Inspection on 24/08/06 for Smallcombe House

This inspection was carried out on 24th 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Smallcombe House 29/09/05

Smallcombe House 20/04/05

Smallcombe House 01/11/04

Smallcombe House 20/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Smallcombe House Oakwood Gardens Bathwick Hill Bath Bath & N E Somerset BA2 6EJ Lead Inspector Jon Clarke Key Unannounced Inspection 24th August 2006 09:30 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 Smallcombe House DS0000008146.V304106.R02.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. Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Smallcombe House Address Oakwood Gardens Bathwick Hill Bath Bath & N E Somerset BA2 6EJ 01225 465694 01225 465769 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) Salvation Army Mrs Ena Margaret Caddy Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 32 persons aged 65 years and over requiring personal care only. 29th September 2005 Date of last inspection Brief Description of the Service: Smallcombe House is a purpose-built care home for older people aged 65 years and over. It is owned and managed by the Salvation Army. However it should be noted that, whilst the ethos of the home is based on Salvation Army beliefs (in particular no alcohol and daily prayers are held), residents do not need to be of the Salvation Army faith. The home has 32 single en-suite rooms arranged over two floors with lift access. There is one main lounge with a smaller lounge area and a dining room. The home is set in extensive grounds and all the residents rooms overlook the grounds. A decking area, accessed from the front of the home, provides a pleasant seating area, along with patio areas at the rear of the home. The home is located about a mile from the city centre on a steep hill, but on a main bus route giving access to the shops and facilities of Bath. The mission statement of Smallcombe House states: To provide long term residential care in a secure, safe, homely and loving environment for elderly people who can no longer manage in their own home. Our staff aim to give a high standard of quality care, ensuring physical, emotional and spiritual support for each resident, while at the same time encouraging the residents to live as independently as possible. Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day, the manager was present during the inspection. As part of this inspection a number of documents were looked at including pre-admission assessments, care plans, training and evidence of health & safety practice in the home. There was also an opportunity to discuss with residents and staff their experience of living and working in the home. What the service does well: What has improved since the last inspection? There has been a lengthy period of change in the home with some uncertainty about the homes working arrangements. This has now been resolved with the formal introduction of new ways of working with the new post of Principle Support Worker and the manager having a greater opportunity to focus on the management and working practices of the home. The period of uncertainty and change did have an effect on staff morale however during this inspection the inspector noted that whilst some uncertainty remains about the new roles morale has improved. The previous inspection identified the need for a Adult Protection policy and procedure this has now been introduced. A further area of improvement identified was that of providing more specialised training for staff specifically around mental health this has now been provided. Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Smallcombe House DS0000008146.V304106.R02.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 Smallcombe House DS0000008146.V304106.R02.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 rating in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs. EVIDENCE: A number of pre-admission assessments were looked at and illustrated good practice in this area. Full information about the health and social care needs is obtained as well as the views of the perspective resident and their carer. When individuals are referred by the local authority copies of their social care assessment is provided. The home will wherever possible undertake a home visit to complete their assessment, during the trial period a fuller picture of the needs of the individual is built to provide a comprehensive assessment. Smallcombe House DS0000008146.V304106.R02.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): 7,8,9,10 The quality rating in this outcome group is good. This judgement has been made using available evidence including a visit to the service. Care Planning and arrangements for meeting health care are generally good providing staff with the necessary information so that the health and social care needs of residents are met. The home’s practice makes sure that resident’s health needs are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld EVIDENCE: A number of care plans were looked at and illustrated some inconsistencies in their completion. Moving and Handling assessments were not always completed and there were gaps in evidencing resident’s involvement. As part of the care plan dependency scoring takes place providing a valuable tool to measure any changes in the individual’s physical and health needs. There was good evidence of care plans being reviewed on a regular basis. The information about the individual needs and associated care tasks was however very Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 Page 10 detailed and through and is to be commended. An area for improvement is to ensure that the resident’s wishes in the event of their death is recorded in care plans or a next of kin is clearly identified who is fully aware of those wishes and again these are recorded. Residents have full access to local health service and there is visiting district nurse service available where individuals need such support. Other services such as chiropody, dental and optician are all arranged by the home and will visit the home or where able residents may use local services. The home has good links with GP surgeries and residents can choose to remain with their GP if they are still in the catchment area. There are also good relationship with the local social services and in particular the community mental health team who are available to provide support and assistance where there are concerns about an individual’s mental health. The arrangements for the storage and management of medication was looked at and showed there are good and secure storage of medication. Administering records showed some gaps in recording however generally satisfactory. However the use of paracetamol and its recording needs to be improved and this was discussed with staff member at the time of this inspection. Controlled drugs are accurately recorded with two members of staff witnessing their administration as required. The pharmacist or their representative signs returns of medication. In talking with residents there were a number of positive comments about how they felt their privacy was respected with staff always knocking on residents rooms before entering and this was witnessed by the inspector. Residents felt they “could choose how I spend my day” “don’t feel there are any real restrictions on me”. Again residents spoke of “always being treated with respect” and they (staff) “treat me as I would wish”. Smallcombe House DS0000008146.V304106.R02.