CARE HOMES FOR OLDER PEOPLE
Coombe 321 Canford Lane Westbury-on-Trym Bristol BS9 2QD
Lead Inspector Sandra Gibson Unannounced 23 May 2005 13.30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Coombe Version 1.10 Page 3 SERVICE INFORMATION
Name of service Coombe Address 321 Canford Lane Westbury-on-Trym Bristol BS9 3PS 0117 3772580 0117 3772581 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bristol City Council Patricia Vera Willis PC Care Home 30 Category(ies) of DE(E) Dementia over 65 registration, with number of places Coombe Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: not applicable Date of last inspection 15 January 2005 Unannounced 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.The care home is accommodated in a two-storey building with a shaft lift to the top floor. All bedrooms are single but do not have ensuite facilities. There is a lounge on both floors and a spacious 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, table and chairs for residents to use in warm weather. Coombe Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a Monday between the hours of 1.45pm and 6.00pm. Evidence was gathered from: • Talking to residents • Talking to two of the management team • Talking to staff • Talking to the chiropodist • Observation • Looking at the premises • Records • Policies and procedures What the service does well:
The care of each resident is looked at individually and is reviewed shortly after admission to ensure that Coombe is the best place to receive personal care. Communication with Health professionals such as General Practitioners, chiropodists and district nurses is very good. Consequently residents receive good health care and get the equipment and treatment they need. Despite the staff shortages staff morale is reasonable and communication with residents is very good. All residents looked relaxed with the staff providing their care. Meals are well managed and provide daily variation, good nutrition and social contact for people. Relatives and friends are encouraged to visit and are made very welcome. They also know how to make a complaint and feel that their complaints will be listened to and taken seriously. Residents have the opportunity to join in with group activities both inside the home and in the community or spend individual time with a named person involved with their care Coombe is very comfortable, homely and clean and has been made more suitable for older people with dementia despite the limitations of the building.
Coombe Version 1.10 Page 6 The manager is benefiting from the management course that she has recently completed. This has a direct effect on residents and staff who benefit from an open positive management approach. Arrangements for resident’s finances and personal records are good which protects residents’ rights and best interests What has improved since the last inspection? What they could do better:
Any residents at risk of harm must be better protected and the appropriate people contacted for guidance as soon as possible to ensure that the measures put in place to protect residents are in accordance with the Local Authority Adult Protection Procedure. The medication administration system needs to be improved to prevent residents being placed at risk as a result of poor record keeping. A stable trained staff team must be developed to improve the safety and continuity of care to residents living at Coombe. All staff including the management team must have training in working with older residents with mental health needs to ensure that residents’ mental health needs are fully met. Coombe Version 1.10 Page 7 Support to care staff needs to be improved so staff are better supported to work with residents with dementia and mental health needs through regular supervision by a senior member of staff. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Coombe Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Coombe Version 1.10 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 standard(s) 1,2,3,4,5. Standard 6 is not applicable Information provided to prospective residents has improved considerably but is still not wholly accurate and could be misleading. Residents are not always provided with a written contract /statement of terms and conditions. Consequently they may not always be informed of their rights when moving to Coombe. The majority of permanent staff have the skills and experience to adequately meet the needs of older people with varying degrees of dementia. However, residents who also have mental health needs may not always have their needs fully met as a result of staff not receiving any training to deliver this specialist care. Residents placements are reviewed following their admission to the home . This allows residents and their relatives to make sure that Combe can meet their individual needs. Coombe Version 1.10 Page 10 EVIDENCE: The statement of purpose states “Coombe will provide care and support to a number of people with dementia who may have some form of physical disability”. It does not mention long term mental health needs that many residents admitted to Coombe have as well as varying degrees of dementia. A new resident was not provided with a contracts /statement of purpose on admission. The training records confirmed that the manager of Coombe has completed a four day training course in dementia care and a one day training course working with older residents with mental health needs. The majority of care staff including the management team have completed dementia care training, but have not yet been provided with mental health training as required at the last inspection. The statement of purpose gives clear details about the review process. Written information was seen in residents’ files to confirm that these reviews are taking place following a trial period of 4-6 weeks. Coombe Version 1.10 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10, The care planning system in place provides staff with the information they need to satisfactorily meet service users needs. The physical heath care needs of residents are well met but the medication administration system needs to be improved to prevent residents being placed at risk as a result of poor record keeping. EVIDENCE: The majority of individual care plans are available. The sample seen had been requested from the placing Social Worker. However, one care plan and the register of residents’ details had been locked away following a resident’s recent admission. Detailed daily entries were seen in the sample of case records. Records confirmed that health professionals such as General Practitioners, district nurse and chiropodists are contacted at the appropriate time. and 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. The chiropodist who visits every six weeks stated that the home is “fantastic” “Officers and staff are very personable and professional …they always speak to you ….all staff are very pleasant … and very caring”. ”Never seen any one ill treated”.
