Inspection on 28/01/08 for Coombe Grange Residential Home

This inspection was carried out on 28th January 2008.

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 Grange Residential Home 02/09/09

Coombe Grange Residential Home 01/08/06

Coombe Grange Residential Home 27/09/05

Coombe Grange Residential Home 25/05/05

Coombe Grange Residential Home 22/11/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Coombe Grange Residential Home Coombe Lane Sway Lymington Hampshire SO41 6BP Lead Inspector Peter J McNeillie Unannounced Inspection 28th January 2008 09:00 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 Grange Residential Home DS0000061686.V356451.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 Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coombe Grange Residential Home Address Coombe Lane Sway Lymington Hampshire SO41 6BP 01590 682519 01590 681836 coombegrange@bmihealthcare.co.uk www.coombegrange-rh.co.uk 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) Coombe Grange Limited Mrs Valerie Anne Clarke Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (40), Old age, not falling within any other category (40) Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st August 2006 Brief Description of the Service: Coombe Grange is a registered care home set in a rural location on the edge of the village of Sway in the New Forest, with limited access to local amenities. It provides accommodation and personal care for up to 40 elderly residents, some of who may have dementia. The home is on ground, first and second floors and there is a lift between ground and first floors. There are a variety of aids and adaptations to allow residents to move about more independently. Twenty-four of the bedrooms are single, and eight are doubles. There are two communal toilets and a bathroom on the ground floor, and one toilet, two bathrooms and two showers on the first floor. There are large, accessible, gardens around the building. Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is [2 star]. This means the people who use this service experience [good] quality outcomes. This key unannounced visit was the first inspection for the years 2007/08 and took place on 28/01/08 between the hours of 09.00 am and 1.15 pm during which all of the key standards for care homes for older persons and all previous requirements were inspected. This report was written after taking into consideration a number of sources of information and evidence including a site visit to the premises, previous reports, examining residents and staff training records, talking with residents, staff and management, responses by the manager to a pre inspection Annual Quality Assurance Assessment. (AQAA) and the results of in house satisfaction questionnaires sent out by The Commission for Social Care Inspection (CSCCI) and completed by residents, residents representatives and visiting health and social care professionals. At the time of this inspection during which no requirements or recommendations were made charges in the home were £425 to £650 per week. The results and findings contained in this report will determine the frequency and type of future inspections. What the service does well: What has improved since the last inspection? What they could do better: Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 6 There were no areas of concern noted and any requirements or recommendations made. However we did highlight: Initial pre admission assessments and care plans should include a written acknowledgement by the resident or their representative they were involved in and consulted and menus should be available in a format that all residents could understand. 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 Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 7 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 Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 8 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): 3 and 6. 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 system of assessing and identifying residents needs which ensures residents safety and that their assessed needs can be met. Intermediate care is not provided. EVIDENCE: The home had written policies and procedures concerned with the admission of new residents to the home which stressed the importance of ascertaining accurately the help and required by potential residents before they moved into the home. A sample of four residents records and pre admission assessments of need and risk chosen at random were viewed. All of the records viewed confirmed that potential residents are only admitted following a full assessment of their care and nutritional needs and risks Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 9 (including falls) by the manager or another member of the homes management team. Whilst talking to residents we established they had been involved in the initial assessment process but this was not evident from the records viewed. The manager gave a verbal undertaking to ensure this information would be included in the future. All potential residents and residents’ representatives are invited to visit the home for a meal prior to an admission being agreed. As part of the admission process management also liaise with external health and care professionals regarding any care needs, risks, equipment and aids that need to be taken into consideration when developing a plan of care. Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,and 10. 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 well-developed system of planning and reviewing care which reflects residents wishes, aspirations and ensures residents needs are met within a risk management policy and involves residents and residents representatives or relatives in decisions that affect them. EVIDENCE: A sample of four residents care plans were viewed and a number of residents spoken to individually or in groups. All of the detailed care plans which were reviewed at least monthly were based on pre admission assessments the home had carried out in order to identify what help and support individuals needed (The previous section, Choice of Home, standards 1-6 of this report refers). Whilst some residents verbally confirmed they were consulted about and participated in the production of the plan, others could not remember and in Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 11 some instances were probably not able to participate in a constructive and meaningful manner