Inspection on 17/12/07 for Coombe Dingle

This inspection was carried out on 17th December 2007.

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

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

Other inspections for this house

Coombe Dingle 15/01/07

Coombe Dingle 30/08/05

Coombe Dingle 28/04/05

Coombe Dingle 28/07/04

Coombe Dingle 06/04/04

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

CARE HOMES FOR OLDER PEOPLE Coombe Dingle 14 Queens Park Road Caterham Surrey CR3 5RB Lead Inspector Kenneth Dunn Unannounced Inspection 17th December 2007 09:15 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 Dingle DS0000013311.V355691.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 Dingle DS0000013311.V355691.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coombe Dingle Address 14 Queens Park Road Caterham Surrey CR3 5RB 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) 01883 345993 01883 341869 alphacarecaterham@yahoo.co.uk Alpha Care (Caterham) Ltd Nirmala Anandi Devi Read Care Home 42 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (42), Learning disability (1), Learning disability of places over 65 years of age (1) Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Up to 1 bed may be used for people with a Learning Disability (LD(E)) 65 years old and over. Up to 5 beds may be used for respite care. Up to 1 resident may be cared for on Day Care basis between the hours of 0800 - 2000 hrs. One place for (DE) Dementia under 65 years of age may be for the named service user only. One place for (DE) Dementia under 65 yrs of age and (LD) Learning disability under 65yrs of age, may be for the named service user only. 15th January 2007 Date of last inspection Brief Description of the Service: Coombe Dingle is a registered care home providing nursing care for up to 42 people with dementia. The home is situated in a quiet residential road facing a large park. The property is detached and has a large garden to the rear and also offers car parking for several vehicles. Additional parking is on the road. Accommodation is provided over three floors. There are a few (9) en suite single bedrooms and 2 double bedrooms with ensuite facilities. The home is owned by Alpha Care (Caterham) who are the registered providers. Fees range from £475 - £1200 per week (with an average figure of £600). This fee does not include toiletries and hairdressing. Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit, which forms part of the home’s first key inspection to be undertaken by the Commission for Social Care Inspection (CSCI), Mr Kenneth Dunn Regulation Inspector carried out the inspection over four and a half hours. The Registered Manager Ms Nirmala Read represented the home for the duration of the inspection. Discussions were held with the registered manager, some residents, staff, and the registered provider. Records relating to the care of the residents and the management of the home were sampled. These included needs assessments, care plans, medication records, staff employment records, risk assessments, and health and safety procedures. Diverse needs of residents are recorded in individual care plans. The kitchen was visited and the cook spoken to. Menus were seen and lunch was observed being served. The manager completed an AQAA (Annual Quality Assurance Assessment) prior to the inspection. There is a complaints procedure in place and there have been no complaints recorded since the last inspection. The Commission for Social Care Inspection would like to thank the residents, and staff for their help and hospitality during the inspection process. What the service does well: The home offers a comfortable and homely environment with a relaxed atmosphere. The residents are fully supported with all aspects of their care needs and their daily life requirements. The staff team demonstrated their understanding of residents and their individual and group needs. The staff were seen to undertake their duties in a caring and confident manner. There are appropriate arrangements in place for health care needs and medication practice within the home has been improved and developed since the previous inspection visit. The training and development of staff is ongoing and records indicated a commitment to this. Staff receive regular supervision. Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 Page 6 The health safety and welfare of staff is promoted and risk assessments are in place for identified risks and safe working practice. The home is well managed in the best interests of residents. What has improved since the last inspection? What they could do better: It is recommended that the registered person carries out a review with all trained nurses of the Nursing and Midwifery Council’s professional guidelines on records and record keeping and the administration of medications. The registered person should review the floor covering in areas within the home to ensure that they are appropriate to the use of the room. The recruitment practices should be reviewed to ensure that they fully comply with current employment legislation. It is recommended that the home expand their quality assurance system to include stakeholders in the community (e.g. GPs, chiropodists, care managers and other health and social care professionals). Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 Page 7 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 Dingle DS0000013311.V355691.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 Dingle DS0000013311.V355691.