Inspection on 23/08/06 for Englishcombe House

This inspection was carried out on 23rd August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Englishcombe House 17/01/06

Englishcombe House 14/06/05

Englishcombe House 17/03/05

Englishcombe House 25/11/04

Englishcombe House 09/12/03

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Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Englishcombe House 33 Englishcombe Lane Bath Bath & N E Somerset BA2 2EE Lead Inspector Jill Cornelius Unannounced Inspection 09:30 23 & 30 August 2006 rd th 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 Englishcombe House DS0000046576.V298341.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. Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Englishcombe House Address 33 Englishcombe Lane Bath Bath & N E Somerset BA2 2EE 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) 01225 428369 Cedar Care Homes Limited To be appointed Care Home 20 Category(ies) of Dementia (20), Dementia - over 65 years of age registration, with number (20) of places Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate people with dementia aged 50 years and over Date of last inspection 17th January 2006 Brief Description of the Service: Englishcombe House is a home registered for twenty people aged 50 years and over with dementia. The home is situated in a southwestern suburb of Bath with easy access to the city centre by car or bus and panoramic views over the city from the front of the building. The home is a converted older property, providing mostly single bedroom accommodation. There is one double bedroom and one en-suite room. Resident’s accommodation is on 3 floors with communal space on the ground and first floors. There is a passenger lift providing access to all areas. The home has a front garden with patio area and a terraced rear garden offering a safe wandering environment for residents. The manager Ms. Jane Ncube has been in post since December 2005. Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report following the unannounced inspection of Englishcombe House, which was conducted on 23rd and 30th August 2006. During the inspection the inspector spent time in discussions with the manager, examined a number of records, including five care plans and records relating to the dayto–day running and management of the home. The inspector spent time observing the residents in the home throughout the course of the visit and spoke with four at length and with three visitors. Members of staff were observed on duty and three were consulted individually. The impression given by all these sources was positive and no complaints or concerns were noted. The management team has undergone a change since the last inspection and the acting manager Ms. Jane Ncube has been successful in her registration with the Commission for Social Care Inspection. What the service does well: Staff were observed as being respectful, warm in manner and sensitive towards the residents within a relaxed homely environment. The manager and staff had built a good rapport with individuals and were knowledgeable about the care needs of the individuals living in the home. The home was well organised and managed by an effective, stable management team. Neither the home nor the Commission for Social Care Inspection has received any complaints about the home since the last inspection. The home’s senior staff team have, however, received a number of thank you letters from relatives praising the quality of care provided and the dedication of the staff team. Three of these highlighted ‘the staff are very caring’, ‘our loved one is very happy here and their health and well being has improved considerably’. Englishcombe House was again found to be clean and tidy. Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Englishcombe House DS0000046576.V298341.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 Englishcombe House DS0000046576.V298341.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): 3 The quality in this outcome area is good. Prospective residents needs are assessed prior to admission to determine the suitability of placement. EVIDENCE: The Inspector looked at two pre – admission assessments, which were completed fully and were informative. The prospective resident, family and carers are involved in the pre – assessment and all information is used to determine the suitability of the placement. The manager had also obtained comprehensive assessments and care plans from other professionals involved, for example, social workers and hospital staff. One resident’s representative said that they “were informed of their loved ones day to day experience by the manager and was grateful for this”. Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 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, 10 The quality in this outcome area is good. Individualised planned care is on the whole detailed in each residents file, along with risk assessments. However, one care file document did not reflect their good practice. The care plans reviewed provided the inspector with evidence to support that the health care needs of the residents’ were being met. There is a good overall standard of personal care provided to residents. Residents can be assured that their right to privacy is respected and that their dignity is promoted. EVIDENCE: The inspector reviewed four random care documents. Care plans were detailed, regular revised and well presented and were relevant to assessed records. They showed evidence of monthly re-evaluation. Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 Page 10 Families or advocates are now signing residents’ reviews. There was evidence of one residents’ thoughts. “ I do not want anyone to come into my room while I am watching television”. An action plan was in place to support this. Care staff confirmed their knowledge of this request. The inspector saw evidence that residents’ received visits from, the chiropodist, and optician. Referrals are made to dentists and specialist health care services. Throughout the inspection it was observed how the management and staff team treat all residents with respect and dignity and how independence is encouraged. Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 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 The quality in this outcome area is good. The flexibility of the home’s routines, the provision of activities and opportunities for residents to make visits outside the home are all good but will benefit from further development. Visitors are made to feel welcome and there is good social contact for residents. EVIDENCE: Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 Page 12 The evidence of this inspection (as drawn from observation, documentation, and discussion with visitors, staff and the manager) is that a lot of effort is being put in to support residents to exercise choice in their day-to-day lives. The first floor lounge is now being used as an alternative to the main communal area on the ground floor a dining table has been placed in there for an alternative choice of enjoying meals. Further exploration to use this room continues by the manager and comments received from residents and their representatives. Residents are supported in their wishes to rise and retire at various times and are also accompanied to go outside the home as much as possible. There is an appropriate range of regular activities. One such occurred during the inspection, when three residents’ enjoyed a trip touring the main areas of Bath in a company minibus. This promoted memories of past experiences of those who lived in Bath. A harvest festival was the next planned event for residents and visitors. Two members of staff have a specific role in providing or co-ordinating activities in the home. At present social activities are available and led by two staff members over daily sessions. This is either one to one or in a group. These are promoted by a notice and verbally when available. However, the notice is not in a suitable format for residents at Englishcombe. A discussion with the manager about this was held. The inspector will look forward to inspect its progression in more detail at the next visit. From examination of the visitors’ book and from discussion with those visitors seen during this inspection, there is indication that residents are able to have visitors at any time and make visits outside the home as they wish and that this is welcomed and encouraged by the home and the organisation. The residents in this home have a deteriorating and variable condition of dementia. They will for the greater part rely on the advocacy role of their carers (whether the home’s staff or their relatives) to interpret the majority of their care needs. Effective advocacy relies heavily on the observational skills of the staff, especially for residents who are unable to express themselves from observation of interactions, there was evidence that staff have the skills and confidence to observe and interpret the needs of residents and advocate effectively on their behalf when necessary. During observation one resident was providing the care staff with challenging behaviour which was supported in a sensitive and calming manner over a thirty-minute time span. However, when case tracking this resident through care documents it was evident that there was no supportive care plan was in place. This was assessed and actioned by the manager by the end of the first day of inspection. On the second day of inspection those care staff spoken Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 Page 13 with confirmed that they had read and at times referred to this care plan which they confirmed gave them guidance. Englishcombe House DS0000046576.V298341.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 The quality in this outcome area is good. Residents and relatives can be assured that complaints and concerns will be taken seriously and acted upon. Clear, robust policies and procedures are in place in order to protect individuals from the likelihood of abuse, neglect and self-harm. EVIDENCE: Evidence gathered during the inspection confirmed that any concerns raised by residents / family / advocates are acknowledged and actions taken where possible to resolve issues. Neither the home nor the Commission has received any complaints for Social Care Inspection. No staff members at the home are on the protection of vulnerable adults list. Englishcombe House has a policy on the protection of service users and follows the inter-agency procedure for the protection of vulnerable adults in Bath and North East Somerset. Staff are trained in ‘Alerter’s awareness of abuse’ and senior staff are trained to ‘Investigator’ level. Discussion with Ms. Jane Mcube, the manager promoted the need for staff to have a heightened awareness of their adult protection responsibilities, due to the vulnerability of the residents Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 Page 15 living at Englishcombe. The inspector spoke with one carer who knew what to do should an incident of abuse be reported to them. They were aware of the different types of abuse and the effect it could have on the resident. Another carer confirmed that they were aware of the ‘whistle blowing policy’ and the ‘No Secrets’ document. One area of concern was highlighted when the inspector read through the home’s accident log. This was discussed and case tracked with the manager. The outcome of this investigation was clearly documented and the inspector can confirm that this was undertaken in a robust manner. Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 Page 16 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): 20, 22, 24, 26 The quality in this outcome area is good. A comfortable, clean, safe standard of accommodation continues to be provided for residents. Further development is required to maximise residents’ independence to areas in the home. EVIDENCE: The home is well maintained both inside and out creates a comfortable homely atmosphere. Residents and their visitors throughout the summer have enjoyed the gardens both of which, has been in consultation with Dementia Voice providing sensory gardens. Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 Page 17 Observation during the inspection period highlighted that residents are assisted in accessing their choice to use other areas of the home. Discussion took place with the manager regarding ideas to maximise residents’ choice and accessibility to other areas of the home independently, possibly in consultation with Dementia Voice or a simliar expert body. The manager was keen to action this. Residents’ bedrooms looked homely and were personalised with residents’ personal possessions and small items of furniture. However, further recognition for residents to find their own rooms was discussed. This could be achieved by using visual prompts. At the previous inspection it was noted that one bedroom’s flooring was in need of replacing: this has been actioned. Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 Page 18 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): 29, 30 The quality in this outcome area is good. Residents are supported by well trained staff and are protected by the home’s recruitment practices. EVIDENCE: The employment records for three staff were checked randomly, good practice was observed. CRB (criminal records checks) checks have been undertaken and POVA (protection of vulnerable adults) The manager maintains a training overview matrix to cover Induction, foundation, NVQ, mandatory and specialist aspects of staff training. There is positive and effective training approach to training in the home evidenced by the training records. Statutory training undertaken include, manual handling, basic food hygiene, fire safety, first aid and protection of vulnerable adults. The manager and Cedar Care’s training organiser highlighted the importance of specialist training such as dementia care and mental health training to ensure Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 Page 19 that all staff have the appropriate experience to work in this care home continues to be maintained. NVQ training for both domestics and care staff are ongoing. Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 Page 20 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, 32, 36, 37, 38 The quality in this outcome area is good. The home is well managed ensuring that individual’s interests and rights are promoted and protected by the staff team. There are effective procedures in place for the supervision, appraisal and team meetings of staff. Arrangements are in place to minimise risk so that the safety and welfare of individuals are promoted. EVIDENCE: Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 Page 21 Since the previous inspection, Mrs Ncube has been approved by the Commission for Social Care Inspection as the Registered Manager of Englishcombe House. She is on target to complete her Registered Manager’s Award and NVQ Level 4 award in care by March 2007. From observation and from discussion with staff and visitors, there is clear evidence of good leadership and management. Throughout the inspection process the Registered Manager’s focus was on Englishcombe House and all aspects of the service addressing the needs and wishes of the residents. Regular supervision is maintained with supervision sessions for care staff at least 6 times per year and the records of these are maintained in the staff files. These records also evidenced that performance issues had been followed up or concluded. Evidence was obtained by viewing 5 staff records. This was verbally confirmed as being undertaken by 3 staff members when asked. Supervision and appraisal overview is used to assist with planning. Senior meetings continue to be held on a monthly basis for the organisation with care meetings every other month. This aims to measure the success in meeting the aims, objectives and the statement of purpose of the home. Records are stored safety and are able to be locked. The organisation has a clear confidentiality policy, a staff member referred to this when asking for identity verification from the inspector upon arrival to the home. Reports by a representative of the Registered Provider of unannounced monthly visits made as required under Regulation 26. Copies of these reports were not in place in the home for inspection. Recent notifications made under Regulation 37 (relating to incidents affecting the well-being of residents) were discussed with the manager and the information these notifications need to contain was clarified. The records of tests to the fire safety equipment were in good order and health and safety issues were well managed. The manager described a scenario that had caused her a concern (wheel chairs blocking a fire exit) and how she used an unscheduled fire alarm to see how carers would deal with the situation. She then held a training session with carers as an immediate follow up. This is good practice. All visitors to the home are asked to sign in and out. Staff have undertaken first aid and food and hygiene training. However, due to the cook being unavailable at short notice a staff member was additionally rostered in for covering the cooking duties. On checking their training documentation it was noticed that they had not attended basic hygiene training. The manager was requested to arrange suitable arrangements for the Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 Page 22 kitchen to be covered long term. This was actioned by the end of the first day and a suitable replacement had been sourced from the head office of Cedar Care. Englishcombe House DS0000046576.V298341.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 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 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 x 3 x 2 3 3 x 3 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x x x 3 3 3 Englishcombe House DS0000046576.V298341.R01.S.doc Version 5.2 Page 24 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 Standard OP22 Regulation 23(2)(n) Requirement Timescale for action 12/01/07 2 3 OP7 OP37 15(1)(c) 26(5)(a) Pursue and action ideas to promote the direction of the homes environment with suitable signs Review care needs to include all 23/08/06 areas of care supported with an action plan The registered provider to 23/08/06 ensure a copy of each report of each visit carried out in accordance with this regulation is sent to CSCI. This is a repeated requirement. 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 Pursue ideas to promote suitable format for activities. 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