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Inspection on 11/06/07 for The Coombs

Also see our care home review for The Coombs for more information

This inspection was carried out on 11th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Coombs provides a homely, safe, very clean and well-maintained environment for the residents living there. It offers a welcoming and inclusive atmosphere for visitors. Residents have access to a good amount of information about the home when making their choice about it, and are admitted on the basis of an assessment, so that they can be assured the home can meet their individual needs. Each has their own individual care plan to meet their personal and health needs, and is afforded good access to all health services, with appropriate medical interventions when required. The care planning was of a good standard, with just very isolated aspects needing some further improvement in order to validate some of the appropriate care decisions taken. Residents are supported to manage their own medications if they choose and are able, and with one exception where an improvement was required, medications are well managed. Residents living at the home were treated with courtesy and friendly respect. Comments from residents and visitors were overwhelmingly positive about The Coombs, and without exception, people were very satisfied with the way in which they were looked after here. With the exception of just one isolated visitor survey response, residents and visitors generally indicated their feeling of confidence and trust in the home. Relationships between staff and residents appear positive, and respect is shown towards residents` choices and preferences for spending their time. A range of social opportunities is available that meet differing tastes and abilities. A good standard and variety of food is served in this home. Residents and their families can be assured that the home has a robust approach to addressing any complaints or concerns, and that the standard of care, services and facilities is regularly reviewed as part of good quality monitoring systems. Employees have the opportunity to attend training appropriate to their work, which includes a good focus on the national vocational training and protection of vulnerable adults. There is a reasonably stable and committed staff team here, which is of benefit in terms of continuity and good relationships for the residents. The home also has the benefit of strong leadership and committed focussed management.

What has improved since the last inspection?

The home`s Statement of Purpose and Service User Guide has been completely revised since the last inspection, and each is now in circulation. The home has introduced and been piloting the use of a new pre-admission assessment tool. The home is having to adjust to the new tool at this point, and this is not entirely without its problems. However the tool is very comprehensive, and provides an improved opportunity for capturing a great deal of valuable information about the care, health and social needs of each resident. Redecoration has been ongoing since the last inspection, and new flooring and curtains have been fitted in the dining room. A replacement resident call bell has been installed, as has a new assisted bath and fire safety panel.

