the outcome that all of three staff members had been dismissed. The policies and procedures regarding the protection of residents are satisfactory and are reviewed and up dated in line with regulations and other external guidance available in the home. Evidence indicated that the service is now clear when incidents need external in put and who to refer the incident to. A staff-training programme in adult protection is now in place. This was confirmed by staff seen at the time of the inspection. Bristol City Council Adult Community Care physical restraint policy is currently under review with the Safe guarding adults’ coordinator. Evidence from observing residents and the staff indicated that they feel safe with the staff providing their care. This was confirmed by the relatives consulted during the inspection and the responses received from relatives comment cards. The Commission for Social Care Inspection receive regular notifications about residents’ welfare and health. The homes aims and objectives include the rights of residents. Residents are supported too live as independently as possible exercising their right to make choices and decisions where possible and with assistance when needed. The manager is aware of the need to facilitate advocacy service on residents behalf, but Bristol City Council Adult Community Care have failed to organise this service. This I situation is discussed in the Section on Choice of Home. The service policies refer to the rights of residents in their placement. Evidence confirmed that staff are aware of the policies and work to them Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Urgent action needs to take place with regards to the cleanliness comfort and safety of the home to ensure that residents live in a safe well maintained environment. EVIDENCE: Prior to the site visit the inspector was informed about some improvements that had taken place in the home including the decorating of several bedrooms and the relocation of the bar lounge. A new fire alarm system has been installed since the last inspection and work commenced on replacing the call alarm system started on the 12/06/06. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 21 The woodwork around the window frames continues to deteriorate following the last four inspections and now looks unsightly. This has been reported to the estates manager, but no further progress or notification has been made despite requirements about this work being made in previous reports including the last report where a plan was requested to be sent to CSCI including details of reasons why there were delays. The management team try to make the building comfortable and homely for residents. However, evidence during this inspection confirmed that the environment does not always meet the residents’ needs For example on visiting a sample of resident’s bedrooms. It was observed that there are other bedrooms that are now in need of attention with regards to maintenance and cleanliness. One bedroom viewed on the top floor had patches of paper coming off the wall and used continence pads were found in the waste bin. This situation is not hygienic and nor does it preserve the residents dignity and privacy. The inspector toured the communal areas and observed that the upstairs hallway floor was stained in several parts. There were tissues and dead moths on the floor. The metal cover over the heating system was also found to be coming off the wall and debris of tissues and old food was seen in the available space Scattered tissues were also found in other parts of the home. One empty bedroom on the upstairs floor was observed to be in use for the builders who are currently working in the home. It was noted that building materials and tools were being stored in this room, which was found to be unlocked on the day of the inspection. This door was immediately locked by one of the members of the management team when it came to their attention. However two requirements were made. One to ensure that the door is kept locked at all times and the other to ensure that a risk assessment is completed in respect of the building works. The manager was advised that a risk assessment should have been in place before the building work commenced in respect of the installation of the new fire alarm and call alarm systems. The inspector viewed the bathroom /toilet facilities on the first floor and saw that one disabled toilet facility had started to be used as a storage facility / hairdressing facility. There was an ordinary armchair in the shower area and a computer chair in the same room. There were paper tissues and dead insects on the floor. Shampoo and conditioners had been left out in reach of residents. The emergency call alarm had been tied up. This room was accessible to all residents. Another toilet facility was seen on the first floor. It was observed that the door lock was broken. Another bathroom was observed to be used as a storage area for continence pads. There was no sign to indicate to residents that these facilities were out of action. Other toilet / bathroom facilities were available on this floor. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 22 The ground floor toilet and bathroom facilities were viewed. Two further toilet facilities were found with out of order signs in place. The first toilet had a stained floor but the door was left open, so it was unclear if it was out of order or not. The other toilet had a broken cistern cover and the floor was wet. This toilet facility also had a broken lock. Prior to the inspection CSCI had received a Regulation 37 notification about a resident who had locked himself in a ground floor toilet and subsequently fallen. This toilet door had been forced by staff in an emergency to come to this resident’s assistance. There was no evidence to confirm that this toilet lock had been repaired. It was also noted that members of staff should not have to break locks to enter a facility when a resident is in danger. They should have master keys to enable them to open the doors in an emergency. A further immediate requirement was made to ensure that the toilet facility that was in use was made immediately accessible to residents and the other facility was made inaccessible to residents until it had been repaired. A resident was seen with her husband on the first floor looking for a toilet facility and they were then later seen on the ground floor also looking for suitable