CARE HOME ADULTS 18-65
Coombe Oak Warren Road Kingston Upon Thames Surrey KT2 7HY Lead Inspector
Michael Stapley Unannounced 9 August 2005 09:30 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Coombe Oak Address Warren Road Kingston Upon Thames Surrey KT2 7HY 020 8547 3777 0208 974 5801 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) Welmede Housing Association Ltd Ms Lorraine Laporte Care Home 22 Category(ies) of Learning disability over 65 years of age (21) registration, with number of places Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Room 2, House 3 may be provided with a suitable alternative floor covering in place of carpet. To be reviewed at least annually. Date of last inspection 261004 Brief Description of the Service: Coombe Oak is a residential care home providing care for twenty-two 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. The home is located a quarter of a mile from local shops and other ammenties. Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This home was inspected under the National Minimum Standards Care Homes for Younger Adults. The inspection took place over one day on 9th August 2005. There has been a change in management at the home in the last year. The current registered manager has been seconded for the last ten months to the housing association’s head office. Chris Stringer one of the service managers is currently supporting the home, although given he is also service manager for another area this is not a satisfactory arrangement. Records examined included service user plans; care manager needs assessments and risk assessments, medication records, complaints, staffing records, health and safety and fire records. Previous requirements and recommendations were discussed with the service manager from the housing association. What the service does well: Service users are very much the centre of attention in the home, service users, families and carers were very complimentary about staff and were generally happy with how the home was run, service users also commented positively about activities, food and their opportunities to be involved in running the home. Individual care plans are very comprehensive and headings include a pen portrait of the service user, weekly activities, health needs and communication skills to mention a few. The arrangements for health care needs of the service users is good, all service users are registered with a local General Practitioner, the home has the support of the local pharmacist for advice on medication. Staff members have access to a range of training courses to build on their skills to ensure that they are able to meet the service users assessed needs. The home holds the “Investor in People” award and has meet most of the requirements from the last inspection. Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
The registered manager has been seconded to the housing association’s head office and although an acting service manager has been appointed to manage the project this is not a satisfactory arrangement. In addition the service manager is also responsible for another of the association’s projects. The housing association must ensure the home has a registered manager without further delay. This is a crucial post for the home to continue its programme of development and have a clear vision for the future. During the course of this inspection it was noted that each of the four houses on the site is managed separately with a distinct client group and a Statement of Purpose that differs from house to house. The manager of each house is not registered with the Commission Social Care Inspection and the managing authority should give due consideration in registering each of the homes managers. There were a number of outstanding requirements that had still not been complied with from the previous two inspections not least the fact that staffing records did not contain all the information required under Schedule Two of the Care Homes Regulations 2001. Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 7 The home has not developed a quality assurance system or sought the views of service users and other stakeholders by means of surveys. Requirements have therefore been made in respect of this standard. 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 Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 and 5 The home provides good information and introduction opportunities for prospective service users to make an informed choice about moving to the home. Contracts between the home and the service users now contain all the information required under standard five ensuring the rights of the residents of Coombe Oak. Staff at the home have access to a wide range of training programmes thus enabling them to offer an effective care programme for service users. EVIDENCE: The home has a preadmission procedure; prospective service users are able to visit the home on an individual basis. Service users are only admitted to the home once a full assessment of their needs; compiled by their care manager or other relevant person has been received. Such assessments were noted on service user’s files inspected. The assessments were completed by a care manager and included additional assessments from other professionals. The home has an excellent training programme including NVQ training. The managing company is also an “Investor in People” The training programme includes epilepsy, medication, working with symbols, makaton training. All staff have a training plan and the service manager is in the process of introducing team building for each house.
Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 10 Contracts between the home and the service users were evidenced and although these are licence agreements they contain all the information as required under standard 5.2. Of the two outstanding requirements it was noted that the Statement of Purpose still requires fine tuning while communication plans and guidance were not in place for all service users. Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9. Service user care plans contain all the information required as per standard six. Staff at the home have all the information they require to satisfactorily meet the needs of the service users. Service users have individual risk assessments and risk management strategies carried to enabling them to participate in activities in the home and in the community with appropriate support. EVIDENCE: Service user individual care plans are comprehensive and contain all the elements of standard six. Care plans contain a pen portrait of the service user, weekly activities, health needs and communication skills. Service users and their respective families are involved in drawing up such plans as outlined in standard 6.6. In addition service users have a key worker although the home must ensure care notes contain evidence of key working. The home has become far more service user focused. Service users are encouraged to become far more involved in the home. Service users meetings take place on average six times a year with an external facilitator and a service users day is
Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 12 planned for September 2005. The service manager explained that the home has moved towards Person Centred Plans where ownership of the plan is given to the individual service user. Staff at the home have undertaken appropriate training in order to facilitate the care plans. It is hoped that such training will enable service users to become more involved in the decision making process. Service users files sampled at random all had individual risk assessments and risk management strategies. Service users are encouraged to make their own decisions within the context of risk assessment wherever possible. All service users have individual choice and the home provides an independent advocate where desired. The home seeks to empower service users through individual and group work. The service manager informed the inspector that “Welmede Housing Association” had reviewed the staffing levels at Coombe Oak. The review has lead to the increase in the number of core staff in each house and an increase in “floating support” leading to more focused work with individual service users. Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15, 17 The daily routines and house rules promote residents’ rights and encourage independence. Service users are given opportunities to engage in age appropriate activities with an emphasis on using community based facilities. Dietary needs are catered for and a balanced diet is provided, to ensure a nutritious diet based on personal preferences. EVIDENCE: The home is supporting service users to access appropriate activities through the activity programme. The service users access local parks, cafes, theatres, local leisure facilities and shops. In addition to swimming, gym and library. The staff team are available to support service users while accessing community resources. Service users spoken to stated that they enjoyed the activities on offer at the home. The home is having a barbecue for the whole project in September where family, friends and parents are invited to the home. In addition the changes implemented in the “floating support review” have meant more focus on individual support and targeting support for the purpose it is intended.
Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 14 Weekly menus were constructed with the aid of the service user’s personal choice, advice from service user’s families and the experiences of the staff. One service user said that he enjoyed what he had to eat at the home. The home has its own mini-bus and the use of other vehicles. Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Personal care is carried out in a way that residents prefer so that dignity and choice are maintained. Residents’ medication is well managed to ensure good health. EVIDENCE: Health records are maintained for each service user. Service users record examined during the inspection demonstrate that the service user had access to routine health checks and specialist health care. Significant events and accidents are recorded and monitored. The staff team at the home keep a central record of incidents as well as an individual record on service users files. Staff members monitor service user’s health and maintain up to date records. Some of the staff team have undertaken epilepsy and medication training. The pharmacist from Boots visits on a regular basis and all requirements from that inspection have been completed save for the development of a Homely remedies policy. All medication records were complete at the time of the inspection. All service users are in the process of being offered the opportunity of having a Health Action Plan and Health Action Checklists are compiled for all service users. In addition all staff are undertaking Health Action Planning Training.
Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 16 Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 There is a complaints policy and procedure, which facilitates good access to the complaints system for the residents, their family or their representatives. The home has the appropriate policies in place to ensure the protection of vulnerable service users. EVIDENCE: The home has a detailed complaints procedure. A pictorial format of this procedure has been developed and provided to service users. The Service Manager said that no complaints have been made to the home since the last inspection. There are also policies and procedures in place regarding the protection of vulnerable adults. The service manager, who is a qualified trainer, stated that the staff team are due to complete a refresher course on adult protection issues. The staff team are aware of the action they must take if they need to report an incident. Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 27, 28, 29 and 30. Service user’s bedrooms provide privacy and reflect individual interests and preferences. The home is homely, bright and clean with the necessary adaptations in place, thus providing the service users with safe, comfortable surroundings that meet their needs. EVIDENCE: The home is set in spacious grounds situated in a quiet tree lined residential road. It is situated in Kingston upon Thames and is close to local shops and amenities. The complex consists of four separate houses. There is a large communal lounge on the ground floor as well as a spacious kitchen/dining room. The furniture is domestic, flame retardant, and of good quality. There has been some improvements in the décor of the home since the last inspection although the kitchen in house four is in need of replacement and in need of decoration. The service manager stated that this work was to be carried out in September of this year. In addition new furnishing, fixtures and fittings are to be purchased as required. There is also a pleasant garden which is well used by the service users in the summer months. Bedrooms viewed provided sufficient and suitable furniture.
Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 19 All areas of the premises viewed were clean and free from offensive odours. There are appropriate laundry facilities. Systems are in place for controlling the spread of infection. This includes staff training in this area. The home has one ‘high low’ bath situated in one of the houses. The home has thermostatic valves fitted to each of the baths to avoid any scalding accidents. The temperature of the water is taken and recorded on a chart in the office. Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34 and 35 The staff team at the home have a range of skills and ability, which appear to meet the needs of the service users. The staff team have all had Criminal Records Check, as a safeguard to offer protection to the homes service users. EVIDENCE: New members of staff complete an induction programme covering various subjects including health and safety, fire drills, and introductions to service users and other staff. The induction programmes are signed, dated and kept on staff files. Criminal Records Checks are completed before a new member of staff can begin work in a home. The home has had a change in management in the last year. Lorraine Laporte, the registered manager has been seconded for the past ten months to the managing authority’s head office and Chris Stringer a service manager with the project is supporting the home. This is a far from satisfactory situation and the managing authority must take steps to appointment a full-time manager to manage the complex. The new manager will, in due course need to make an application to the Commission for Social Care Inspection to be the registered manager of the home. The home does not have a deputy project manager but each house has a house manager (team leader) and senior support workers who act as shift
Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 21 leaders. The service manager is responsible for supervising the house managers while house managers supervise their respective staff. Supervision is in line with the standard. The service manager advised that staff meetings usually take place every fortnight. They are used as a communication tool, where information is shared and common themes are addressed. Staff meetings minutes evidenced were clear and focused on service users needs. There are a minimum of two or three staff members on duty on each shift depending on the needs of service user’s. Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 22 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 and 42 The management of the home appears to be open and transparent with clear lines of accountability, which is aimed at ensuring the well being of the service users. EVIDENCE: Records required for the safety and well being of service users are in place including accidents, water temperatures, complaints, incidents, food records, fire records, staff and service user’s case files, medication records and so forth. The home has a new Fire alarm system. Fire drills are up to date and a fire risk assessment is in place. The staff team attend mandatory health and safety training including moving and handling. The home has regular staff meetings and the registered providers, Welmede Housing Association have introduced service users meetings to involve service users in decision- making progress. Copies of the homes policies and procedures are kept in the office and the
Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 23 current acting service manager as revised those that were out of date as per requirement at the last inspection. The home has yet to introduce a quality assurance system. This is in the process of being drawn up by the managing authority and should include service user, relatives, staff and outside professional questionnaires. Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 24 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 2 x 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 x 3 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Coombe Oak Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 x 2 x x x x G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 25 YES 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 YA1 Regulation 4 Requirement The registered person must ensure all the information detailed in Schedule 1 of the Care Home Regulations (2001) is included in the homes statement of purpose covering the homes admissions criteria; arrangements made for consulting service users about the operation of the home; fire precautions and associated emergency procedures; and arrangements (frequency) made for dealing with care plan reviews. In addition, the home must ensure a copy of the revised version of the homes statement of purpose is forwarded to the Commission. The Registered Provider must ensure that specific communication plans and guidance is in place for all service users who are nonverbal, drawing on, and reviewing as necessary, professional assessment and guidance, the views of friends and family, and the experience of staff at the home. The Registered Provider must
G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Timescale for action 30/09/05 2. YA3 15 30/09/05 3. YA24 23 30/09/05
Page 26 Coombe Oak Version 1.40 4. YA34 17 and 4 ensure that the door and draws in house number four’s kitchen are repaired or replaced. Records to be kept in a care home to include a record of all persons employed, name, address, date of birth, qualifications and experience; copies of the birth certificate and passport, each reference; dates on which they commenced and ceased to be employed; position and hours worked; correspondence, reports, records of disciplinary action, CRB Checks and any other records in relation to their employment. 31/09/05 5. YA37 9 and 10 6. YA39 24 The managing authority must 31/12/05 appoint a qualified manager(s) to the home(s) without further delay; or, if a manager(s) is employed without NVQ at Level 4 in care, they must commit to completing the Course (31.1, 2, 4 5). Any registered manager(s) must have at least two years experience in a senior management capacity in the managing of a relevant care setting within the past five years. A quality audit system, including 31/12/05 an annual development plan must be in place to assess whether the aims and objectives of the home have been met and:The home must implement a professionally recognised quality assurance or ‘join up’ their own quality assurance tools into a cyclic quality assurance system. Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 27 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 Good Practice Recommendations Coombe Oak G53-G53 S13382 CoombeOak unann V221910 090805 Stage 0.doc Version 1.40 Page 28 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor, Grosvenor House 125 High Street, Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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