Inspection on 30/08/05 for Coombe Dingle

This inspection was carried out on 30th August 2005.

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 17/12/07

Coombe Dingle 15/01/07

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 Kathy Martin Announced 30 August 2005 10:00 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 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 h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Coombe Dingle Address 14 Queens Park Road, Caterham, Surrey, CR3 5RB 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) 01883 345993 Alpha Care (Caterham) Ltd Nirmala Read CRH N 42 Category(ies) of DE - Dementia - 1 registration, with number DE(E) - Dementia - over 65 - 42 of places LD(E) - Learning Disability - over 65 - 1 Coombe Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 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. The one (1) place for (DE) Dementia under 65 years of age may be for the named service user only. Date of last inspection 28th April 2005 Brief Description of the Service: Coombe Dingle is a revistered care home providing nursing care for up to 42 residents with Dementia. The home is situated in a quiet residential road in Caterham facing a large park. The property is detached and benefits from a large secluded back garden and parking for several vehicles in the front of the house. There are 9 single en suite bedrooms and 2 double bedrooms with ensuite facilities. The home is owned and run by Alpha Care (Caterham) who are the registered providers. Coombe Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second CSCI inspection this year. The home was inspected against some of the key standards in April 2005. This inspection was announced and therefore all residents, staff and their families were made aware that this was going to take place. The manager had provided a completed pre-inspection questionnaire ahead of the inspection and a lot of information in this document has been used in the report. The residents, their visitors and health care professionals who visit the residents were also offered an opportunity to feedback to the inspector (see extracts of these in the next section of the summary). The manager was present during the inspection and the inspector had ample opportunity to speak to residents and staff. Several residents were engaged in a group reminiscence activity also listening to music from the past. There was clear evidence that residents who were participating enjoyed this session and several talked to the inspector about the memories of cards they were looking at and music they listened to. The activities organiser was keen and interested in this role and was highly spoken of. The inspector had a long conversation about her involvement in the home, which was found as beneficial to the residents. Staff were responding well to the residents’ requests and were calm and relaxed. They appeared confident in their approach and showed respect and sensitivity towards the residents. The home was clean and tidy. The previous requirements made at the inspection in April have now all been met. What the service does well: Several completed feedback cards were received and were on average very encouraging and concluded that persons who lived there were generally happy, their family and their visitors had little complaints and felt that the residents were generally well looked after. Comments extracted include: “we are delighted with the care given and have no complaints” “everyone was warm and friendly” “I was very happy to leave (resident) in their care” Coombe Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 Page 6 “my (relative) has been in the home for 4 years. ..I have no complaints….staff are helpful, welcoming and the home is always clean” “…has received the very best of nursing care and attention at all times and I am very happy knowing (resident) is so well looked after” “I am confident that my (resident) has been placed in such a home…rely on the fact that (resident’s) future is assured and (resident) will always be treated with dignity” “the staff and owners are always more than friendly and supportive” “as a care manager for a service provider I have found this home to be caring and staff are well informed” “Coombe Dingle have provided excellent communication” What has improved since the last inspection? What they could do better: These issues were raised from one feedback form and were discussed with the manager who will rectify them: Clothing going missing even though they are marked. Toiletries bought for (resident) are used on others Communal washing for residents’ clothing Other issues raised during the inspection: 1. It was required for the home to have an updated policy and procedure for fire at night time. This was done immediately. Coombe Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 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. Coombe Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 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 Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 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) This section was assessed during the last inspection and comments made then remain current. Standard 6 is not relevant to this home. EVIDENCE: Coombe Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 Page 10 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) 9 and 10 The home policies and procedures for managing medication were sound. It was evident that residents and their relatives considered that they were treated with dignity and respect in Coombe Dingle. EVIDENCE: The home received a pharmacy inspection visit from the CSCI in June this year. Compliance with any requirements made was achieved. The staff received training in medication management. Being a home that provides nursing care, only the registered nurses dealt with medication. There were no residents in the home who took their medication themselves without some form of assistance from the registered nurses. The residents spoken with on the day of the inspection were observed being treated with utmost respect and courtesy by the staff present. Furthermore the feedback cards completed by their relatives expressed their reassurance that residents were treated appropriately with care and attention and their rights as individuals were being respected. Residents were encouraged to take part in activity, go in the garden or their bedrooms and mingle with each other if they wished in the communal areas. Staff received induction and training in respecting privacy and the rights of residents. The home has policies and Coombe Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 Page 11 procedures that encourage the staff to pay attention to their principles of care. There is a key working system in place that also promotes staff to work closely with residents and have continuity of care, which encourages staff to know the residents well and also to ensure their needs are met. The manager reports that one main issue relating to respecting privacy, which sometimes results in some aggravation was when residents enter each other’s room uninvited due to their symptoms of Dementia and memory loss. Coombe Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 Page 12 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) 14 a 15 There is a lot of effort exerted to ensure residents received maximum choice in their daily life and are helped to