Coombe Version 1.10 Page 12 The assistant officer told the inspector about a resident with dementia and mental health needs who had been admitted two weeks previously and had developed increased mental health needs which had resulted in her/ him refusing food over the weekend. The same resident had also stopped drinking that day. A community psychiatric nurse was helping to support this resident and advise the staff before she/he was readmitted to hospital for a psychiatric assessment. Another resident who had suffered a right-sided weakness and was not eating properly was due to see the doctor that afternoon. On examination of medication administration records it was noted that when residents are admitted their prescribed medication is not always adequately recorded. Some tablets had been given out of order which resulted in the administration sheet being misleading. Another resident had been administered paracetamol, but it was difficult to confirm if the resident had been given one tablet or two as the system of recording was not consistent. Coombe Version 1.10 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 Coombe provides residents the opportunity 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: There was information in the activities book to confirm that residents were receiving one to one time with their named carer, two residents had been accompanied to Weston Super mare and two residents had been to Bristol Zoo. Groups of residents are also encouraged to join in with activities such as making egg and cress sandwiches, painting or making pots. These activities are supported by an activities coordinator. Musical entertainers visit Coombe on a regular basis and the “Pat” dog Scheme visitor visited the home yesterday for the first time. A visit to Weston Super Mare is planned next month with relatives following a gift to the home from a relative. A further trip to the Pantomime is planned for Christmas Time. Coombe have recently bought several new videos that are appropriate for the older age group accommodated in the home.
Coombe Version 1.10 Page 14 The home holds an annual fete and members of the local community are invited. There is a church service that takes place on a monthly basis. Reflexology and aromatherapy sessions are held once a week in addition to visits from the hairdresser. All of this information was confirmed by the management team. Comments from residents included “I like it here” “staff are very nice and caring” and “They keep me right”. A member of the domestic staff said, “The residents get very well looked after here “. “ There is lots going on”. “ I would be happy for my parents to be cared for here”. Menus were inspected and were found to be balanced and interesting. Meal times are also flexible enough to accommodate individual preferences. The inspector observed the relaxed communal lunch taking place in the dining area. Residents were seen being assisted by staff members to eat soft diets in a sensitive, skilled manner. Residents were observed enjoying their meal and positive comments were received about its content. Coombe Version 1.10 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home has a satisfactory complaints system with some evidence that service users feel that their views are listened to and acted upon. Arrangements for protecting residents from harm have improved considerably but are still not satisfactory placing residents at possible risk or harm. EVIDENCE: There have been no complaints since the last inspection. There was written evidence of compliments the manager had received from relatives about the care provided to residents. Relatives meetings are held every four months. Residents who were able to said that they felt the staff listened to them. Staff were observed talking to residents with patience and respect. There have been several allegations of abuse involving residents with other residents in this care home in the last year. All care staff and management staff have received protection of vulnerable adults training in line with the NO Secrets in Bristol guidance (Local Authority Adult Protection Guidance). Management staff have gradually gained experience of who to contact and when. And have started to become more familiar with the process. This information is confirmed in the Incident reports sent to the Commission for Social Care Inspection. However, during this inspection the inspector was not notified about an incident that occurred between two residents two days prior.
Coombe Version 1.10 Page 16 to the inspection, despite the police being contacted at the time. In this case The Commission for Social Care Inspection was notified almost a week later. Coombe Version 1.10 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22,23,24,25,26 A comfortable, clean, safe standard of accommodation is provided internally for the residents of Coombe. The residents’ health and safety may be at risk due to the deterioration of the exterior of the care home. EVIDENCE: In general, the environment is well maintained and suited to residents’ needs Disabled access is available in this home. Coombe is decorated and furnished to a standard that creates a comfortable homely atmosphere despite it being purpose built. There is an ongoing project in the home to create a more homely environment which is partially met There is also a programme of redecoration and refurbishment to further improve the environment.
