Inspection on 05/07/07 for Coombe House

This inspection was carried out on 5th July 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 House 05/06/06

Coombe House 14/03/06

Coombe House 12/07/05

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 Cornwall PL14 4JU Lead Inspector Alan Pitts Unannounced Inspection 09:30 5th July 2007 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 House DS0000009004.V334958.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 House DS0000009004.V334958.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coombe House Address Coombe Lane Lamellion Liskeard Cornwall PL14 4JU 01579 346819 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) anngray@clara.co.uk Ms Ann Elisabeth Gray Care Home 16 Category(ies) of Dementia - over 65 years of age (9), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (9), Old age, not falling within any other category (16) Coombe House DS0000009004.V334958.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service users to include up to 16 adults of old age (OP) Service users to include up to 9 adults aged over 65 with a mental illness (MD(E)) Service users to include up to 9 adults aged over 65 with dementia (DE(E)) Total number of service users not to exceed a maximum of 16 Date of last inspection 5th June 2006 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. The range of fees charged at this home is £349.10 to £390.00. Coombe House DS0000009004.V334958.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 5th July 2007 over a period of approximately 5 hours, commencing at 09.30am. The registered provider was present throughout. The inspection comprised meeting with residents, staff, a tour of the premises, and inspection of care documentation and other records. Coombe House is an established home offering a relaxed, comfortable setting, in which residents’ care needs are appropriately met by a small, established care team. The registered provider is in day-to-day control with able assistance from her senior carer. The local rural surroundings, the home’s décor, and the staff team contribute to a relaxed, calm atmosphere. What the service does well: What has improved since the last inspection? The registered provider has ensured that a number of the recommendations identified at the previous inspection have been acted upon. The registered provider and staff manage to maintain a homely, family atmosphere. The residents were pleased with the quality of care and accommodation provided, and made positive comments about the kindness and consideration shown by the staff. Staff were seen to interact well with residents in a friendly yet professional manner. There is a commitment to ongoing staff training. The registered provider and staff take pride in the quality of the care provided, and are also committed to meeting the National Minimum Standards. Coombe House DS0000009004.V334958.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Coombe House DS0000009004.V334958.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 House DS0000009004.V334958.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 registered provider is thorough in ensuring that prospective residents will have their needs met at Coombe House. EVIDENCE: The registered provider provides each resident, or their representative, with a copy of the home’s Service User Guide, along with an individual Statement of Terms and Conditions that specifies the fees to be paid, and how, and the room to be occupied. The home has had a small number of new admissions since the last inspection. The care documentation for the most recent admission was inspected and showed a care needs assessment was undertaken prior to admission. Prospective residents may visit for coffee, meals, or stay for the day. The Coombe House DS0000009004.V334958.R01.S.doc Version 5.2 Page 9 registered provider ensures that all prospective service users or their representatives are aware of this at the time of carrying out the home’s preadmission assessment. Significant time and effort is spent making admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life changing decisions they need to make. There is a high value on responding to individual needs for information, reassurance and support. The home does not provide intermediate care. Coombe House DS0000009004.V334958.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. Care plans are in use for each resident, and the care needs of the residents are met. Medicines are handled, stored, and disposed of in a proper manner. Residents are treat with dignity and their right to privacy is respected. EVIDENCE: Detailed assessments and plans of care highlight residents needs, appropriate action and review procedures that include the residents. Senior staff and carers are involved in daily handover procedures to facilitate the necessary communication of the changing care needs and support required by residents. Care plans are in place for each resident, which set out their individual care needs and include reference to mental capacity. The care documentation shows the involvement of other healthcare agencies and professionals as necessary. Each resident is registered with a general practitioner at The Parade and Dean Street Surgeries and have access to any specialist treatment required. Community nursing and mental health support staff visit the home to support residents. Coombe House DS0000009004.V334958.R01.S.doc Version 5.2 Page 11 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. Medicines are appropriately stored and administered, in line with the medicines policy in use. A record is kept for the receipt and return of medication. Medicine Administration Records were seen to be accurate and current. Residents confirmed that they are happy with the care provided and the manner in which it is provided, they said that the staff were considerate and polite. The residents felt that their privacy was respected. Staff and the registered provider were observed to knock before entering residents’ rooms. The residents were clearly relaxed and comfortable in their interactions with the staff and the registered provider. Coombe House DS0000009004.V334958.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, 15 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home could do more to demonstrate that residents are able to exercise choice and control over their social/recreational lives. The home offers freshly cooked meals and a balanced, attractive diet. EVIDENCE: Staff were observed to be busy and interacting with residents throughout the inspection, and there were a number of cards received from relatives praising the care offered at Coombe House. The majority of residents have a mental health condition, in addition to being physically frailer through old age. Whilst it is recognised that there are some limitations on the ability of this client group to express choice, the social/recreational records still do not show the efforts of staff and the social/recreational options available to residents on a daily basis. There is no formal activity programme, though there is a selection of equipment available for activities. The registered provider and staff confirmed that there is usually a recreational activity offered every day. Residents spoken with did not express a preference in respect of social/recreational activities, and similarly did not say they were happy or unhappy with the options available. Coombe House DS0000009004.V334958.R01.S.doc Version 5.2 Page 13 There is a visitor’s book and an open visiting policy operates at the home. The daily records show that residents do receive visitors, and the staff and registered provider confirmed this. All the residents have a family member or representative. A two-weekly menu is in operation, which is amended seasonally. A record of food provided, including whether a resident eats well or not, is kept. Alternative meals are available, and the residents are asked on a daily basis if the alternative would be preferred. The home has undertaken a ‘Making Food Safely’ programme that involved the frequent attendance of the Environmental Health Officer. The residents were complimentary about the quantity and quality of the food provided. Coombe House DS0000009004.V334958.