Inspection on 29/06/07 for Coombe

This inspection was carried out on 29th June 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Coombe 13/07/06

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 Jones Key Unannounced Inspection 09:30 29 June & 6th July 2007 th 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.V341715.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.V341715.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.V341715.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th July 2006 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 £603.00 per 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 resident’s contract. Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection visit was conducted unannounced over two days, one in June and the other in July 2007 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined, a tour of the premises was conducted and feedback sought from individuals and staff. “Have your say” surveys were sent to relatives and fourteen surveys were received at the Commission. Feedback from Health and Social Care Professionals was sought through comment cards. Comment cards were received from the district nurse, GP and pharmacist. Prior to the visit some time was spent examining documentation accumulated since the previous inspection, including the AQAA (Annual Quality Assurance Assessment) and notified incidences in the home, (Regulation 37’s). This information was used to plan the inspection visit. There are twenty-five people living at the home and six were case tracked during the inspection. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The home’s policies and procedures were also used to confirm the findings. The views of the manager, staff and people using the service were gathered either by face-to-face discussions or by surveys. What the service does well: The district nurse stated that there is a warm and open atmosphere whenever visits to the home take place. The district nurse also stated that there is multi professional working between the staff and outside agencies that visit the home. Ten relatives made direct comments through the “Have your say” surveys about what the home does well. Comments made were about the staff attitude towards the people that live at the home. For example, “ The are extremely caring, patient and supportive and nothing seems too much trouble” and “ Good atmosphere-caring with fun/humour and good interest and commitment to the tasks and individuals.” Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 6 Regarding the staff skills one relative stated, “ Their understanding the needs of dementia residents” and “ Dementia is a devastating illness, and as a relative, it helps to know that everybody at Coombe is sympathetic to all the residents’ needs.” Three individuals giving feedback during the site visited stated that they are treated well by the staff. Members of staff were observed using a variety of approaches but overall a their approach was individual to the person and respectful. What has improved since the last inspection? What they could do better: There are a number of outstanding requirements from previous inspections and enforcement action may be taken for non-compliance. Information packs are available to relatives and representatives to assist with them to make decisions about the home. Information must be more accessible to people with dementia so that they can make decisions about living at the home. A care plan must be developed for all new admissions to the home. Care planning systems must be more person centred, health care needs must be included within care plans to provide an individualised and consistent service. Safe medication systems must be introduced. Activities must be more consistently provided and records of meals must be kept. An Immediate Requirement was issued for adequate provisions for washing hair to be provided. The manager must ensure that individuals at the home are safeguarded from abuse and, restraint must only be used in exceptional circumstances. Repairs and redecoration of the property must continue to provide a homely environment that respects individuals living at the home. Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 7 An assessment of the staffing levels must be conducted to ensure that the needs of the people at the home are met. 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. The summary of this inspection report can be made available in other formats on request. Coombe DS0000035952.V341715.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.V341715.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Whilst information is presented to relatives and representatives of prospective residents to enable them to make decision a about the suitability of the home, the home fails to provide information in a format that can be understood by those for whom it is intended. In addition the home fails to demonstrate that it can meet the assessed needs of those admitted to the home by its failure to compile care plans. EVIDENCE: The Statement of Purpose in place briefly outlines the approach towards meeting the needs of people with dementia. While the range of needs is listed, the criteria for admission to the home is not specified so that potential admissions, placing agencies and relatives are informed of the range of needs that can be met by the staff at the home. Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 10 Recent changes require that the home make clear within documentation, the range of needs that can be met at the home and in particular the manner in which the needs of people with dementia are to be met. The Annual Quality Assurance Assessment (AQAA) states that since the last inspection there were eleven admissions to the home. There are two vacancies, two blocked beds for redecoration and one allocated. It was stated by the assistant manager that external managers’ arrange admissions. For the most recent admission, it was explained that the home was alerted that family members would be visiting the home on behalf of a person with dementia. The social worker faxed a copy of the care plan and a date for admission was then arranged with the home staff. One person was admitted two days prior to the inspection and the assistant manager said that a keyworker was allocated and will be consulting the person about their likes and dislikes. Members of staff are currently recording their findings to develop a picture of the person. The social worker’s care plan is currently being used as a guide and a home’s care plan is to be developed. A home’s care plan must be developed for each person that is admitted to the home. There is a pack of information for relatives to assist them with making decisions on behalf of their family member. A copy of the Statement of Purpose, Complaints procedure, development plan and contract are included within the pack. Eleven “Have your Say” surveys from relatives indicate that they always get enough information to help make decisions about the care home and four stated it was usual. However, the information pack does not take into account the people with dementia. Information that enables individuals to make decisions about the home is not in a format for the people its intended. Coombe DS0000035952.V341715.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Whilst people that live at the home can expect sensitive and prompt support for their person and health care needs from a skilled staff team the home fails to evidence that it provides a consistent service because of omissions in the care planning system and in the procedures for the safe administration of medication. EVIDENCE: The case files of five people were used to assess whether people who use services receive good quality care that meets their individual needs. It is evident from the case records that members of staff are taking steps to seek background information from relatives and friends to develop pen portraits. Care plans are brief and action plans would benefit from a more person centred approach to meeting needs. This involves incorporating the individuals like, dislikes and preferred routine into the plan of action. Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 12 Eleven “Have your Say” surveys from relatives indicate that the care home always meets the needs of the people at the home. Two relatives stated that it is usual for the home to meet the needs of the people at the home and one said it was sometimes. The people at the home have a diagnosis of dementia and care plans must be specific about the way their dementia manifests itself. The actions must be specific to guide the staff to ensure that the person’s needs are being met. Additionally there are people accommodated at the home with communication needs and that at times exhibit aggressive behaviours. However, care plans are not clear about the way individuals make decisions. For the person that at times exhibits aggressive behaviour, care plans must guide the staff on the actions to be taken. The care plans for individuals with mental health care needs must clarify the triggers of deteriorating mental health along with the actions that must be taken by the staff to meet the needs identified. The staff at the home reviews care plans. Relatives are invited to review meetings and where possible the person signs their care plan. Feedback was sought from the staff on duty. Members of staff stated that there is a keyworker system in operation, which includes looking after designated individuals bedrooms and providing personal care. For instance bathing. Keyworkers are given keytime to have with their allocated people and a member of staff stated “keytime is a joke, sometimes keytime takes place during bath time but two staff are generally needed so there is little 1:1 time” Risk assessments are developed for people that have moving and handling needs, which are reviewed monthly by the staff. Moving and handling risk assessments detail the equipment needed for each type of transfer and the number of staff that must be present to undertake safe manoeuvres. While risk assessments are in place for people that have pressure areas, care plan action plans must be more specific about the actions that must be taken by the staff. It is acknowledged that the two samples examined, indicate that preventative measures are being taken to reduce any reoccurrence of pressure sores. The assistant manager stated that ‘profiling beds’ were purchased for people that need assistance with getting in and out of bed and for people that have pressure areas. The district nurse gave feedback about the standards of care at the home. It was stated that the staff are caring and provide high levels of care. Regarding the staff skills the district nurse said that members of staff are undertaking nursing tasks, which include pressure care, assisting people to eat their meals and catheter care. However, care plans are not specific about the input individuals are receiving from health care professionals. The deputy manager stated that it is normal practice for long term care needs to be included in care plans and daily reports for all other medical needs. Members of staff record observations, outcomes of visits and the person’s general well being. Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 13 Information recorded indicates that the staff monitor the individual’s health care and advice given from health care professionals is recorded within the daily reports. To offer continuity of care, individuals health care needs must be recorded within care plans. The arrangements in place for respecting the individual’s privacy and dignity is included within the Statement of Purpose. It states that through staff induction, training and supervision, the tasks undertaken by the staff will respect individual’s rights. In terms of facilities, routines and administration systems, the person’s rights are further enhanced. Regarding preferred routines, the procedure states that the individuals preferred routines would be sought. However, the preferred routines of the individual are not currently sought. The assistant manager explained the manner in which individual’s rights are respected. It was stated that clothing is labelled to ensure that individuals wear their own clothing and keyworkers are expected to support individuals to purchase new clothes. Health care is conducted in bedrooms and equipment for dressings are kept in the person’s bedroom. “Have your Say” survey from the district nurse states “It is always hard caring