Coombe Version 1.10 Page 18 However, the woodwork around the window frames has deteriorated further since the last inspection and now looks unsightly. This has been reported to the estates manager, but no further progress has been made despite requirements about this work being made in previous reports. Prior to the inspection the Commission had been notified that an infestation of rats in the drains had been reported to Environmental health (Pest control department). The inspector was informed at the time of the inspection that the infestation had been successfully dealt with and no further sighting of rats had been made. However, the drains to the home were reported to be collapsing at the rear of the building and that major maintenance work was due to take place as soon as possible to repair the drains. There are a number of small lounges through the home in the care home which residents were seen using and appeared comfortable and relaxed. Residents’ bedrooms looked homely and were personalised with residents’ personal possessions and furniture. The toilet and bathroom facilities are sufficient to meet the needs of the residents and the toilet doors have all been painted in red and sign posted following consultation with Dementia Voice. There were no unpleasant smells in the home and the rooms were cleaned to a high standard. Coombe Version 1.10 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 30, 31 Staff morale has improved since the last inspection following the recent recruitment of care staff. However, poor attendance and sickness disrupts consistency as Coombe has to rely on agency staff which may prevent residents receiving continuity of care There are gaps in training for both the permanent staff and agency staff which may result in residents not being in safe hands at all times. EVIDENCE: On the day of the inspection the staffing levels were appropriate to meet the needs of the residents, but there was a higher proportion of agency staff than permanent staff on duty. The new assistant officer who had transferred from another Local Authority care home for older people the week before the inspection told the inspector that she had limited experience in dementia care but had completed a course a couple of years ago. None of the three agency staff interviewed and the one permanent staff member had completed dementia care training. Only one agency staff member had completed first aid training. There were also gaps in other statutory training such as manual handling, food hygiene and adult protection. NVQ training for both domestics and care staff is on going, but the home may not reach the national minimum target of 50 of the care staff being trained to NVQ2 by December 2005.
Coombe Version 1.10 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,35,36,37,38, The residents and staff team benefit from an experienced manager who has encouraged an open style management approach. Support to care staff needs to be improved so staff are better supported to work with residents with dementia and residents who may also have mental health needs. The system for accessing records that must be available for an inspection is good and the majority of records were found to be up to date and accurate. This protects residents’ rights and best interests Safe working practices are in place that promotes the health, safety and welfare of residents and staff EVIDENCE: Coombe Version 1.10 Page 21 The manager was not available on the day of the inspection, but records confirmed that she has completed NVQ4 (management of care) and has recently completed a registered managers award. As previously stated she has completed training in dementia care and limited training on working with residents with mental health needs. All staff consulted confirmed that the manager is very approachable and supportive. A sample check of residents’ personal allowance was conducted and was found to be up to date and accurate. There was evidence of receipts being well maintained and all transactions were individual accounted and signed for by management staff. There was only one permanent care staff member on duty when staff were interviewed. This member of staff had received no supervision since her appointment four months ago. A sample of records that are required to be available for inspection were found to be secure and well maintained The records of tests to the fire safety equipment, fire drills and fire safety training were in good order and health and safety issues were well managed. Coombe Version 1.10 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 1 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 x x 3 2 3 3 Coombe Version 1.10 Page 23 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 op1 Regulation 6 Requirement The statement of purpose must be reviewed to include information about residents who have long term mental health needs All staff including management staff must be provided with training in working with residents with mental health needs Care plans must be made available to residents and staff at all times The Medication administration system must be reviewed . All medication must be accurately recorded Any allegation of abuse must be reported immediately to the Commission for Social Care Inspection Plans to repair / repaint the window frames and replace / repair the drains must be sent to the Commission for Social Care Inspection Residents must receive care provided by suitably qualified experienced staff Residents must be provided with continuity of care Timescale for action 23 rd July 2005 2. op4 18( c)(i) 30th November 2005 immediate immediate 3. 4. op7 op9 15(2) 13(3) 5. op18 37 immediate 6. op19 23(2)(b) 30th July 2005 7. 8. op28 op30 18(a) 18 (b) 30th November 2005 30th November 2005
Page 24 Coombe Version 1.10 9. 10. 11. op36 18(2) All staff must receive one to one supervision at least six times a year 30th June 2005 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 Good Practice Recommendations Coombe Version 1.10 Page 25 Commission for Social Care Inspection 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
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