Inspection on 12/07/05 for Coombe House

This inspection was carried out on 12th July 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 House 05/07/07

Coombe House 05/06/06

Coombe House 14/03/06

Coombe House 27/01/05

Coombe House 15/06/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Coombe House Coombe Lane Lamellion Liskeard PL14 4JU Lead Inspector Mike Stokes Announced 12 July 2005 10:00 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 House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Coombe House Address Coombe Lane Lamellion Liskeard PL14 4JU 01579 346819 01726 71967 www.coombe-house.org.uk Ms Ann Elisabeth Gray 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) CRH 16 Category(ies) of Old age, not falling within any other category registration, with number (16), DE(E) 9 and MD(E) 9. of places Coombe House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 16 adults of old age (OP) 2. Service users to inlcude up to 9 adults aged over 65 yrs with a mental illness (MD(E}) 3. Service users to include up to 9 adults aged over 65 yrs with dementia (DE(E}) 4. Total number of service users not to exceed a maximum of 16 3rd February 2005 Brief Description of the Service: Coombe House is situated in a quiet rural setting at the head of the Looe Valley. It is one mile from the centre of Liskeard, which provides a range of shops and community facilities. Coombe House provides accommodation and personal care for up to 16 older persons, some of whom may also have a mental disorder/dementia. Accommodation is provided on two floors. A stair lift is available to assist service users with access to the upper floor. Date of last inspection Coombe House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection of care standards at Coombe House. I arrived at 10.00 am and the inspection finished at 3.00 pm. During the inspection I was able to discuss what it is like to live at the home with service users. The registered person and a senior carer assisted me in reviewing records kept to monitor care at the home and discussing issues regarding the welfare of service users. A tour of the home occurred to monitor environmental standards. Comment cards were received from a service user and 2 relatives. I discussed issues raised in the comment cards with a relative and these were discussed with the registered person during the inspection. The registered person completed a detailed pre inspection questionnaire to assist in the inspection process. What the service does well: What has improved since the last inspection? What they could do better: 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 House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 6 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 House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 and 4. The registered person has provided a statement of purpose and service users guide that details the facilities and services available within the home. The registered provider will assess all prospective service users prior to admission to ensure that the home can meet their care needs. EVIDENCE: A statement of purpose is available within the home and a service users guide has been issued to each service user or relative. These documents explain the services and facilities available within the home. The registered person has recently updated them and amended copies were provided at this inspection. The registered provider ensures an appropriate assessment is completed prior to admission and these records include information received from relatives and other agencies to assist in appropriate admissions to the home. Coombe House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, and 9. The health needs of service users are met with evidence of multi disciplinary work occurring to provide for service users welfare. EVIDENCE: Detailed assessments and plans of care highlight service users needs, appropriate action and review procedures that include service users. Senior staff and carers are involved in daily handover procedures to facilitate the necessary communication of the changing care needs and support required by service users. The registered provider plans to develop personal history or life stories that are pertinent to service users and provide staff with details that may assist in daily communication and understanding. Each service user is registered with a general practitioner at The Parade and Dean Street Surgeries and have access to any specialist treatment required. The Consultant Psychiatrist visits the home at 3 monthly intervals to conduct reviews of care. Community nursing and mental health support staff visit the home to support service users. A recommendation is made regarding the recording of agreements for service users requiring bed rails. The home has a medication policy and procedure that is read and signed by all staff and an accredited training course on medication has been provided. The home uses the monitored dosage system to administer medication and recordings are clear and accurate. Coombe House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 9 Coombe House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 13. The registered person enables relatives to visit service users and provide support; advocacy services are also available, where service users are isolated. EVIDENCE: The majority of service users have a mental health condition, in addition to being physically frailer through old age. On arrival service users were using the ground floor lounge areas and also seated in external areas enjoying the pleasant weather. The morning tends to be a peak time of activity for staff providing breakfast between 7.30pm and 10am, assisting service users to wash and dress, cleaning the home and attending to service users as required. The staff on duty stated that after lunch and a 2.30pm handover, other staff involve service users in planned activities. The registered person stated that for frailer service users an escorted garden walk, musical entertainment, visitors to the home and enjoying the peaceful surroundings are preferred activities. Risk assessments dictate that staff or relatives escort service users wishing to access community facilities. The home does not provide transport and service users generally require an ambulance, relatives or taxis for health appointments and access to community facilities. The pre inspection information completed by the registered person states,’ one person has outings which he pays for – agreed by family and social worker’. Coombe House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 11 The relatives and friends of service users are welcome at the home. Relatives are invited to contribute to reviews of care and quality assessment surveys. The continued consultation assists in maintaining communication with service users and to identify preferences regarding meals, environmental, personal issues and interests. The registered person has identified a number of service users that are isolated from relatives and the Care Aware Advocacy Service has been used to support service users. Comments received from a relative were discussed with the registered person. The registered person is aware of these issues and is negotiating with the relative to find a successful resolution. The registered person is providing appropriate staffing levels and will discuss this perception of services with the relative to give an assurance that staff time is spent with service users. Coombe House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 12 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 and 18. The