for residents with dementia but everything possible is done to respect their dignity and privacy.” The deputy manager stated that one person will enter other people’s bedrooms and for this reason bedroom doors are kept locked. To ensure that the actions taken were appropriate, the consent of relatives was sought. All rooms are single and lockable and currently one person has a key to their bedroom. Three people were consulted about the way staff respect individual’s rights. Individuals gave examples of the way staff respect their privacy. Staff knock on bedroom doors before entering, they also make sure that doors are closed when personal tasks are undertaken and single bedrooms were examples given. Case records confirm that the individuals preferred form of address are used An Immediate Requirement was issued about the way individuals hair is washed at the home. The current practice of washing individual is not respectful to the individual. (Please see Protection). The person’s funeral arrangements are sought during the admission process and included within their case records. There is a Dying and Death procedure, which describes the steps that will be taken for impending deaths. Medications are administered through a monitored dosage system and records of administration indicate that staff sign the records immediately after administering medications. Appropriate use of codes are used by the staff to record reasons for not administering the medication at the specified times. Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 14 Homely remedies are not currently administered from a stock supply when required by the person. From the records of controlled medication, it was noted that one person is prescribed with a controlled drug. The deputy manager stated that this individual no longer has controlled medications administered by the staff. Two separate records for recording controlled medicines are in use. However, records are not clear about medications returned to the pharmacist for disposal. “Have your say” survey from the pharmacist states that the individuals at the home are unable to selfadminister medications. It was also stated that the staff have up to date training to administer medications. The pharmacist recommended in the survey that incident reports should be completed for medication errors. Coombe DS0000035952.V341715.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Whilst there are some opportunities for social activity and the home supports links with family and friends, it fails to fully enable service users to have truly active lifestyles. The home fails to evidence that a wholesome appealing diet is provided. EVIDENCE: The home has a designated activity room and employs an activity coordinator three days per week to undertake activities with the people at the home. The assistant manager said that the coordinator generally works Tuesday to Thursday and on Fridays the hairdresser and aromatherapist visits. On the days that the coordinator is at the home, individuals that want to participate in activities are taken to the activities room to undertake arts and crafts, listen to music, gardening clubs and reminiscence. It was further stated by the assistant manager that there is an expectation that the staff at the home undertake activities with individuals at the home. Daily reports are completed by the staff and describe the type of activity undertaken to keep individuals stimulated and engaged. However, the last entry was five days before the day of the site visit. Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 16 Four relatives made specific comments through “Have your Say” surveys about the activities provided at the home. Three people made comments about the lack of outings, another said “My mum loves aromatherapy, it helps her relax” and another said “More chance for the residents to move around. They appear to spend too much time sitting around.” Three individuals at the home were consulted about the way they occupy themselves during the day. One person stated, “I watch the TV and occasionally I go out”. Members of staff were consulted about the range of activities provided by the staff at the home. An agency worker that regularly works at the home said that activities only take place when the basic routines are completed. Two staff explained the daily routines that must be undertaken. Staff stated, “ There are beds to be made, laundry, cleaning commodes and assisting people with toileting and eating. Sometimes the district nurse needs support from carers. Most times there are only two – three staff on duty and we are supposed to do activities in between.” The Statement of Purpose in place states that visiting can take place at any time and during the inspection, visitors were observed entering the home at various times and using bedrooms for additional privacy. Three “Have your Say” surveys from relatives indicate that the staff always help the individual at the home to keep in touch with them. One relative made additional comments about the way staff support individuals to maintain contact with family and friends. It was stated, “ I phone my aunt frequently and visit occasionally, and I am impressed with the quality of care provided by the staff.” The home’s contract of residency states that individuals living at the home have access to their records on request. Also stated is that personal items can be taken into the home for individuals to make their personal space homely. People that have no involvement into their care from family and friends do not currently use advocates. The assistant manager stated that the manager and cook generally devise menus. There is a four-week rolling rota, which reflects seasonal changes. The cook was consulted about the arrangements for providing meals to the people at the home. The cook stated that with the exception of Fridays there is always a choice on meals. The cook also said that the meals served are freshly prepared and where possible tinned and frozen foods are avoided. There is a wide range of fresh foods, with frozen and tinned foods also available. Special diets are catered for and alternatives are provided for meals that are disliked by the person. The ways that individuals are enabled to make choices about the meals served was explained by the cook. Every effort is made to make meals appear attractive and members of staff show each person the choice of meals at each mealtime and individuals make decisions about the meal from the visual choice provided. However, there a record of the food provided to the individual is not maintained. Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 17 Three individuals were consulted about the meals provided and one person said, “The food is normally good and there is enough to eat” and the other two people agreed with the statement. Members of staff were observed assisting individuals with eating their meals. Members of staff sat beside the person and engaged with the person that they were supporting with their meal. Through the “Have your say” questionnaire one relative made a comment about practices that relate to mealtimes. It was stated, “While serving drinks agency staff do not test if the drinks are too hot or like my mum are unable to feed herself with liquid and miss fluids” The comments made by the relative were discussed with the deputy manager. The deputy manager said that it would be rare for only agency staff to be on duty. Permanent staff are always rostered with agency staff and the staff would challenge poor practice. The home has experienced some difficulties with rodent infestation. The manager has acted appropriately by contacting Environmental Agencies to resolve the problem. The cook stated that regular visits take place from the relevant agencies and there are no further problems. Coombe DS0000035952.V341715.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Representatives of the individuals at the home know how to make complaints. The complaints procedure does not empower service users to have their views sought and taken seriously. Current hairdressing practices could be viewed as inappropriate restraint that fails to safeguard those that live in the home. EVIDENCE: The Bristol City Council Complaints/Compliments procedure is used at the home and provided to relatives during the admission process, which is available in a variety of formats and languages. While the procedure is provided to relatives in formats that can be understood, the individuals at the home are not empowered to make complaints about the service they receive. This is because the complaints procedure does not take account of people with dementia. One complaint was received at the home since the last inspection and the records indicate that staff raised concerns and the manager undertook an investigation which was partially upheld. Fourteen “Have your say” surveys were received from relatives and thirteen stated that they know how to make a complaint about the care provided by the home. Seven relatives indicated through the survey that the home had responded appropriately and four said that the occasion where they had to make complaints had not arisen. Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 19 Additional comments about their experience of the complaints process were made, one person stated, “ When I raised a concern about my mother’s health, the carers were one step ahead of me and already contacted the doctor” and another stated “ I have raised a number of small concerns which are not always addressed.” The comments raised by relatives were discussed with the deputy who has agreed to add the complaints procedure to the agenda for the next relative meeting. The Protection of Vulnerable Adults policy and guidelines are in place at the home. The procedure and guidelines require updating to ensure that in-house policies and procedures follow “No Secrets” guidance. A Whistleblowing policy is available at the home and requires updating to ensure contact details are up to date. Members of staff consulted were clear on the forms of abuse and their responsibilities towards safeguarding adults from abuse. The deputy manager stated that there is a Safeguarding Adults referral in progress regarding an allegation of physical abuse by a member of staff. It was explained that a hearing has taken place and the person remains suspended from duty. Attention was drawn to the manager that the way individuals hair is being washed is potentially abusive because members of staff must assist the individuals to keep their head down which is a forced activity, as restraint is being employed. Also individuals are not offered the choice to have their hair washed in their preferred manner. An Immediate Requirement was issued for the home to cease this practice and to provide suitable facilities for washing hair. Coombe DS0000035952.V341715.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. For individuals to have a homely environment, repairs and redecoration must take place. EVIDENCE: Coombe is a large care home operated by the Local Authority, close to shops, amenities and bus routes. It is arranged over two floors with bedrooms and communal space on both floors, with disabled access into the home. Three individuals consulted during the inspection stated that they have single bedrooms. Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 21 There were six requirements made regarding the environment, at the last inspection. These include to formulate of a programme of repairs, to keep the home clean and reasonably decorated, to keep bedrooms that are being decorated locked, to develop risk assessments for the installation of an alarm system and to keep toilets accessible at all time. The Annual Quality Assurance Assessment (AQAA) completed by the manager states that the property is old, outdated and in need of major repair work. In terms of meeting the requirements, the AQAA confirms that action was taken to meet the requirements made. A Regulation 37 report was received regarding the roof leak, which has resulted in the décor of several individuals’ rooms as well as the staff sleep in room being potentially affected by dampness. The assistant manager stated that the home was informed by the responsible individuals that there will be a repair to the roof. It was also stated that because of the roof leak, some bedrooms are being redecorated every six months. Two relatives made direct comments about the environment. One person said that the care home can improve by “Possible changes of layout of lounge