Inspection on 05/06/06 for Coombe House

This inspection was carried out on 5th June 2006.

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 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 Key unannounced Inspection 5th June 2006 10:00 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 House DS0000009004.V297842.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.V297842.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.V297842.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 14th March 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 £340.50 to £375.00. Coombe House DS0000009004.V297842.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 May 2006 over a period of approximately 6 hours, commencing at 09.30am. The registered provider was present throughout. The inspection comprised meeting with service users, staff, and a visiting District Nurse, 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 service user’s care needs are appropriately met by a small, established care team. What the service does well: What has improved since the last inspection? The registered provider has responded positively to the requirements and recommendations identified at the previous inspection, providing each service user with a copy of the home’s Statement of Purpose and Service User Guide, arranging for the provision of National Training Organisation compliant induction training for new staff, and improving the entries in the daily records to better show the daily lives of service users (though further improvement is possible). Coombe House DS0000009004.V297842.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. Coombe House DS0000009004.V297842.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.V297842.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 6 A Statement of Purpose and Service User Guide, along with a Statement of Terms and Conditions is provided to each service user or their representative. Prospective service users are assessed prior to admission. The home does not provide intermediate care. EVIDENCE: The registered provider provides each service user, or their representative, with a copy of the home’s Statement of Purpose and 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 not had any new admissions since the last inspection. The care documentation for the most recent admission was inspected at the last inspection and showed a care needs assessment was undertaken prior to admission. Prospective service users may visit for coffee, meals, or stay for the day. The 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. Coombe House DS0000009004.V297842.R01.S.doc Version 5.2 Page 9 The home does not provide intermediate care. Coombe House DS0000009004.V297842.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Care plans are in use for each service user, and the care needs of the service users are met. Medicines are handled, stored, and disposed of in a proper manner. Service users are treat with dignity and their right to privacy is respected. 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. Care plans are in place for each service user, which set out their individual care needs. The care documentation shows the involvement of other healthcare agencies and professionals as necessary. Each service user 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 service users. A visiting District Nurse confirmed that the home communicates information well and had no concerns about the care provided, believing it to meet the care needs Coombe House DS0000009004.V297842.R01.S.doc Version 5.2 Page 11 of the service users. Two service users had hospital appointments on the day of the inspection. 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, though when it is necessary to hand-write a prescription on to these the registered provider should ensure that two staff initials are entered to show that the entry has been checked as correct. Service users spoken with 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 service users felt that their privacy was respected. Staff and the registered provider were observed to knock before entering service user rooms. Service users spoken with were clearly relaxed and comfortable in their interactions with the staff and the registered provider. Coombe House DS0000009004.V297842.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The home could do more to demonstrate that service users are able to exercise choice and control over their lives. The home offers freshly cooked meals and a balanced, attractive diet. EVIDENCE: The majority of service users 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 tend to show where a service user was on any given day, rather than what they were doing. There is no formal activity programme, and the registered provider should consider and 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). Service users 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. There is a visitor’s book and an open visiting policy operates at the home. The daily records show that the service users do receive visitors; one service user was waiting to be taken out for the day. All the service users Coombe House DS0000009004.V297842.R01.S.doc Version 5.2 Page 13 have a family member or representative. The registered provider has recently sent service users and their representatives information about the advocacy services available. A weekly menu is in operation. A record of food provided, including whether a service user eats well or not, is kept. Alternative meals are available to service users, and the service users 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 service users were complimentary about the quantity and quality of the food provided. Coombe House DS0000009004.V297842.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 There has been one complaint received by the Commission for Social Care Inspection since the last inspection, which was not upheld. There is a complaints procedure in place. Service users are protected by the home’s Protection Of Vulnerable Adults procedure. EVIDENCE: There has been one complaint received by the Commission for Social Care Inspection since the last inspection, which was not upheld. The registered provider liaised effectively and cooperated fully with the relevant agencies. A complaints procedure is in place. 