Inspection on 15/05/07 for Coombe Oak

This inspection was carried out on 15th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Coombe Oak 12/12/05

Coombe Oak 09/08/05

Coombe Oak 26/10/04

Coombe Oak 08/04/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Coombe Oak Warren Road Kingston Upon Thames Surrey KT2 7HY Lead Inspector Adrian Gordon Key Unannounced Inspection 15th May 2007 10:30a Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 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 Oak DS0000013382.V339863.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 Adults 18-65. 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 Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Coombe Oak Address Warren Road Kingston Upon Thames Surrey KT2 7HY 020 8547 3777 0208 974 5801 chris.stringer@welmede.org.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) Welmede Housing Association Ltd Julie Anne Webb Care Home 22 Category(ies) of Learning disability over 65 years of age (22) registration, with number of places Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th December 2005 Brief Description of the Service: Coombe Oak is a residential care home providing care for twenty service users with learning disabilities. Care is provided in four separate houses on one site. Each house provides ground floor accommodation for service users. The Royal Borough of Kingston upon Thames own the home and it is managed by Welmede Housing Association Limited on a contract basis. Information about the service is available in the Statement of Purpose and Service User Guide. The current range of charges is £1152 to £1701 per week. Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and completed over the course of one day by two inspectors. The inspection consisted of a tour of the premises, examination of records and observation of care practice. We met with four residents, and had discussions with the staff and the area manager. Feedback questionnaires were received from seven residents and four relatives. These were used to inform the inspection. The inspectors visited each of the four houses but the majority of the time was spent in Houses 1 and 4. What the service does well: What has improved since the last inspection? What they could do better: It would improve the overall level of care if areas of good practice in each house were shared with and taken up by other houses. This means that individual areas of expertise could be shared which would benefit staff and residents. As all four houses are currently registered as one service, more must be done to ensure a consistent approach throughout. Needs assessments must be in Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 6 place for all residents and care plans must include details of how to meet all needs identified in the assessment. Diversity issues must be explored so that residents are not disadvantaged in any way. Training needs profiles must be kept up to date and include a plan of training for the current year. This will ensure that there is a more effective and competent staff team who have the necessary skills to carry out their roles. The standard of cleanliness in House 4 must be improved, including replacing the hall carpet and removing the unpleasant smell. This will enable residents to better enjoy their time inside the house. 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 Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Admitting residents without a full assessment makes it difficult to show that the home is the most suitable place for them, and means that staff may not be aware of each individuals needs. EVIDENCE: A Statement of Purpose and Service User Guide is in place in each house, which helps people thinking of living there make a choice about moving to the home. However some of the information must be updated to show what happens at each house, including current staffing. Two people who recently moved in did not have a full needs assessment in their records. Other residents who have lived at Coombe Oak for longer also did not have assessments. This makes it difficult for staff to show that they are meeting peoples needs and increases the chances that an area of need has not been identified. New residents are encouraged to visit the home before moving in. This was confirmed by one person who said that they had visited and chosen to move Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 9 in. The person added that it was better than their previous home because it was fully accessible. Contracts were not in place for all people that use the service. These must be provided so that residents and their representatives are clear about terms and conditions. Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Because care plans do not always give full details of each how each individuals needs must be met, some residents may not be getting all the support they need. EVIDENCE: Care plans are in place although they varied in quality between each of the houses. Person Centred Plans (PCPs) in Houses 3 and 4 are colourful and include pictures and photos of important people and things. These were up to date and recently reviewed. However PCPs were not in place for all people who live at Coombe Oak, and care plans did not always include full details of individual needs which means staff cannot provide the necessary support. There was little information on sexuality and personal relationships. One residents PCP talked about their family but did not detail their cultural background, needs, and beliefs. Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 11 A ‘Parliament’ group runs in Kingston which is group of people that use services who get together to discuss issues relevant to them. Minutes from this meeting show that a booklet has been produced about sexuality. However, staff were unaware of the booklet and no copies were available in the home. Residents meetings were seen to take place regularly in two of the houses, with good participation. However they do not take place in House 2 and it is unclear how residents here take part in the day to day running of the house. Risk assessments are in place to cover help with personal care and supporting daily living skills. These are up to date and regularly reviewed. One file did not contain a risk assessment around a residents challenging behaviour. This makes it harder to protect staff and other residents from harm. Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from having access to a good range of appropriate activities. EVIDENCE: Most residents attend a day centre though a few people remain at home and do activities of their choosing. Throughout the inspection people were seen to be talking with staff, watching television and going out to appointments or activities. Most residents are part of the taxi card scheme though one person said they use a bus as it is accessible. One resident also has there own car and is driven by staff , although this relies on staff being available. Welmede arrange a variety of things to do outside the home and notice boards have information these. Trips include a disco cruise and a visit to see the Moscow State Circus. The Area Manager talked about setting up a new Activity Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 13 Service to provide community based activities. It is hoped to use this if day services are cut, however funding has not been agreed. One resident said that staff treat them with respect and that they often have visitors come to see them. A relative commented that their daughter is ‘given choice and respect’ and that the relative will ‘visit with very little notice’. Residents said they enjoyed the food and that they could choose what to eat. Menus in House 4 are decided with the residents and showed a good range of food on offer. However more effort should go into providing freshly cooked food rather than rely on frozen meals and vegetables. When alternatives to the menu are given to residents this is not always recorded. Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents health needs are well met because of good information and support from outside professionals. EVIDENCE: People who live at the home were seen to be supported by staff at times convenient to them and giving them privacy if needed. Residents said that staff give them the help they need. The ground floors are fully accessible to wheelchair users. There is good information available to support staff in meeting the health needs of residents. One person’s service review held a large amount of information about their diagnosis, mobility, vision and diet. There is also good support from outside services such as the Community Learning Disability Team, psychologist, and community nurse. Medication Administration Record (MAR) sheets were signed and up to date. A photo of the resident is attached to avoid any confusion. Medication profiles Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 15 were not in place. These must be done to include details of the reason for each medication and any possible side effects or risks. Staff administer most medication using a monitored dosage system which is prepared by a pharmacist. Records are kept of medication received at the home and returned to the pharmacy. There have been four reported incidents of medication errors since March 2007, however records were well maintained at this inspection. Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The procedures for dealing with allegations of abuse are carried out in practice and protect residents from harm. EVIDENCE: A complaints procedure is available for people who live there. It is visible on the notice board at two of the houses and has been written in an easy read format to help residents understand it. Three residents said that they had no concerns and would speak with staff if they did. We were told that no complaints had been received since the last inspection. Two recent allegations of abuse had been investigated properly and all the necessary people had been informed. These were dealt with under the Protection of Vulnerable Adults (POVA) procedures. Staff are able to go on POVA training but not everyone has attended this recently. Training profiles say that POVA training only needs updating if a member of staff agrees. In order to protect residents, staff must attend POVA refresher training every year. Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each house provides accessible and comfortable accommodation for residents but standards of cleanliness vary, which disadvantages some people who live their. EVIDENCE: Coombe Oak is situated in a private road in Kingston which is quite a distance from local shops and leisure facilities. One resident said that the path on the private road is difficult to use in a wheelchair as it is covered in gravel. However, we were told that this will be resurfaced soon. Coombe Oak has four separate houses, each with a similar layout consisting of a lounge, kitchen/dining room, toilets, bathroom and bedrooms on the ground floor. Upstairs there is a staff office and sleep in room. Each house has a small garden area. Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 18 Bedrooms were made personal to people that used them with pictures and ornaments and other decorations. Bathrooms had adapted baths to assist residents that needed support to use them. House 4 is for wheelchair users and portable hoists are available if needed. One resident in House 4 said that the lounge can be cramped if everyone is in there. The inside of the houses was generally well maintained, clean and tidy. A few areas were in need of redecoration. There was a smell of urine in House 4 and parts of the hall carpet were stained. Areas in the kitchen were also quite dirty, for example the top of the fridge. Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are competent in their role and provide a good level of care, but staffing levels must be reviewed to ensure all residents are getting the support they need. EVIDENCE: Staff are clear about their roles and what is expected of them. They were observed to support residents when needed and had friendly but professional relationships. Some staff have been moved to work in different houses but team building takes place regularly to support staff in dealing with any issues that come up. An incident between two residents was observed in House 2 when staff were not around. Because of the higher needs of the people that live their, staffing levels in House 2 must be closely monitored to make sure residents are given the support they need. Staff recruitment files are well presented and showed evidence of probation and induction and two references. However, two files held Criminal Record Bureau Disclosures that were over three years old. One record did not have Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 20 evidence of permission to work and their were unexplained gaps in the employment history. Staff said that they have access to the training they need. Training records were looked at in House 4. Recent training includes Medication, Manual Handling and Sexuality and Personal Relationships. Training plans are in place but these must be updated to include training needs for the year ahead. Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is aware of the need to meet health and safety requirements, but to protect residents more must be done to make sure each house is carrying out the necessary checks. EVIDENCE: Each of the four houses in Coombe Oak has it’s own manager and staff team. The Area Manager has overall responsibility. Welmede is currently in the process of registering each of the four homes on the site individually, with each house having a registered manager. The Area Manager was knowledgeable about the service and had a good understanding of the needs of individual residents and the situation in each house. Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 22 A new Quality Assurance system is going to be introduced later in 2007. This will focus on areas such as activities, relationships and sexuality, privacy and person centred planning. Monthly monitoring visits are taking place as required. Health and safety records are generally well maintained and up to date. However, there was no evidence of a recent Portable Appliance Test and Legionella certificate. A fire risk assessment was seen, however weekly fire point tests are not happening in all the houses. Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 2 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X 2 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 2 X Coombe Oak DS0000013382.V339863.R01.S.doc Version 5.2 Page 24 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 1 2 YA2 YA5 14 12 Requirement In order to fully meet the needs of people who use the service, a needs assessment must be in place. So that residents and their representatives are clear about terms and conditions, contracts must be in place for all people that live their. So that staff can provide the necessary support, service user plans must cover all their needs and include information on culture, sexuality and relationships. To protect health and welfare, risk assessments must be in place where behaviour may cause harm. In order to prevent maladministration a medication profile must be in place for all residents. To protect residents from abuse all staff must receive training in the Protection of Vulnerable Adults every year. To improve the environment in House 4, the hall carpet must be replaced and the offensive odour removed. DS0000013382.V339863.R01.S.doc Timescale for action 01/08/07 01/08/07 3 YA6 15 01/08/07 4 5 YA9 YA20 13(4) 13(2) 01/08/07 01/07/07 6 YA23 13(6) 01/08/07 7 YA30 16(k) 23(2)(b) 01/08/07 Coombe Oak Version 5.2 Page 25 8 9 YA33 YA34 18(a) 19 10 11 YA35 YA39 18(c) 24 12 YA42 13(4) Staffing levels must be reviewed in House 2 to ensure that residents needs are met at all times. In order to protect residents recruitment records must include all the information in Schedule 2 of the Regulations. So that all staff are appropriately skilled, training plans must include training needs for the current year. To make sure there is effective monitoring of the service, the new Quality Assurance system must be implemented. For the protection of residents, weekly fire point tests must take place. 01/08/07 01/08/07 01/09/07 01/09/07 01/07/07 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 2 3 4 Refer to Standard YA1 YA8 YA17 YA42 Good Practice Recommendations So that people that use the service have the right information the Statement of Purpose should include up to date details of staff. To make sure that all people that use the service are consulted, resident meetings should take place in all the Houses. To encourage a healthy diet more emphasis should be given to providing freshly cooked food rather than frozen meals. As evidence that the residents is being kept safe the home should supply a copy of the recent Legionella test and Portable Appliance Test. 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