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): Standards 3 & 6 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are only admitted to the home following an assessment of their needs. The home does not provide intermediate care. EVIDENCE: The manager discussed the admission procedure. All the residents admitted to the home have a full needs assessment undertaken prior to admission. The manager or one of the trained nurses undertake the assessment to determine if the home is able to meet individual needs and the suitability of the prospective resident within the home. Assessments are either carried out in individual’s own homes, the residence or service they are currently living in or a hospital. Five needs assessments were randomly sampled. These are detailed and include all the relevant information for example medical reports and information provided by the relatives in order to make a decision regarding the placement. The home does not provide intermediate care. Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 Page 10 Coombe Dingle DS0000013311.V355691.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): Standards 7, 8 & 9 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are treated with dignity and respect. The medication policy has been designed to protect the residents. EVIDENCE: Individual care plans are in place. Five care plans were randomly sampled they were well maintained and under review in order to improve there user friendliness and visual appearance. The care plans are developed from the information gathered from the initial needs assessment, input from the resident whenever possible, and information obtained from family and other health care professionals. These care plans are reviewed regularly and updated when required. The arrangements in place to meet the health care needs of the residents are satisfactory. All the residents are registered with a local GP. The Community Psychiatric Nurse (CPN) visits the home regularly. The home has medication policy in place and all staff who administer medication are familiar with this policy. Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 Page 12 The medication recording charts (MAR) were seen and are well maintained. Residents are treated with dignity and respect. Staff were observed to interact with residents in a caring and professional manner. Staff always spoke to residents prior to undertaking a task. Staff was seen to knock on residents doors prior to entering. Locks are provided on toilet and bathroom doors, and screens are provided in shared rooms. Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The activity programme provides a flexible approach, which is both individual and group orientated. Family links are maintained, and residents are supported to make choices. The nutritional needs of the residents are being met. EVIDENCE: The service has rearranged its activity coordination two senior care workers have taken on the responsibility of coordinating activities within the home. The manager stated that the changes have allowed the staff to provide activities on a more spontaneous fashion. The manager further stated that since the change was undertaken the residents are enabled to participate more often and activities happen when the residents are more receptive and can enjoy the bustle of life around them. The service has continued to further develop its links with the National Association for Providers of Activities for older people (NAPA) who continue to offer training and support to staff. The manager also stated that all staff are involved and are enthusiastic about this new way of working. Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 Page 14 There are no restrictions to visiting times and staff support and encourage the residents to maintain family links and friendships both inside and outside the home. Menus were sampled and seen to be varied and well-balanced. The lunchtime meal was taking place during the visit and the food was presented in an appetising manner. Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a set of complaints policies and procedure in place. Staff training offers reassurances to the residents’ and their relatives’ that concerns are listened to and acted upon. Robust safeguarding adults’ policies are in place to protect the service users from abuse. EVIDENCE: The home has a complaint policy, which outlines the processes the home undertakes to respond to complaints received. There have been no complaints made since the last key inspection. The manager said that any issues that are raised are dealt with instantly before they spiral into a complaint. The CSCI has not received any complaints about the home. There is also a copy of Surreys Multi-Agency Policies and Procedures on Safeguarding Vulnerable Adults and the manager has attended training in these policies. This has also been cascaded throughout the staff team. No referrals have been made under the local multi agency Safeguarding Adults procedures. The home also has a ‘Whistle Blowing’ policy in place and basic awareness of the protection of vulnerable adults is included in the home’s induction training. A copy of the latest ‘Surrey Multi-agency Procedure for the Protection of Vulnerable Adults’ is available in the office. Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 Page 16 Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The location and layout of the home and gardens are suitable for their stated purpose. An ongoing redecoration programme provides the residents with clean, pleasant and homely surroundings in which to live. EVIDENCE: A full tour of the home the was undertaken by the inspector the premises were seen to be well maintained. The resident’s bedrooms were individualised to their or their families’ wishes and were seen to contain many personal items and mementos. The gardens were well kept, with seating areas provided for the use of residents and their visitors in warmer weather. The home has recently competed remodelling some areas of the garden, which included a large gazebo for the resident. Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 Page 18 On the day of inspection the home was found to be warm and bright with a homely atmosphere and a relatively good standard of cleanliness. However there was one isolated area where there was a strong mal odour, this was discussed with the manager and a recommendation was made to review the style and type of floor covering used in that area. Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are met by a team of staff with the appropriate skills and training. The recruitment procedure protects the residents in the home. EVIDENCE: The staff duty rotas were reviewed and they evidenced that staff are employed in sufficient numbers to meet the assessed needs of the residents. The staff spoken to had a good understanding of the resident’s needs, and their care plans. They also had a good understanding of their roles and responsibilities. There is a well-established staff team in place with a low turnover. The service has reviewed the staffing ratios deployed during peak periods specifically meal times. The manager stated that by reconfiguring and staggering meals the residents are now able to enjoy their meals at a more relaxed pace and in addition the staff can interact more appropriately with the smaller groups they are working with. The home has a recruitment procedure in place. This is robust and protects the residents living in the home; it is however recommended that the registered manager review the policy to ensure that it is fully compliant to current employment law. Four staff files were sampled. These are well maintained and included all the required documents required for employment legislation, including two written references, an employment history, and a CRB (Criminal Records Bureau) disclosure number. Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 Page 20 Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 Page 21 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): Standards 31, 33, 35 & 38 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a strong ethos of transparent and open management within all areas of running the home. The views of the residents and their relatives are sought but require to be formalised. The residents’ financial interests are safeguarded. The service provides training on health and safety issues for all staff, and residents and their relatives are invited to become involved in the home. EVIDENCE: Mrs Read has been the manager of Coombe Dingle since 2005. She is a registered nurse; holds a Registered Manager’s Award and is an A1 NVQ assessor. The manager’s role is described as a “hands on approach” and there was an agreement within the staff on duty that the manager operates “an open and inclusive style of management”. Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 Page 22 Quality assurance is monitored by regulation 26 visits by the provider. These are retained in the home for inspection. Regular reviews of care take place and health and safety audits are undertaken. There are relatives’ meetings held every three months the manager stated that these meeting allow the relative to become more involved in the home and the quality of the service they are providing. However a recommendation made during the previous site visit (date 15/01/07) has still to be considered or implemented the home should expand the quality assurance system to include stakeholders in the community (e.g. GPs, chiropodists, care managers and other health and social care professionals). Review of documented records demonstrated that health and safety checks are routinely carried out at the home. All equipment examined on the day was properly maintained. Records indicated that fire drills, fire alarm, water temperature, fridge and freezer recordings were regularly checked. Random sample of staff’ training files demonstrated that up to date and relevant training was carried out to protect residents’ health, welfare and safety. In discussion with care workers they were able to discuss their understanding and implementation of appropriate procedures to safeguard the residents. Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 Page 23 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 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X 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 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations It is recommended that the registered person carries out a review with all trained nurses of the Nursing and Midwifery Council’s professional guidelines on records and record keeping and the administration of medications. It is recommended that the registered person review the floor covering in areas within the home to ensure that they are appropriate to the use of the room. It is recommended that the registered person review their recruitment practices to ensure that they fully comply with current employment legislation. It is recommended that the home expand their quality assurance system to include stakeholders in the community (e.g. GPs, chiropodists, care managers and other health and social care professionals). 2. 3. 4. OP26 OP29 OP33 Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 Page 25 Coombe Dingle DS0000013311.V355691.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South East Region The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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. 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