toilet facilities. It was the inspector’s opinion that on the day of the inspection that there appeared to be a shortage of toilet facilities due to the failure in the domestic arrangements, repairs not being completed and toilet facilities being used as storage areas/ hairdressing facilities. The maintenance list was examined and it was noted that there was an ongoing problem with bedroom doors and the office door not closing properly. Evidence confirmed that this had been reported to the estates office but no date to been agreed to when this work would take place. There are a number of small lounges through out the care home which residents were seen using and appeared comfortable and relaxed. It was noted that the main entrance hall continues to be the most popular spot to sit where residents can see what is happening around them and who is coming in and out. Disabled access is available in this home. However, communal space is confined particularly in the lounge and dining areas and therefore only a few wheel chair users may be accommodated. From the sample of residents’ bedrooms seen, it was observed that they look homely and are personalised with residents’ personal possessions and furniture. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 23 Bedroom doors are now alarmed to assist night staff to establish which residents are out of their rooms and can be offered assistance back to bed where appropriate. As discussed at the last inspection this is a form of mild restraint. The manager was advised that it must be only used following consultation with the multidisciplinary team and agreement must be sought from the residents or their representatives. Risk assessments must then be completed about the use of these alarms as they restrict residents’ freedom and privacy. Bristol City Council Adult Community Care Physical restraint policy is currently under review as discussed previously in the section on protection. The inspector was informed during the inspection that there are currently no residents accommodated who have been assessed as needing this alarm switching on at night. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The staffing situation has improved considerably since the last inspection. Coombe no longer relies on a high level of agency staff, which ensures that residents now receive continuity of care from experienced staff. The procedures for the recruitment of staff are satisfactory which protects residents from risk of harm. The staff training and development programme has improved since the last inspection. However further attention needs to be given to rolling programmes in respect of specialist training to ensure that residents’ needs can always be fully met. EVIDENCE: On the day of the inspection the staffing levels were appropriate to meet the needs of the residents. The inspector was informed that there has been a change in policy since the last inspection in respect of employing more casual staff that are employed by Bristol City Council on temporary contracts rather than use a higher proportion of agency staff. This change in policy has improved the continuity of care provided to residents. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 25 These members of staff are now included in the staff training and supervision programmes which are targeted and focussed on improving outcomes for residents. However as discussed in the section regarding the Choice of home it was observed that some new staff including casual staff have not received dementia care training. One member of staff who had been working in the home for a year said that she had had lots of training opportunities including protection of vulnerable adults but confirmed that she had not received dementia care training. Regular agency staff are still used in Coombe on occasions. Consequently any information regarding training experience consequently information about their training Residents and their relatives have confidence in the staff that care for them. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently with particular attention given to busy times of the day and changing needs of residents. Staff consulted confirmed that they now have more time to spend with residents on a one to one basis as a result of improved staffing levels. One relative said, “I have been very impressed with the level of care my mother receives at Coombe. They are a wonderful team” Staffing levels at night consist of two waking care staff. Emergency arrangements are in place if a third member of staff is required and there are also on call management arrangements in place. The service has a satisfactory recruitment procedure that clearly defines the process to be followed. This procedure is managed by Bristol City Council Personnel Department. It is difficult to inspect as the personnel records are held centrally Written evidence confirmed that further progress has taken place since the last inspection in respect of staff completing NVQ training. Staff consulted confirmed how they had enjoyed the training and how supportive their assessors had been. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The residents and staff team continue to benefit from an experienced manager who has encouraged an open style management approach. Support to staff has improved since the last inspection. The systems in place now ensures that residents benefit from staff that are appropriately supervised. There are satisfactory systems in place to ensure those residents’ financial interests and valuables are safeguarded by the homes record keeping, policies and procedures. The system for accessing records that must be available for an inspection is satisfactory. This ensures residents best interests are maintained. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 27 Health and safety checks are not wholly satisfactory. Further urgent attention must be given to these checks to ensure that the health, safety and welfare of residents and staff is promoted and protected at all times. EVIDENCE: The manager was not present on the day of the inspection. However records confirmed that she has completed NVQ4 (management of care) and the registered managers award. She has also completed training in dementia care and working with residents with mental health needs. As discussed previously in the section on choice of Home the manager is currently enrolled on a one-year City and Guilds course called Community Mental Health. All staff and relatives consulted confirmed that the manager continues to be very approachable and supportive. Regular staff meetings take place. Staff confirmed this information. One member of staff said if you cannot attend the meetings any issues you wish to raise are brought up for you. Records confirmed that staff supervision is now taking place on a regular basis for all members of staff. This was confirmed by the care staff and domestic assistants on duty that day that all said that they felt very well supported and that the officer responsible for their individual supervision was very approachable, A sample of records that are required to be available for inspection were found to be secure and well maintained. Regular reports are received by The Commission for Social Care Inspection from the nominated responsible individual who conducts monthly visits to the home. The system in place for carrying out and reporting on these visits these visits is currently being reviewed. The financial arrangements for managing residents finances and valuables is satisfactory Coombe is operated by Bristol city Council and the registered person has the skills and ability to deliver good business planning effective financial controls and provides a quality assurance and monitoring process. Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 28 Arrangements to conduct an independent survey of residents and relatives views of this home is due to take place in the autumn. The home has access to professional business and financial advice and has the necessary insurance cover in place to fulfil any loss or legal liabilities The home works to Bristol City Council health and safety policies and procedures that generally meet health and safety requirements and legislation. However as discussed in the environment section there were a number of health and safety issues that came to the attention of the inspector during this The fire log was examined and all checks and tests were noted to be up to date. An annual review of the fire assessment is now carried out. The new fire alarm system is now in operation and records confirmed that staff have received training in respect of this new system. It was noted that the weekly water temperature checks had last been conducted on 3/06/06. No explanation was available to state why these checks had not taken Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 2 18 3 1 2 1 2 3 1 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 2 Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 OP2 Regulation 5 Requirement All residents must be provided with a contract/statement of terms and conditions, which stipulates their room number and fees payable. Advocates must be found for those residents who do not have a representative A rolling programme of dementia care training must be set up in the home The social background / pen picture must be compiled for all individual residents where possible. This information must be coordinated in consultation with the resident and their representative where possible. It must be signed and dated by the people involved All care staff must receive training on death, dying and terminal illness All staff must receive training on equality and diversity DS0000035952.V296670.R01.S.doc Timescale for action 30/09/06 2 OP4 18(a) 30/09/06 3 OP7 15 30/09/06 4 OP11 18(1) 31/12/06 5 OP10 18(1) 31/12/06 Coombe Version 5.2 Page 31 6. OP19 23(2)(b) 7. 8 9 OP19 OP26 OP19 23(2)(d) 16(2)(k) 13(4) 10 OP19 13(4)(c ) 11 OP21 23(2)(j) A programme of maintenance work including: Plans to repair / repaint the window frames refurbishment of the kitchen and detail of redecoration must be sent to the Commission for Social Care inspection and reasons for any delay must be put in writing This requirement is ongoing from the last inspection conducted on 10/11/05 All parts of the home must be kept clean and reasonably well decorated tidy The home must make suitable arrangements for the disposal of continence aids Room 29 which currently contains building material and tools must be kept locked at all time A risk assessment must be completed for current building work in respect of the installation of the new call alarm systems All functioning toilets must be accessible at all times and all toilets awaiting repair must be kept locked. The manager must ensure that there are adequate accessible toilet facilities at all times i.e. clearly marked, close to lounge and dinning areas and within close proximity of residents bedrooms Designated toilet and bathroom facilities must not be used as storage/ hairdressing facilities. All harmful products such as shampoo and conditioners must be kept locked away 30/09/06 13/08/06 13/08/06 13/07/06 15/07/06 13/07/06 Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 32 12 13 OP22 OP24 13 (4)(b) 23(2)(b) 14 OP24 13(7) 15 OP28 18 Emergency call alarms must be accessible at all times in all rooms residents have access too An audit of all doors in Coombe home must be conducted and any repairs carried out. All rooms residents have access to must have suitable locks installed on the doors. (These locks should be suitable to residents capabilities and accessible to staff in emergencies The physical restraint policy must be reviewed to ensure that it complies with The Department of Health Statutory Guidance Residents must receive care provided by suitably qualified experienced staff. The registered manager must ensure that all agency staff have the appropriate qualifications and experience before the agency member of staff works in the home. A written record of each agency staff training and experience must be available for inspection This is an ongoing requirement made at the last inspection conducted 10/11/05 13/07/06 30/08/06 30/09/06 30/09/06 Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 33 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 OP9 Good Practice Recommendations Staff should use black ink when signing the record after they have administered medication. A record of the individuals initials or signature (where appropriate) should be clearly recorded Regular medication reviews for individual residents should be requested by the management team on a regular basis Water temperatures should be checked weekly 2 3 OP9 OP38 Coombe DS0000035952.V296670.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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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