Inspection on 24/06/05 for The Coombe House

This inspection was carried out on 24th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

The Coombe House 19/12/06

The Coombe House 10/01/06

The Coombe House 09/11/04

The Coombe House 29/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE THE COOMBE HOUSE The Coombe Streatley-on-Thames Berkshire RG8 9QL Lead Inspector Marie Carvell Unannounced 24 June 2005 at 1pm 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 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. THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Coombe House Address The Coombe Streatley-on-Thames Berkshire RG8 9QL 01491 872174 N/K N/K Mrs M J Windebank and Mrs S C Major 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) Mrs S R Hutchinson Care Home 24 Category(ies) of Older Person (OP) registration, with number of places THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 09/11/04 Brief Description of the Service: The Coombe House provides accommodation and care for up to twenty four service users over the age of sixty five, who have care needs associated with old age. The home is not registered to provide care to individuals who have dementia or require nursing care, over and above the care that can be provided by the community nursing team. The home is located in a rural village and is within walking distance of a range of amenities. Accommodation is situated on the ground and first floors of the home and five bedrooms are situated in an annexe which is separate to the main building. There are twenty single and two double occupancy rooms. The home and gardens are maintained to a high standard, with appropriate aids and adaptations to meet the care needs of service users. There is a registered manager in post. THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector from 1pm until 8pm and was unannounced. This was the first visit to the home for the allocated inspector. A tour of the premises was made and time was spent with one of the two providers, the registered manager and service users in communal areas of the home and in private. A sample of records relating to service users and health, safety and fire required to be kept in the home were examined. Feedback was given at the end of the inspection to the provider. Following the inspection the CSCI received many letters from relatives expressing their satisfaction with the care provided and facilities. What the service does well: What has improved since the last inspection? The providers are updating and developing policies and procedures. THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 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. THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 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 standard(s) 3 and 5 Service users do not have their needs assessed prior to moving into the home. EVIDENCE: The manager confirmed that service users do not have their needs assessed before moving into the home. An assessment of need and ability is completed, when the service user has moved into the home. This information is well recorded, but needs to be developed to form a care plan. Evidence was seen that one of the last three service users to be admitted to the home visited before moving in. The home’s Statement of Purpose refers to a needs assessment being undertaken prior to admission. The Service User Guide and contracts state that service users “have one month built into their occupancy agreement to decide whether this is the place for them” The provider said that following the trial period an agreement would be made “ over the phone” rather than a meeting with the service user and relatives/advocates. THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 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 standard(s) 7,8, 9 and 10 Care plans must reflect the care needs of the service user and should be reviewed every time there is a change in the persons needs. The information needs to be sufficiently detailed to enable care staff to provide care based on assessed needs. Care provided to service users is delivered with respect and their right to privacy is upheld. EVIDENCE: A sample of four service user files were examined, including the three most recently admitted service users. Care plans must be developed and implemented and include aspects of health, personal and social care needs including psychological health and nutritional screening. Records are not kept on a daily basis, as only significant information is currently recorded. The daily records of three service users, demonstrated that over a period of six weeks minimal information was recorded. Daily records must validate care plans and evidence care provided. Service users where appropriate are able to be responsible for their own medication. Staff who administer medication have received appropriate training. THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 Page 10 Service users confirmed that they are treated with respect at all times and their right to privacy is respected. Staff were observed to be respectful and dealing with service users in an appropriate manner. THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 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 standard(s) 12,13 and 15 The social stimulation and activities provided have a positive effect on service users. Meals are nutritious and well presented. Staff engage with service users whenever they are in contact with them. EVIDENCE: Many service users have relatives who visit regularly. On the day of this visit, several service users were having their hair set. The majority of service users were in their bedrooms resting or watching television. Service users said that the food provided was “very good” and although there was not a choice of food at lunchtime, if requested the cook would prepare an alternative meal choice. At the request of a service user, the provider is to review the evening meal menu, which is always sandwiches and soup. THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 Page 12 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 standard(s) 16 and 18 The complaints procedure is displayed in the home. Not all staff have received training in the protection of vulnerable adults from abuse. EVIDENCE: No written complaints have been received for several years. Although service users said that they had made complaints and that these had been acted upon immediately. Advice was given to the provider about the recording of complaints. The provider said that she was unclear about the definition of a complaint. The inspector’s opinion is that a complaint is an expression of dissatisfaction. The provider regularly receives letters of satisfaction from relatives and other visitors to the home. A suggestion was made to have a comments book for visitors. This has been actioned by the provider as well as a new complaints book. Only care staff undertaking NVQ training have had training in the protection of vulnerable adults from abuse. The provider agreed to arrange for all staff including ancillary staff to receive appropriate training and to obtain a copy of the Multi Agencies policy and procedures for the protection of vulnerable