CARE HOMES FOR OLDER PEOPLE
Coombes Wood House Coombesend Road East Kingsteignton Newton Abbot Devon TQ12 3DZ Lead Inspector
Mark Sharman Unannounced Inspection 27th April 2006 09:45 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 Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 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. Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Coombes Wood House Address Coombesend Road East Kingsteignton Newton Abbot Devon TQ12 3DZ 01626 365101 01626 365101 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) Mr Louis Cook Mrs Marjorie Cook Care Home 36 Category(ies) of Dementia - over 65 years of age (36), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (36), Old age, not falling within any other category (36), Physical disability over 65 years of age (36) Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 06/09/05 Brief Description of the Service: Coombes Wood House is registered to provide personal care for up to 36 people aged 65 or over, who may also have a degree of physical or mental disability including dementia. The home owners are both registered nurses (general and psychiatric nursing) and have substantial experience of working with elderly people, including those suffering from dementia or functional illness such as depression. The home is situated in a rural position a little more than a mile from the centre of Kingsteignton, and there are attractive views from many of the windows. All but one of the bedrooms are single rooms, and nearly all have en suite facilities. There is a shaft passenger lift. A substantial purpose-built extension was completed a few months ago which has provided additional bedrooms and communal facilities. Thus there are now two lounges (one very large) and two dining rooms, one with an adjoining sun lounge. There are extensive grounds, including a secure courtyard area, and ample car parking space. Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection and about seven and a half hours were spent at the home. A completed pre-inspection questionnaire and other documentation was provided by Mr Cook before the inspection. Four completed comment cards were received from residents and six cards were received from relatives. Also seen were a large number of the home’s own completed quality assurance questionnaires sent out to residents and their relatives. Several of the residents and staff were consulted during the inspection, and three visiting relatives were also spoken with. All of the communal parts of the home and several of the bedrooms were seen. What the service does well: What has improved since the last inspection?
The new extension is now in use. It has provided an additional very large lounge and separate dining area and two additional assisted bathrooms. There is also now a fairly secure courtyard area which is easily accessed by residents who wish to get some fresh air. Improvements to the old building are continuing and at present a new bathroom, new shower room and a new laundry room are being created. A sophisticated new call system for the
Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 6 residents’ use has been installed, including the facility for pendants to be used outdoors. The one recommendation made at the last inspection has been complied with, namely the fitting of a lock to the medicines refrigerator. 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. Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 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 Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 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): 3. Standard 6 is inapplicable. Quality in this outcome area is good. No resident is admitted to the home unless her/his needs have been assessed first. EVIDENCE: Three of the residents’ individual files were inspected. Two of them contained a written assessment carried out by a local authority care manager prior to admission. One of these also contained a health assessment and the other contained a nursing care referral (the person had been admitted to the home from hospital). The third file inspected also contained an assessment carried out by nursing staff with a summary of needs provided. Whenever practicable a prospective new resident is seen by two of the home’s senior staff at home or in hospital, and this was confirmed by senior staff. Mr Cook said that every effort is made to carry out the home’s own assessment in respect of a new resident, and recently he travelled to Poole for this purpose. Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 9 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 and 10. Quality in this outcome area is good. The residents’ health care and social care needs are set out in individual care plans, and these needs are being well met. There is a safe system for handling residents’ medication. EVIDENCE: The evidence available showed that the residents’ health care, personal care and social needs are set out in individual care plans. Three of these care plans were examined, together with daily records for these particular residents. Each included a personal risk assessment, a falls risk assessment, a pressure (skin) assessment and a nutrition assessment. There was an informative personal profile for each resident which would be useful to new staff. The care plans had been regularly reviewed. All residents are registered with a general practitioner, and visits by general practitioners are recorded in the care plans. One general practitioner (with whom many of the residents are registered) holds a weekly surgery at the home. This general practitioner commented that “I am always impressed by the standard and quality of care at Coombes Wood House”. Visits by health professionals are recorded in the residents’ files, including regular visits by dentist and chiropodist. There was evidence in one file of involvement by the
Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 10 mental health team for the older person (psychogeriatrician). Mrs Cook is able to offer massage and reflexology to residents. The care manager said that siton scales have been ordered to enable staff to weigh residents with reduced mobility. The medication trolleys were seen and a sample of medication administration recording sheets was inspected. Controlled drugs were stored and administered correctly in accordance with the Standard. The medicines refrigerator has now been fitted with a lock. Senior staff administer medication to residents. All of the residents consulted were very complimentary about the caring attitude of the staff, and the staff on duty interacted with them in an affectionate but respectful way. No bedroom was being shared. A cordless telephone is available for the residents’ use (some have their own telephone). Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 11 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 and 15. Quality in this outcome area is generally good. Residents can please themselves as to their own routine and interests. Some regular activities are offered, although this aspect of the service should be reviewed in view of the substantial expansion of the home. The catering arrangements are satisfactory. EVIDENCE: The residents able to express their views said that they are able to please themselves as to their preferred routine, for example getting up and going to bed, and whether or not to join in with activities. They are able to personalise their bedrooms, and some have made their rooms very cosy and individual. Contact by relatives and friends is encouraged and three visiting relatives were spoken with during the afternoon. One of these said that she visits her husband every day. There are some regular activities, including musical entertainment (monthly), indoor games and videos. There is a weekly bus trip out, and about fifteen residents were involved in this on the day of the inspection. There is a regular fellowship meeting, and some residents attend bible class and church in the community. However two residents and one relative felt that the activities available had diminished over the last few months, coinciding with the expansion of the home. It is recommended that this issue should be reviewed
Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 12 with residents on an individual basis (since not all wish to participate in group activities). There was universal praise among the residents for the meals provided, and they said that drinks are available at all times (including at night). Menus are changed with the season, and the lunch on the day of the inspection looked appetising. Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 13 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 and 18. Quality in this outcome area is good. Residents and their relatives are confident that any complaint would be taken seriously by the home’s management. There are arrangements in place to ensure that residents are protected from abuse. EVIDENCE: The residents consulted all said that the owners take a real interest in their welfare and would try to deal with any complaint or concern. The visitors seen also said that Mr Cook and the staff take care to keep them informed of progress or problems in respect of their relative. The home’s complaints procedure is satisfactory and a copy was displayed in the home. No complaint has been made to the Commission for Social Care Inspection since the last inspection. There is an adult protection policy in place and other appropriate policies, and the home has a training video on abuse which is used with new staff (“No Secrets”). The staff consulted were aware of the home’s policy on abuse. Experience has shown that an allegation of abuse will be taken seriously by the home owner and reported appropriately. Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 14 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, 20 and 26. Quality in this outcome area is good. The environment is being continually improved and has been greatly enhanced by the new extension. EVIDENCE: The home is in an attractive rural location and there are good views from many of the windows. There is a large garden, with level access from the building, and a courtyard area which has been made secure (bearing in mind residents who are confused). All current residents have single bedrooms. The communal facilities have been greatly enhanced with the completion of a large extension, and there are now two lounges (one very large) and two dining areas. There is also a conservatory area. An additional assisted bathroom and a new shower room are being created at present. A new wireless call system has been installed, and residents can use their pendant outside in the grounds. The parts of the home which were seen were clean, and residents confirmed this is normally the case. No unpleasant odour was detected. A new laundry room is being created at present (which was seen), and Mr Cook said that a
Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 15 washing machine with a sluicing function is on order. One staff member is designated exclusively to do the laundry. Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 16 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 and 30. Quality in this outcome area is generally good. The staffing arrangements are satisfactory and staff morale is high, resulting in a good standard of care for the residents. There is some room for improvement in recruitment practice. EVIDENCE: The staff rota was inspected. All of the comment cards received from residents’ relatives indicated that staffing levels in the home are sufficient to meet residents’ needs, and this was confirmed by staff spoken to. This follows a period of adjustment when new residents were admitted into the new extension, and two residents felt that the staff were rather rushed during this time. There is a staff training programme, and the staff consulted said that the home offers good training opportunities. Nearly all of the staff had attended a manual handling training session with an external trainer the day before this inspection, and the care manager said that all would have food hygiene training in May. The 50 NVQ training target is met at present. The Standard in relation to recruitment practice was not fully met. Although a large number of Criminal Records Bureau disclosures were available for inspection, disclosures had not been applied for in respect of the foreign nationals working in the home. This must be done (on the basis that they may have worked in the UK previously). Also two written references were not
Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 17 available in respect of the most recent staff to be employed, and every effort must be made to obtain such references. Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 18 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 and 38. Quality in this outcome area is good. The home is managed in a responsible and caring manner, and there are quality assurance measures in place. Health and safety arrangements are satisfactory, although fire training for staff is now needed. EVIDENCE: One of the registered providers, Mr Cook, is in day to day control of the home, although a care manager is employed. Mr and Mrs Cook have run the home for over six years. They both have first level nursing qualifications and Mr Cook has a management qualification. Residents and visiting relatives commented on the owners’ helpful and caring attitude. Mr Cook is present in the home on weekdays and makes a point of speaking to all residents regularly, and Mrs Cook also gives residents her individual attention when in the home. Quality assurance strategies include regular discussion with staff, and staff meetings are held (minutes from the last meeting of 10/01/06 were seen).
Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 19 Quality assurance questionnaires were sent out to residents and their relatives in April this year, and a large number of completed questionnaires were available. Mr Cook said that the home’s current development plan (seen previously) is now being reviewed. With regard to health and safety, the core training for all care staff includes manual handling, fire safety, first aid and food hygiene. A fire safety officer visited the home in April and found that the records of staff fire training were inadequate, and so this training must be arranged as soon as possible and appropriate records kept. All of the radiators accessible to residents are covered (or of low surface temperature type), to prevent residents from sustaining a burn injury. Mr Cook confirmed that the upstairs windows have restricted openings to prevent residents from falling from them. Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 20 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 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 4 x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes. 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 2 Standard OP38 OP29 Regulation 23 19 Requirement All staff must receive fire safety training, which must be appropriately recorded. A Criminal Records Bureau disclosure (of an appropriate level) must be applied for in respect of any foreign national employed in the home. Timescale for action 30/06/06 31/05/06 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 OP12 Good Practice Recommendations The provision of activities available to residents should be reviewed. Coombes Wood House DS0000003676.V289010.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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