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, 18 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Complaints Procedure and Adult Protection Procedure protect residents. EVIDENCE: There have not been any complaints received by the Commission for Social Care Inspection since the last inspection. The registered provider liaises effectively with relatives and relevant agencies. A complaints procedure is in place, and is included in the Service User 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 residents and staff as required. There is a record of feedback from relatives kept. The complaints policy shows the old Commission for Social Care Inspection address in St Austell and should be updated. The registered provider is fully aware of local Adult Protection procedures and has provided training on this for the staff. The registered provider also includes the Adult Protection, and confidentiality in 1:1 supervisions with staff. An effective Adult Protection procedure is in place. Coombe House DS0000009004.V334958.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in safe, comfortable, clean accommodation and a homely environment, enhanced by their own possessions around them. EVIDENCE: Coombe House is in a rural, peaceful setting that requires access across a railway line (this involves telephoning the nearby train station and opening and closing two gates). New visitors to the home would be advised to ring for directions once in the local area. The house is in keeping with its country surroundings, and there is an atmosphere of calm throughout. The premises were clean. The lavatories and bathrooms were seen to have hand-washing provisions, though there can be difficulties with paper towels and the registered provider is intending to change to liquid alcohol wash. Heating, lighting, and ventilation are domestic and suitable to the home. Radiators have protective guards and are individually Coombe House DS0000009004.V334958.R01.S.doc Version 5.2 Page 16 controlled. Restrictive window opening devices have been installed in all bedrooms to protect residents. All the hot water outlets are provided with mixing valves to reduce the risk of scalding. Communal areas are light, spacious and suitable for a range of activities, with plants and pictures in all areas. Downstairs, there are two lounges, a dining room, and a large office used for visiting relatives and residents. The gardens are well maintained and a patio has been built with extending views across the surrounding countryside. Residents’ rooms were seen to be comfortably and pleasantly furbished and furnished, appropriate to their care needs, and all were personalised to varying degrees. The registered provider is constantly increasing the variety of aids available as the physical health of residents deteriorates, including hospital beds and tracking hoists. The laundry area is small, but functional with a washing machine and separate dryer provided. Fouled items are currently hand washed in the sluice sink. Coombe House DS0000009004.V334958.R01.S.doc Version 5.2 Page 17 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 judgement has been made using available evidence including a visit to this service. There is an evident commitment to staff training and resident welfare in an active and ongoing staff training programme. EVIDENCE: There are generally 3-4 staff on duty on the early shift, followed by 2-3 staff on the late shift. There is always one waking member of staff and one sleeping member of staff at night. Staff turnover is small, and there is an established core of experienced staff. The registered provider is assisted in the day-to-day running of the home by an able senior carer. There are sufficient staff to meet the care needs of the residents, but consideration should be given to comments in this report about recording the lifestyle of residents. The registered provider lives in adjacent premises and is available to support if needed. There are 16 care staff employed, of which 14 have achieved NVQ Level 2 or above, approximately 88 . Each member of staff has an individual training record. Recent and planned training includes: manual handling, infection control, activities for dementia, medication, communication and swallowing, food hygiene, diabetes, and 1st Aid. Two sample personnel files were inspected and these showed that the home adheres to a robust recruitment procedure in order to protect residents. Coombe House DS0000009004.V334958.R01.S.doc Version 5.2 Page 18 All staff have been provided with General Social Care Council handbooks. The registered provider is using a National Training Organisation compliant induction programme for new staff. Coombe House DS0000009004.V334958.R01.S.doc Version 5.2 Page 19 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, 38 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s leadership, management, and policies and procedures benefit and protect residents. The home has achieved and maintained Investors in People status. EVIDENCE: There is a clear management hierarchy, with the registered provider taking day-to-day control and therefore being available to residents and their representatives. An experienced senior carer assists the registered provider. This is a small care home with an established and trained staff team and an experienced and qualified registered provider. Coombe House DS0000009004.V334958.R01.S.doc Version 5.2 Page 20 Annual quality assurance questionnaires are used and anonymous quotes from the responses are used in the annually reviewed Service User Guide. The registered provider agreed to look at ways of summarising the questions asked and responses so as to provide more information to readers of the Service User Guide. The registered provider does not handle any resident money, any transactions being invoiced to the resident or their representative retrospectively. Residents are supported in maintaining their personal finances and affairs through relatives and Power of Attorney processes. Staff are supervised and a record is kept, though the frequency of this has lapsed in recent months. The supervision is complemented by an annual appraisal for all staff and frequent staff meetings. The home has achieved and maintained the Investors in People Award. There is a training matrix in place for each staff member that shows training planned, training done, and when training is due. The home’s policies and procedures are comprehensive, regularly reviewed, and as issues arise for discussion the relevant policy is brought to the attention of staff. The home’s maintenance records folder showed that the fabric of the building and the equipment within it are regularly and properly maintained for the safety of all. Coombe House DS0000009004.V334958.R01.S.doc Version 5.2 Page 21 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 3 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 2 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 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 House DS0000009004.V334958.R01.S.doc Version 5.2 Page 22 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 OP14 Good Practice Recommendations The registered provider should implement a daily social/recreational programme, in keeping with service user’s interests and capabilities. The registered provider should ensure that the care records more clearly show the options available to service users and the choices made on a daily basis (e.g. enjoyed activity or declined to join in activity). In the interests of infection control, the registered provider should provide an industrial washing machine with a sluice cycle, and dissolving laundry sacks for fouled linen, when the time comes to replace the existing machine. The registered provider should consider the provision of an automated sluice machine. 3. OP26 Coombe House DS0000009004.V334958.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP 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 House DS0000009004.V334958.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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