adults from abuse. THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 19,21,23,24 and 26 The service users live a comfortable and spacious accommodation. The home is clean, pleasant and hygienic. EVIDENCE: Service users expressed their satisfaction of the accommodation and premises. All bedrooms have en-suite facilities in addition to two communal bathrooms fitted with appropriate aids and adaptations to assist with independence and safe bathing. Bedrooms are well furnished and service users are able to bring in personal possessions. The five bedrooms in the annexe have a kitchenette area. The home was found to be clean, pleasant and free from unpleasant odours. THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 It is not evident that the home has sufficient staff on duty to meet the needs of all service users. EVIDENCE: The provider informed the inspector that all staff work fixed hours. The permanent rota demonstrated that there is not always two care assistants on shift. Frequently one of the two staff on duty is employed as a General Help this post involves mainly housekeeping and food preparation tasks. The registered manager assumes the role of carer when on duty. The permanent rota demonstrates the carer rostered for night duty on a Monday only. The provider told the inspector that when the night care assistant leaves the main building to carry out the regular checks on the five service users in the annexe, the care assistant locks the door to the main house. One service user living in the main house has behaviours that challenge the service and in order to monitor this service user an alarm has been fitted to the service users bedroom door and the care assistant carries a baby alarm monitor, the alarm has been fitted in the service users bedroom. The inspector was told that this is because this service user has on at least one occasion absconded from the premises and wanders into other service users bedrooms. The shift patterns are 7.30am until 2.00pm, 2.00pm until 8.00pm and 7.30pm until 7.30am. THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 Page 15 At weekends one care assistant or the registered manager is rostered to work from 7.30am until 2.00pm, assisted by general assistant rostered to work 7.30am until 9.00am. In addition there are ancillary staff on duty. At the time of this inspection, both providers were in the home. Two senior care assistants were on duty from 7.30am until 2.00pm and supported by an general assistant working 9.00am until 2.00pm, cook 8.30am until 2.00pm, a domestic and handy man both working 9.00am until 3.00pm. The registered manager came on duty at 2.00pm until 8.30pm and was assisted by a general assistant also working until 8.30pm. During the inspection the general assistant accompanied a service user to hospital. An additional care assistant came on duty to assist the manager. From 7.30pm a care assistant was rostered to work until 7.30am the following morning. The home has a vacancy for a night bank worker. THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35 and 38 The registered manager is well qualified and experienced to manage the home, however she is responsible for care issues only and provides direct care to service users. Some health, safety and welfare issues were identified as needing attention. EVIDENCE: The registered manager is well qualified and experienced to manage the home full time. However, the manager is rostered to provide hands on care to service users and is responsible for care planning, medication and other care issues, but does not undertake any management tasks or responsibility although as the registered manager is equally liable in law as the providers. Service users were complementary about the care provided by the manager. The home manages a small amount of cash for one service user. Advice was given regarding the keeping receipts and staff signatures for all credits and debits made. THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 Page 17 Service user records such as risk assessments were not in place for the service users admitted since May 2005. The inspector identified risks such as risk of falling, self-medication and safe bathing. The provider has advised the CSCI that risk assessments are being completed. The sample of service user records identified that one service user had fallen at least three times since admission. Two entries were recorded in the home’s accident book. The provider agreed to discuss this with the member of staff involved. It was noted during the tour of the premises that the cellar door did not have a lock fitted, to reduce the potential risk of a service user or visitor falling down the steep steps. An immediate requirement was made and an appropriate lock was fitted before the end of the inspection. No COSHH policies or records, fire records, hot water temperature records or premises risk assessments were available for examination by the inspector. THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x 2 N/A 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 x 15 3 COMPLAINTS AND PROTECTION 3 x 3 x 3 3 x 3 STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 2 x 3 x x 2 THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 Page 19 No 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 3 Regulation 14 Requirement That the providers ensure that no service users are admitted before a full assessment of need is undertaken. That the providers advice the CSCI of action to be taken to ensure that a review is undertaken and outcomes recorded. That the manager ensures that a care plan is generated from a comprehensive assessment for all service users. This should be validated by daily records being maintained. The providers are to ensure that staffing levels do not fall below two staff on duty during the day, to meet the needs of service users with additional management and ancillary staff on duty. The providers are to review the staff arrangements at night, to ensure that the service users in the main house and annexe are appropriately supervised at all times. The results of the review H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc 2. 5 14 3. 7 15 Timescale for action Before the next service user is admitted. To commence with the next service user to be admitted. 24/09/05 4. 27 18 24/08/05 5. 27 18 24/08/05 THE COOMBE HOUSE Version 1.30 Page 20 6. 7. 33 38 8 17 8. 38 17 and action taken are to be sent to the CSCI. That the manager, is enabled to 24/08/05 carry out her role and responsibilities full time. That all records required to be 24/08/05 kept in the home are maintained, up to date and available for examination by the inspector. That the providers confirm that 24/08/05 records relating to COSHH, fire safety including risk assessments and hot water are available in the home. 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 THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 2nd Floor 1015 Arlington Business Park Theale Berks RG7 4SA 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 THE COOMBE HOUSE H52-H01 11218 Coombe Hse V228726 280605 Stage 4.doc Version 1.30 Page 22 - 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. 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