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 registered provider is fully aware of local Protection Of Vulnerable Adults procedures and has provided training on this for the staff. The registered provider has also included the Protection Of Vulnerable Adults, and confidentiality in 1:1 supervision with staff. A Protection Of Vulnerable Adults procedure is in place. Coombe House DS0000009004.V297842.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Service users live in safe, comfortable, clean accommodation and a homely environment, enhanced by their own possessions around them. EVIDENCE: 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 area is also available. 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. Rooms are individually and naturally ventilated. Restrictive window opening devices have been installed in all bedrooms to protect service users. Radiators have protective guards and are individually controlled. The premises were clean throughout on the day of Coombe House DS0000009004.V297842.R01.S.doc Version 5.2 Page 16 the inspection. The lavatories and bathrooms were seen to have hand-washing provisions. Heating, lighting, and ventilation are domestic and suitable to the home. 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. As discussed at the time of the inspection, 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. Coombe House DS0000009004.V297842.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The number and skill mix of staff meets Service user’s care needs. Service users are protected by the home’s recruitment policy, and there is an evident commitment to staff training. EVIDENCE: At the time of the inspection there was the registered provider, 4 carers and a cook on duty. 2 waking night carers are provided for service users that require attention at night. Extra staff are provided to assist with events such as hospital appointments. Staff were observed to be fully occupied with their duties, without appearing overly rushed. Staff were observed to be considerate and respectful in their dealings with service users. There are 14 care staff in total, of which 11 have NVQ Level 2 or above (approximately 80 ). The remaining 3 staff are currently undertaking this training. 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 provider should maintain a record of interview also. The most recently employed staff arrived having already achieved NVQ level 2. The registered provider has National Training Organisation Induction Programmes available in readiness for new staff, and one existing staff member is undertaking this training. The staff have been provided with General Social Care Council handbooks. The home has an in-house induction Coombe House DS0000009004.V297842.R01.S.doc Version 5.2 Page 18 programme in use. The sample inspected showed that the wide variety of topics covered had been signed off as completed on the same day. The registered provider should ensure that the home’s induction record shows that the induction process occurs over a period of time maximising the trainee’s understanding of the topics covered. Coombe House DS0000009004.V297842.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 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 day-today basis and ensures appropriate standards are maintained. There is a clear management hierarchy, with the registered provider taking day-to-day control and therefore being available to service users and their representatives. The registered provider has commenced a quality assurance programme, with a good response to questionnaires being received from service user’s families/representatives. The registered provider should expand the use of these quality assurance questionnaires to include visiting professionals and the Coombe House DS0000009004.V297842.R01.S.doc Version 5.2 Page 20 staff, publishing a summary of the feedback (perhaps in the home’s Service User Guide). The registered provider does not handle any service user money, any transactions being invoiced to the service user or their representative as appropriate. Receipts support any financial transactions. Staff are regularly supervised and a record is kept. The supervision is further complemented by an annual appraisal for all staff and frequent staff meetings. The home’s policies and procedures are comprehensive, and as issues arise for discussion the relevant policy is brought to the attention of staff. The home’s maintenance and safety documentation was inspected and seen to be in order: • Boiler service • Electrical system • Fire Training (the registered provider should identify a fire warden to undertake relevant training and subsequently cascade training to the other staff). • Fire Equipment • Hoist maintenance • Stair-lift maintenance • Pest control • RIDDOR • COSHH • Accident book Coombe House DS0000009004.V297842.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 3 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 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Coombe House DS0000009004.V297842.R01.S.doc Version 5.2 Page 22 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. 1. Refer to Standard OP9 Good Practice Recommendations When it is necessary to hand-write a prescription on to the Medicine Administration Records the registered provider should ensure that two staff initials are entered to show that the entry has been checked as correct. The registered provider should consider and 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 DS0000009004.V297842.R01.S.doc Version 5.2 Page 23 2. OP14 3. OP26 Coombe House 4. 5. OP29 OP30 6. OP33 7. OP38 registered provider should consider the provision of an automated sluice machine. The registered provider should maintain a record of interview also. The registered provider should ensure that the home’s induction record shows that the induction process occurs over a period of time maximising the trainee’s understanding of the topics covered. The registered provider should expand the use of these quality assurance questionnaires to include visiting professionals and the staff, publishing a summary of the feedback (perhaps in the home’s Service User Guide). The registered provider should identify a fire warden to undertake relevant training and subsequently cascade training to the other staff. Coombe House DS0000009004.V297842.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall 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 DS0000009004.V297842.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. 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