registered provider uses the policy and procedures at the home to assist in the protection of service users. EVIDENCE: The complaints procedure containing the Commissions contact number and address was displayed in the home and is detailed in the service users guide. The registered person lives on premises adjacent to the home and works at the home on a daily basis. This ensures she is available to monitor standards and support service users and staff as required. The homes adult protection policy and procedure includes references to supporting staff in reporting concerns (whistle Blowing) and reporting allegations or incidents immediately to the Social Services (No Secrets) and the Commission in compliance with regulation 37. The registered person stated that staff will be attending Adult Protection training provided by social services. Service users are supported in maintaining their personal finances and affairs through relatives and Power of Attorney processes. A comment received by family friends acting as the Power of Attorney for a service user stated,’ the care is gentle and understanding and we are very pleased that she is cared for at Coombe House’. Coombe House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22 and 23. The registered provider is providing a good standard of décor and maintenance to ensure service users live in a safe and comfortable environment. EVIDENCE: Coombe House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 14 Communal areas are light, spacious and suitable for a range of activities, with plants and pictures in all areas. There are 2 lounges, a dining room and a large office used for visiting relatives and service users. The gardens are maintained and a patio has been built with extending views across the surrounding countryside. There is a stair lift, mobile hoist, bath hoist and grab rails that enables service users access to all parts of the house. There is also a variety of pressure relieving equipment. The home has adequate bathing and toilet facilities, with all hot water outlets provided with mixing valves to reduce the risk of scalding. A hoist providing overhead tracking is installed in the upstairs bathroom for the safety and convenience of the service users and staff. The home has a call bell system providing detailed information regarding staff response times and frequency of calls. This system also alerts staff to movement where service users are at risk of falling. Community nursing equipment hire has provided 2 bed rails and 2 are the homes own property. The home has also purchased buffers to reduce the risk to service users. A recommendation is made that the registered person should record the consultation and agreement with service users or relatives where appropriate, and the advice of the Community Nursing Team regarding the purpose and appropriate fitting of all bed rails. This should be recorded in care plans as part of the risk assessment procedure and care to be delivered. Rooms are individually and naturally ventilated. Restrictive window opening devices have been installed in all bedrooms to protect service users. The registered person discussed the development plan to redecorate a service users room and replace a stair carpet. Radiators have protective guards and are individually controlled. A discussion occurred with the registered person regarding issues raised by a relative about the radiator in a service users room. The registered person assured me that this maintenance has been completed and this will be monitored in the Autumn to ensure appropriate heating is supplied. Coombe House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 15 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 29 The registered manager is providing suitably trained staff, in appropriate numbers to provide for the welfare of service users. EVIDENCE: There is a minimum of 2 carers at all times with 4 carers at peak times of activity, in addition to the registered person and ancillary staff. 2 waking night carers are provided for service users that require attention at night. The recruitment procedures and records were reviewed for staff and the registered person was able to provide written references and satisfactory records regarding this process. The registered person has a commitment to providing a trained workforce and is currently reviewing individual staff files regarding training schedules. Appropriate training has occurred at NVQ levels 2 and 3, NVQ assessors training, activities in dementia care, food hygiene, moving and handling, firstaid and health and safety. The induction records for individual staff are signed and dated. The registered person discussed an incident concerning a service user injured at the home by an older person attending the home for day care services. The registered person has assessed the situation and is providing an additional staff member to supervise the day care attendee. A staff rota was provided and a recommendation is made that the registered person records the time spent at the home to demonstrate being in day-to-day control, in the absence of a registered manager. Coombe House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35 and 38. The registered person is providing clear and effective leadership and management to maintain a safe and comfortable home for service users. EVIDENCE: The registered person is currently undertaking the Registered Managers Award and is a qualified nurse. The registered person manages the home on a dayto-day basis and ensures appropriate standards are maintained. The registered person is currently reviewing all policy and procedure at the home, to complete an audit of care and a quality assessment survey is proposed for this year. All service users are the subjects of Power of Attorney procedures. Staff supervision is organised and the home has achieved the ‘Investors in People’ award. The health, safety and welfare of service users and staff is promoted and protected. All staff receive induction and foundation training and updates on ‘safe working’ topics. A recommendation is made regarding the provision of fire precautions signage on a ground floor hallway exit door. Coombe House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 17 Coombe House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 18 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 3 x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 3 3 3 3 x x x STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x 3 x x 2 Coombe House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 19 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 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 7 Good Practice Recommendations The registered person should record the consultation and agreement with service users or relatives where appropriate, and the advice of the Community Nursing Team regarding the purpose and appropriate fitting of all bed rails. This should be recorded in care plans as part of the risk assessment procedure and care to be delivered. The registered person should record the time spent at the home to demonstrate being in day-to-day control, in the absence of a registered manager. The registered person should review that the provision of fire precautions signage on a ground floor hallway exit door is appropriate. 2. 3. 27 38 Coombe House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell PL25 4AD 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 House D52-D09 S9004 Coombe House V228783 120705 Stage 4.doc Version 1.40 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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