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): 12,13,14,15 The quality rating in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. EVIDENCE: Whilst there is no structured programme of activities staff make a good effort to provide some form of activity on daily basis. This has included quizzes, exercise and reminiscence. There are regular religious services held in the home and the home’s chaplain provides pastoral care to all the residents. One area identified by residents was the lack of outings though some outings have been arranged particularly in the summer months. Residents where able are encouraged to attend local clubs and community resources. Residents spoke positively of the welcome made to any visitors to the home and described staff as “always friendly” and “welcoming”. The home recognises Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 Page 12 the importance of residents maintaining links with family and friends and actively encourages visitors to the home. One visitor spoken to at the time of this inspection said they were “always made to feel welcome” and “the staff always tell me about what is happening I feel informed about how my relative is”. The homes makes a good effort to avoid strict routines and inflexibility this was confirmed by a number of residents who said that “apart from mealtime” they didn’t feel there were strict routines. One individual who spends a lot of time in their room said they never felt under pressure to spend more time in the communal lounge “they really leave up to me”. Daily records also showed that staff are flexible when getting individuals up and going to bed and again residents of the home confirmed this. Menus for the home were looked and showed a varied and interesting range of meals being provided. On the day of this inspection the meal was well presented and appetising. Residents spoke highly of the food provided “always a good choice” “can’t fault the food” “I always enjoy my meals here” were typical comments made to the inspector. Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 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): 16,18 The quality rating in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The home has clear procedures in place and this enables individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to all staff in this area. EVIDENCE: In talking with a number of residents there was a clear sense that they felt confident to raise any concerns or complaints, individuals were aware of the homes complaints procedure. One resident said “I would hesitate to say something if I was worried” another “I know they would listen to me and do something”. No complaints have been made since the previous inspection. Following a requirement from the previous inspection the home has now put in place policy and practice guidelines around Protecting Vulnerable Adults from Abuse. These set out definitions of abuse, roles and accountability of staff, responsibility of managers and actions to be taken when any allegation of abuse is made. The policy is linked to the BANES Adult Protection policy. The majority of staff have taken Adult Protection training with senior and manager completing Investigators training to enable them to response effective. Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 Page 14 Training must be extended to all staff including domestic and catering staff who work in the home. Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The quality rating in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The home provides a safe, well-maintained and hygienic environment for the residents and staff. EVIDENCE: The home is purpose built and therefore has good level access for residents with lift available. There is regular programme of maintenance and all areas of the home are homely and décor is of a good standard. There is however limited access to the gardens though the home has a level accessible seating area overlooking the grounds. Policies and procedures are in place to minimise the risk of infection and maintain a good standard of hygiene. Infection Control policy states that “Smallcombe House believes that adherence to strict guideline on infection control is of paramount importance in ensuring the safety of both residents and Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 Page 16 staff.” Residents spoke of the home as “always clean” “kept very clean all the time”. At the time of this inspection the home was clean and free from offensive odours. Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 The quality rating in this outcome group is good. This judgement has been made using available evidence including a visit to the service. Staffing arrangements in the home are generally good so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. EVIDENCE: Staffing rotas were looked at over a period of one month and showed that there are generally 3 staff on duty am, 3 pm and 2 waking night. In addition with the new staff structure there is a Principle Support Worker on duty. This level of staffing is adequate to meet the needs of current residents. In talking with residents they commented that staff were “always available” “only have to ask and they do the best they can” “staff all very good”. The home has good practice in recruitment of staff and TOPSS induction programme. When recruiting staff the required checks are made with 2 references and CRB. Application forms provide full details of employment history and a medical declaration is completed by the applicant. Training records were made available and showed a good level of training with all staff completing the mandatory areas of training: Moving & Handling, Health & Safety, Food Hygiene and Fire Safety. Majority of staff have completed First Aid training however there remains a number of night staff Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 Page 18 who have not undertaken this essential training. All staff have undertaken Mental Health training. Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35,38 The quality rating in this outcome group is good. This judgement has been made using available evidence including a visit to the service. There are good opportunities for residents and others to express their views about the service they receive. The practices of the home help to make sure that the health, safety and welfare of residents and staff is protected. EVIDENCE: The manager Ena Caddy has extensive experience of working in a care setting and has recently successfully undertaken NVQ 4 Registered Managers Award. She has a good understanding and knowledge of the needs of older people with a supportive and sensitive approach to the residents of the home. Residents described her as “approachable” and “always there to help”. The new Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 Page 20 management structure has meant that she now has clear responsibilities for the management of the home though one of her strengths is her ability to remain very much in touch with the daily lives of residents. Financial records were completed correctly with two signatures to evidence money given or paid out on behalf of residents. It is generally not the practice of the home to deal with resident’s pensions and where this does occur separate accounts are held. Residents are encouraged where able to manage their financial affair or a representative if they unable to do so. Health and |Safety records were looked specifically fire drill and testing of equipment. Weekly tests of fire alarms are undertaken as are emergency lighting tests. Whilst fire drills are regularly held there is no record of staff members who were present. Servicing of equipment takes place annually: lift last service 7/02/06, Fire Alarms 20/04/06. A Gas safety report and certificate was issued 06/03/06. All staff undertake Health & Safety training. Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 Page 22 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. 1. Standard OP7 Regulation 15 (2) Requirement Ensure all elements of an individual’s care plan are completed specifically Moving and Handling assessments and individual’s wishes on their death. Ensure all mediation given to residents is recorded on the appropriate record. Ensure all staff undertake fire drills at the intervals laid down by Avon Fire & Rescue Service. Ensure all night staff undertake first aid training. Timescale for action 24/08/06 2. 3. 4. OP9 OP38 OP30 13 (2) 23 (4e) 18 (1c) 24/08/06 24/08/06 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Smallcombe House DS0000008146.V304106.R02.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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