and television areas” and another said “ The television is difficult to see, and has poor reception. The chairs are jammed together in the TV room, It is difficult for staff to move residents at the end of the room as there is not enough space.” It is evident that individuals at the home mainly gather in the foyer of the property. For individuals that sit in this area, seating is arranged in the foyer and two small lounges adjacent to the foyer. The comments made by a relative about the TV not working and chairs being crammed into a small lounge were confirmed during the tour of the property and in staff’s comments. Environmental factors that have an effect on communications with the people at the home have being considered and some changes have taken place. The individual’s photographs are on bedroom doors for individuals to find their bedrooms easily. There is a variety of single seating and settees in the lounges, and there is a separate activity room, which is used for arts and craft and 1:1 time. While the dining room is not accessible to individuals at all times, the area is large enough for the group to sit together and eat their meal. Toilets and bathrooms are in close proximity of bedrooms and communal areas. Bathrooms are functional and it is evident that in some instances they are also used to store equipment. Toilets are marked so that individuals can find them easily. It was noted during the tour of the premises that two toilets and two bathrooms are not in use because of the roof leak. Three bedrooms are also in need of redecoration because of the roof leak. Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Recruitment records fail to demonstrate that the process is robust and safeguards individuals from abuse. Whilst steps are taken to ensure that staff are qualified and skilled to meet the individuals changing needs this could be enhanced by formal supervision of the team. EVIDENCE: The deputy manager described the arrangements for staffing the home. It was explained that the aim is to have six care staff in the morning, three in the afternoon and three at night, with two staff awake at night. At weekends the staffing levels fall to four in the morning, three in the afternoons and three in the evenings. Ancillary staff are also employed for cooking and cleaning the home. There is an on-call service for assistance with additional staff, the deputy stated that the person is generally based at another home and already being used or they are unable to be at the home at the time needed. Regarding the staff vacancies, the deputy said that there are two, ten-hour vacancies and an eight-hour vacancy for a domestic. Agency staff are used at the home to cover annual leave and sickness. Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 23 An agency care assistant consulted about the home stated that the home is always short staffed and the staff could achieve more if the rotas were better organised. Two home care assistants were also consulted and one person stated “I get a lot of satisfaction from working with the individuals at the home. If we had more staff we could do more”. Members of staff criticised the staffing levels in place, it was explained that in the morning six staff are rostered yet in the evening when the task are the same but in reverse, only three staff are rostered. Another person explained the different staffing levels during the week and at weekends. It was stated that during the week there are six staff in the morning to assist five- eight people that require assistance with feeding and there are twelve people that need assistance with dressing. However, at weekends four staff are rostered, which is difficult to understand, as the individuals needs do not change at weekends. The AQAA received from the manager acknowledges that the staffing levels need to increase at weekends. The “Have your say” survey from the district nurse states, “ they need extra staff, they have many residents who need extra care (e.g. hoisting, feeding etc) and the amount of staff doesn’t always reflect this.” At the time of the inspection there were four staff rostered in the morning instead of six, which meant that two staff were undertaking caring tasks and two were making beds. The home is failing to provide staffing that meets the needs of the individual. There are twenty-one care staff employed at the home and sixteen will have NVQ level 2 by July. The assistant manager on duty said that their responsibilities include assessing candidates on the NVQ level 2. The assistant manager also stated that the manager would generally make the decision about which staff have the priority to undertake vocational qualifications, for instance, night staff. Personnel files for staff employed at the home are held centrally by Bristol City Council Personnel Department. Checklists are kept at the home to confirm the checks that evidence the recruitment process followed. The manager signs the checklist once the references are received and, Criminal Disclosure Bureau (CRB) disclosures and proof of identity are seen. The personnel files of the four most recently employed staff were examined and inconsistencies in the completion of the checklists were found. The checklists in place for these staff indicate that the manager has not seen the references for three staff, dates of employment were not listed for three and CRB disclosure was missing for one person. Individual staff profiles that lists the dates of references, CRB disclosures and training provided is kept for agency staff to ensure they are suitable to work with vulnerable adults. The deputy manager was consulted about the induction provided to new staff. It was stated that new staff receive a first day induction, which included a familiarisation of the building followed by shadowing of staff. From then onwards staff are expected to work unsupervised. Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 24 New staff attend statutory training as soon as possible. The agency care assistant on duty described the training provided by the agency. It was stated that the agency provided Health and Safety, Moving and Handling, Fire, First Aid and POVA. It was also stated that training in dementia is optional and home staff will offer guidance and interact with regular agency staff. Since the last inspection two members of staff have attended dementia and mental health care training. Members of staff are to attend external mental health training and in the meantime mental health in reach team provided a training session and consultation to increase staff insight. The GP stated through the comment card that the staff demonstrate a clear understanding of the care needs of the people at the home. The district nurse stated within the “Have your Say” survey that the staff are keen to learn and very helpful. Eight surveys from relatives indicate that the staff have the right skills and experience to look after people properly and five stated it was usual for the staff to look after people properly. One person commented, “ Coombe care staff show compassion and treat residents with dignity” another person stated “At times the staff lack experience possibly more at weekends. The number of staff sometimes seems low” The three individuals consulted about the staff stated that they are treated well by the staff. Two members of staff were consulted about the training available and the systems that offer consistency at the home. Members of staff said that staff meetings are not regular but they are taking place more often. It was also stated that individual supervision occurs every six months to discuss personal development, people in key groups and personal development. Records confirm that supervision has not taken place at the recommended frequencies. The comments made by the staff were discussed with the assistant manager on duty and stated that sometimes staff meetings are more productive and supervision should take place every eight weeks. Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The people living at the home can expect to live in a safe environment and can be re-assured that standards will be the subject of ongoing monitoring. EVIDENCE: The manager was not present during the two days of the site visits to the home. The staff on duty were consulted about the management style used by the manager. The agency worker stated that the relationship between the staff and managers is good and the two permanent staff said that there is not enough communication between managers. Overall the “Have your say” surveys from relatives were positive about the standards of care. Relatives stated that the staff are committed and caring. Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 26 Bristol City Council operates a Quality Assurance and monitoring system. The assistant manager states that the manager is usually in charge of the management of the system. Surveys were recently sent to relatives to seek their views about the service. The assistant manager on duty stated that the Local Authority manages the finances of three people and their personal allowance is paid to the person each week. Cash is held in safekeeping on behalf of the individuals at the home. A sample of the cash held was checked and the arrangements for managing finances and valuables are satisfactory. The training records in place indicate that staff undertake statutory training, which ensures safe working practices. Members of staff attend Manual Handling training with yearly updates, all ancillary and catering staff attend Food Hygiene and all staff attend First Aid training every three years. The manager ensures compliance with other legislation by the annual checks of the gas central heating. Checks by competent people are carried out annually for portable electrical equipment, hoists and the passenger lift. In line with the Regulatory Reform (Fire Safety) Order 2005, the manager has formulated fire risk assessments. Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 27 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? no 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 OP19 Regulation 23(2)(b) Requirement 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 Advocates must be found for those residents who do not have a representative. (Previously required 13/07/06) A rolling programme of dementia care training must be set up in the home. (Partially met) The physical restraint policy must be reviewed to ensure that it complies with The Department of Health Statutory Guidance. Not followed-up at this inspection. Timescale for action 30/12/07 2. OP2 5 30/09/07 3. OP4 18(a) 30/10/07 4. OP24 13(7) 30/10/07 Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 29 5 OP1 6 6 OP7 12 (2) 7 OP7 15 (1) 8 OP9 13 (2) 9 10 OP12 OP18 16 (2) (m) 13 (7) 11 OP27 18 91) (a) 12 OP29 7,9,19 Sch.2 The Statement of Purpose must be reviewed. In particular the criteria for admission and the manner in which the needs of people with dementia are to be met. Consideration must be given to the format in order to enable the person to make choices about living at the home. The care planning process must be more person centred. Individuals’ preferred routines, likes and dislikes must be included within their care plans. Care plans must be specific about the actions that must be taken to meet the individual needs, which include the way individuals make decisions, health care needs and triggers of a deteriorating mental health. Safe systems of medication administration must be introduced. The manager must ensure that there are safe disposal of controlled medications. Activities must be more consistently provided. A hairdressing sink must be installed to cease the current practice which can potentially lead to restraint of individuals. An assessment of the staffing levels must be conducted to establish that the current staffing levels can meet the needs of the people at the home. A copy of the assessment must be provided to the Commission. Records kept at the home must demonstrate that the staff employed at the home are suitable to work with vulnerable adults. 30/10/07 30/12/07 30/12/07 30/07/07 30/10/07 30/07/07 30/07/07 30/10/07 Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 3. Refer to Standard OP38 Good Practice Recommendations Water temperatures should be checked weekly Coombe DS0000035952.V341715.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South west Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 - 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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