due to their dementia. We were informed by the homes management approximately 60 of residents have dementia. There was no written confirmation by residents or their representatives to confirm their participation. A verbal undertaking was given by the manager that in the future this information would in be available. All of the residents spoken with confirmed they were very satisfied with the care and support they received, contented, liked the staff and management, were treated with respect felt wanted and would recommend the home to anyone”. Residents responses to our questions about how they were cared for and liked living in the home were all very positive and included comments such as “ Hotel service”” I am more than happy”,” Well satisfied”,” Care is very good” “The staff are great”.” You wont find anything wrong here”, ”The best”. Resident also confirmed that staff always knocks on their bedroom door and wait before entering, a practice we observed during this visit. Residents spoken with also confirmed they were able to see the doctor of their choice or any other health and social care professional when they needed to. The records viewed indicated that apart from doctors, district nurses, physiotherapists, occupational therapists, other specialists had been consulted when required. Records were kept of appointments with GPs, dentist, optician, chiropodist and any other external health and social care professional and included details of any advice and treatment given. Medication records confirmed that all prescribed drugs and medicines, which are securely stored, are dispensed by a pharmacist into a blister pack system and administered in accordance with a medication policy and procedure by trained staff who confirmed they were aware of and had read the procedure. The record of drugs and medicines administered to residents and unwanted drugs disposed of were complete and accurate. A procedure that ensures residents who wish may assume responsibility for their own medication was in place. Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The social activities family contacts and the provision of varied and nutritious meals were well managed and reflected residents interests and choices. EVIDENCE: Since the last inspection the home has employed a full time activities organiser who attends daily and is responsible for organising and carrying out a publicised programme of events and entertainments. Activities on offer included, bingo plus exercise, beetle drives, picture quizzes, craft, musical bingo, reminisance, knit and natter, lunch club, sing songs, keep fit, dancing, games as well as visiting entertainers. Residents confirmed how important the activities were and how much they enjoyed them and the variety on offer. All confirmed there was plenty to do and that participation was up to the individual, no one was forced to join in. The home has regular visits from local Church of England clergy who conduct services and communion in the home. Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 13 The needs of members from any other Christian denominations or other faiths would be if required catered for but at the time of this visit no members from other faiths were residing in the home. Residents confirmed they were fully consulted and were able to exercise choice in all aspects of their lives for example; when to get up and go to bed, mealtimes and where meals are taken, visiting times, the right to receive and converse with visitors and to make and receive telephone calls in private. Since the last inspection a family and friends group has also been set up to feed back any information regarding the home and the service provided. The quality, quantity, presentation and choice of food served came in for particular praise from the residents. We observed a member of staff discussing in some detail with residents choices of meals available for the following day. A daily menu was available and displayed but only in a written format, which some residents may not fully understand. The homes staff and management recognised that alternatives to a written menu is of importance for persons in particular those with dementia who may find the addition of pictures would be beneficial to their understanding and assist in them making meaningful choices. A verbal undertaking was given to produce menus in a format that all residents are able to understand. Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has clear policies and procedures in place which ensures residents are protected from abuse. The complaints procedure was satisfactory with evidence that residents feel their views will be acted upon. EVIDENCE: An in house Adult Protection policy and procedure that operates in tandem with the policy and procedure produced by Hampshire County Council designed to safeguard residents from abuse was available. Records viewed and staff spoken with confirmed they had received training in recognising various types of abuse. All were able to demonstrate they knew the procedure to follow should they witness or suspect the abuse of any resident. The homes complaints procedure, which included information on how to contact The Commission for Social Care Inspection (CSCI), was seen, as was a record of complaints. The procedure, which was included in the service users guide, was also displayed within the home. No complaints had been received by CSCI since the last inspection. Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 15 Residents spoken with said felt comfortable in raising any concerns they had with the homes management or any member of staff and confident any matters raised would be dealt with fairly and promptly. Staff also confirmed they felt confident in raising any matter or complaint with the homes management on behalf of a resident. Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 16 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): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A safe, well maintained, clean and suitably furnished home is provided for residents which meets their needs. EVIDENCE: All areas of the home were very clean and free from unpleasant odours and free form obvious hazards. The implementation of strict infection control measures was evident as soon as we entered the home. Those responsible for the high standard of cleanliness within the home are to be commended. Residents spoken with and returns from CSCI surveys confirmed the home is always clean and smells fresh. Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 17 Furniture was comfortable, homely and met residents needs. Professional assessment to ensure that any equipment and personal aids required by residents was available has been carried out sometimes as part of the pre admission assessment. Aids currently in use within the home include hoists, special beds, special baths, walk in shower, bedsides, grab rails, ramps, lifts and handrails. Since the last inspection apart of the routine maintenance, five bedrooms have been refurbished; two walk in showers created, and new furniture purchased. Future plans apart from a rolling programme of maintenance and refurbishment there are plans to improve the external patio area and repaint the building. Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 18 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): 27,28,29 and 30. Quality in this outcome area is excellent. This judgment has been made using available evidence including a visit to this service. The home has an appropriate level and mix of staff, ensuring that the needs of residents can be met. The home had clear staff recruitment, training and development procedures to ensure that service users are protected and supported, but need to clarify staff qualifications. EVIDENCE: At the time of the inspection the seven care were supported by the deputy manager, a cleaner, a handy man, a cook and a kitchen assistant and an activities coordinator. Residents who were full of praise for their carers confirmed the number of staff available ensured help was always prompt, efficient and carried in a pleasant and discreet manner. Care staff commented they had ample time to carry out their tasks and always had time to help residents on a one to one however long it took. Three care were available at night (two waking and one on call sleeping carer). Staffing levels are frequently reviewed and adjusted to ensure the assessed needs of residents are met at all times. Staff training is given a high priority by the homes management. Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 19 As part of their terms and conditions of employment, all staff are expected to participate in N.V.Q training courses, which they undertake following an in house and Skills for care induction and foundation course. At the time of the inspection 22.2 of staff had been trained to N.V.Q level 2, 44.4 to level 3 with a further 11 currently on a level 2 course. Comprehensive individual staff induction and training records that detailed dates when training was completed and when refresher courses on additional subjects such as dementia, the administration of medication, food hygiene, infection control moving/handling, fire safety (including evacuation), protecting persons from abuse and first aid were due. Staff spoken with informed us they were encouraged to participate in and enjoyed training and felt the training they had received had equipped them well to meet the needs and expectations of residents. Well maintained, presented and user friendly personnel records viewed confirmed all staff are recruited in accordance with a corporate equal opportunities selection and recruitment procedure which includes the completion of an application form, an interview, signing a rehabilitation of offenders declaration and satisfactory Criminal Records Bureau (CRB), Protection of Vulnerable Adults (POVA), immigration, qualification and reference checks. Records viewed also indicated staff turnover was low. Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home ensures the health, safety and welfare of residents and staff are promoted and the home is run in the best interests of the residents whose views about living in the home are formally sought. EVIDENCE: The manager who has a considerable number of years experience in a senior capacity has completed the Registered Managers Award, undertaken specialist training in dementia care and developed clear lines of accountability and a well-defined management structure within the home. Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 21 Staff who confirmed regular staff meetings and regular individual staff supervision takes place described the home management as being available approachable and supportive and willing to listen to suggestions and ideas for improving the existing service. As part of the homes quality monitoring system, residents, residents relatives and visiting health and social professionals are invited to participate in satisfaction surveys, however we were informed the response from health and social care professionals was always disappointing or on some occasions non existent. The views expressed in the surveys which are converted into an action plan, are seen as key in highlighting areas that may require improvement or attention and the future development of this service. In addition to surveys information is also fed back from the friends and families group set up by the home since the last inspection (Section 12-15 of this report also refers.) and reports produced by external management following visits made as required in accordance with regulation 26. We were informed no resident’s cash was being held by the manager for safekeeping, and residents or their representatives are responsible for all cash transactions carried out. A corporate health and safety policy was in place to ensure the day-to-day safety of staff and residents. Procedures include, weekly health and safety checks, the regular servicing of equipment, staff training in the techniques of moving and handling infection control, control of substances hazardous to health (C.O.S.H.H.) first aid, health and safety, reporting accidents and procedures to follow in the event of fire (including evacuation). As part of the health and safety arrangements and to protect residents, all of the hot water supplies to baths were fitted with thermostatic controls are set at 43 degrees centigrade and all radiators and hot pipes covered. Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTCTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 23 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. 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. Refer to Standard Good Practice Recommendations Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Coombe Grange Residential Home DS0000061686.V356451.R01.S.doc Version 5.2 Page 25 - 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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