maintain as much control in what they do. The catering arrangements are reported as good. EVIDENCE: The residents received choice in a variety of ways from the food they choose to eat and the clothes they wear and where they liked to sit and walk. The staff encouraged residents to choose but sometimes choices are not always appropriate due to their memory loss and staff know how to manage this once they know their residents well and have time to adjust in the home. Relatives’ input is encouraged as much as possible. The next of kin, power of attorneys or solicitors often assist the residents in exercising control over their lives. The catering arrangements were good. There was a seasonal menu, which is changed regularly. This offered a choice of main meals also catering for special diet requirements such as diabetic, low salt, low fat, vegetarian or other as the need arise. The kitchen staff have worked there for a number of years and are an integral part of the home management and worked well with the nursing team and the relatives. Visitors can have a meal wit the residents if they wished and many already do this regularly. Snacks and beverages are available at all times including nights. The manager also solicits the assistance of a dietician as needed to advise on nutrition and feeding. The kitchen was Coombe Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 Page 13 clean and all equipment was in good order. The kitchen staff have obtained all appropriate training in food hygiene. Coombe Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 Page 14 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 a 18 There were no complaints received and there were no vulnerable adults issues being dealt with. The home has procedures to deal with these. EVIDENCE: The home has procedures for dealing with complaints. The manager and the owners are very keen to resolve any issues when they arise. The rapport with residents, visitors and staff is very good. The comments raised in the feedback from relatives to the CSCI were passed on to the manager to look into. The home uses the Surrey Multi Agency policy and procedure to deal with suspected cases of abuse. The home was not dealing with any issues at the present time. The staff are aware through training how to deal with these procedures to ensure the safety of the residents in their care. Coombe Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 Page 15 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) This section was assessed during the inspection in April 2005. There were no changes in the comments made then. EVIDENCE: Coombe Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 Page 16 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 and 30 The home is functioning to full establishment of staff. The recruitment practices have been rectified. Staff received training in all aspects of their jobs including NVQ. EVIDENCE: During the previous inspection, staff files were sampled and there were a number of issues relating to new staff fitness. These issues have been rectified and new procedures have been written to ensure staff were appropriately and thoroughly checked prior to starting work in the home. The manager explained that the management team responsible for recruitment was now more vigilant. There were no vacancies in staffing. The home employs the services of a trainer who organises both internal and external training for all levels of staff. The care staff are able to receive NVQ training. Including the new adaptation nurses on the staffing rota, the home now employs 9 staff with NVQ level 3 and 2 with level 2. Another 4 are going to undertake level 2 this year. All other mandatory (health and safety and protection of vulnerable adults) training is offered and updates are also offered yearly. The registered nurses are able to request any professional courses (venepuncture, wound management, nutrition), conferences or training in clinical aspects of their jobs. The manager and one registered nurse have now started the A1 (NVQ assessors training). Coombe Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 Page 17 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) 33, 35 and 38 There is evidence to suggest that the home took residents’ experience and welfare seriously and aim to provide a reasonable and happy environment. There are policies established to help residents manage their money. There were policies and procedures for health and safety although the night time fire procedures needed immediate review. EVIDENCE: The home welcomes feedback from all the visitors and the residents. There are consistent efforts from both the management and the care staff to encourage residents to take part in the running of the home. The residents and their families are regularly consulted when changes are planned. There are opportunities offered for one to one discussions with the manager. The management style is proactive. Staff met regularly to discuss their involvement in the home and there is much teamwork observed. Staff appeared encouraged to suggest changes if they thought of any ideas that would benefit the residents. Coombe Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 Page 18 The home has polices and procedures to deal with residents’ finances. The residents’ families and solicitors mainly dealt with those. Staff did not take responsibilities to manage residents’ monies. There are procedures to safeguard residents from potential financial abuse and they are not encouraged to keep money if they can’t look after this themselves. There are a number of good health and safety policies and procedures in the home. The staff received training in all aspects of health and safety with regular yearly updates. When discussing fire procedures with the manager, it was apparent that a day time procedure could not possibly be used at night due to such decline in the number of staff present alone and the fact that residents would be in their bedrooms on separate levels. An immediate requirement was left for the home to provide a night time fire procedure and training for all staff who worked on night duty. A copy of the procedure was sent to the CSCI as evidence that this had been actioned promptly in time for this report. The manager stated that she would ensure training for those staff who worked night duty to be familiar with the night time procedures. There is a maintenance man available to take care of any day-to-day repairs and general checks on premises and equipment and contractors are also used. Temperatures are checked and recorded on clinical pharmaceutical fridge that houses any medication needed to be stored there. Additionally the temperatures of all the kitchen refrigeration equipment are also recorded daily and any faults duly reported and fixed. Coombe Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 x x 2 Coombe Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 Page 20 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 38 Regulation 23 (4) Requirement Provide a suitable night time fire procedure and fire training for staff who work on night shifts Timescale for action immediate 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 Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Coombe Dingle h09-h58 s13311 Coombe Dingle v233522 300805 stage 4.doc Version 1.40 Page 22 - 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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