CARE HOMES FOR OLDER PEOPLE The Coombs Sparrow Hill Coleford Glos GL16 8QE Lead Inspector Mrs Ruth Wilcox Unannounced Inspection 11th June 2007 09:00 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 The Coombs DS0000064579.V335012.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. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Coombs Address Sparrow Hill Coleford Glos GL16 8QE 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) 01594 833200 01594 837615 manager.thecoombs@osjctglos.co.uk The Orders of St John Care Trust Mrs Gillian Shaw Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th December 2005 Brief Description of the Service: The Coombs provides accommodation for up to 40 residents who require nursing and personal care. It is an attractive property, situated within its own spacious private grounds, and lies within easy reach of the town of Coleford. The Coombs is a listed property, and comprises of a main house, where accommodation for up to 16 residents is provided on two floors, accessed by a shaft lift. There are three additional small lodges, known as Holly, Oak and Beech, in which there is accommodation for a further twenty-four residents, eight in each unit. All areas of the home are pleasantly furnished and well maintained. A selection of comfortable communal facilities is also provided. The extensive beautifully maintained gardens are easily accessible and may be enjoyed by the residents in the summer months. Information about the home is available to prospective residents and interested parties in the printed Service User Guide, known as the Residents’ Handbook, and a copy of the most recent CSCI report is attached to the home’s Statement of Purpose, which is readily available in the home for anyone to read. The charges for The Coombs range from £348.66, basic Local Authority rate, to £682 per week privately. Hairdressing, chiropody, toiletries, magazines and newspapers, transport and name labels are extra costs. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this unannounced inspection over two days in June 2007. A check was made against the small number of requirements that were issued following the last inspection, in order to establish whether the home had ensured compliance in the relevant areas. Care records were inspected, with the care of four residents being closely looked at in particular. The management of residents’ medications was inspected. A number of residents were spoken to directly in order to gauge their views and experiences of the services and care provided at The Coombs. Some of the staff were interviewed. Survey forms were also issued to a number of residents, visitors and staff to complete and return to CSCI if they wished; a large number were returned, and some of their comments are featured in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, training and provision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 7 The home’s Statement of Purpose and Service User Guide has been completely revised since the last inspection, and each is now in circulation. The home has introduced and been piloting the use of a new pre-admission assessment tool. The home is having to adjust to the new tool at this point, and this is not entirely without its problems. However the tool is very comprehensive, and provides an improved opportunity for capturing a great deal of valuable information about the care, health and social needs of each resident. Redecoration has been ongoing since the last inspection, and new flooring and curtains have been fitted in the dining room. A replacement resident call bell has been installed, as has a new assisted bath and fire safety panel. 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 summary of this inspection report can be made available in other formats on request. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 8 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 The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living in this home have access to a good amount of information about it, and are assessed fully prior to their admission, so that they can be assured that the home will be able to meet their needs. EVIDENCE: The home has recently introduced a new and revised Statement of Purpose and Service User Guide, known as the Residents’ Handbook. The former is readily available in the entrance hall for anyone wanting to read it, and a copy of the latter, which contains all the information that is required, is issued to each prospective resident. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 10 In each of the four care records inspected as part of the case tracking exercise there were fully completed assessments that identified each individual’s care and social needs prior to admission to the home. At least two of these, plus a fifth assessment carried out more recently for a new admission had been done using new assessment tools as part of a pilot scheme. These were lengthy and very comprehensive tools, which although time consuming to use, captured a very good standard of information and identified any risks at an early stage, which gave a very clear and much fuller picture prior to admission. This assessment tool also provided a good planning tool for staff ahead of the person actually coming into the home. In some cases assessments were supported by information provided by other health and social care professionals previously involved in the care of the individual. Prospective residents and their representatives and families are supported to visit the home to spend time and look around before making their decision about it. The ethos of the home is to endeavour to give as much quality time to people viewing the home as possible. Some residents and visitors commented that they had received a good amount of information about the home, and that staff had offered a lot of time for their questions and answers. Prospective residents receive written confirmation of their placement in the home, as is required. The Coombs does not provide intermediate care. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home have their health and care needs met through good care planning and delivery, which is mindful of their privacy and dignity, and through a generally well managed system for administering their medications. EVIDENCE: All residents have their own personal plan of care. Four were selected for a case tracking exercise, and were scrutinised in closer detail. Each of these care plans was directly linked to a full assessment of needs, including a good range of risk assessments, which incorporated all health, personal and social issues. Plans were fully detailed, providing clear guidance to staff when caring for the individual. There was clear evidence that due regard should be shown towards individuals’ dignity, choices and preferences, and levels of independence. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 12 All aspects of care plans had been reviewed regularly, and residents, and their families if they wished, had been involved in this process and had also taken part in a full six monthly review of their care and services they had been receiving. Despite the regular reviews there were very isolated comments in care plans that transpired were no longer relevant, the circumstances having changed for one reason or another, and the deputy manager resolved to amend these straight away. In one particular case the resident had been assessed as being vulnerable to the risk of pressure sores, although was fully mobile and quite active. There was no care plan necessary to specifically address this, but in cases such as this staff should record their rationale in the care plan for not introducing any preventative measures, having quite rightly made the decision they were not necessary. In another case records showed that the resident had bed rails in place to reduce certain risks to her, and care plan recording associated with their risks and use could have been much fuller; the deputy manager resolved to address this straight away. There was very good evidence of multidisciplinary working between the home and other health care services, with residents afforded regular medical reviews and consultations, and access to a range of health care services, either in the community or in the home. Residents themselves were overwhelmingly positive regarding the way in which they were looked after at The Coombs. Specific comments were received in this regard, such as ‘the staff go beyond the call of duty’, ‘we get excellent care’, ‘I am very happy with the service’, and ‘all my needs are met and I am delighted to get in here’. Residents are able to manage their own medications if they wish and are able, and this is done on the basis of a documented risk assessment process. Although no-one is currently doing this, the risk assessment process was about to be undertaken for one particular resident, and the home was able to provide the necessary safe storage for anyone needing it in their rooms. Storage for medications was secure, clean and well organised, and was in a cool area. Items requiring cold storage were stored in a designated refrigerator; temperatures were monitored and recorded regularly. Controlled Drug (CD) storage was provided, and a meticulously and tidily recorded bound register was maintained. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 13 In order to comply with The Misuse of Drugs (Safe Custody) Regulations 1973 the CD cupboard must be rag/rawl bolted, through two pre-drilled holes in the reinforcing plate at the back of the cupboard, to a solid wall; although the cupboard certainly seemed solid and well bolted, there were no such bolts within the inner cupboard, and this will need further investigation by the home in case adjustments have to be made. The supplying pharmacist prints the medication administration charts, and also carries out a six monthly review and inspection of the systems in the home. The receipt of medications was recorded on the charts, and a separate book of returned items was kept. Hand written entries on medication administration charts were signed by the author, with a second signatory as witness. One such entry was not easy to read, although was definitely legible, and would have been better if written in capital letters. Variable dosages were recorded, with just one omission in this regard seen. Some of the external medications were prescribed to be used to the ‘affected area’ or ‘affected eye’; these were not linked in writing to a plan of care, and although staff were aware of how to use these particular medications, the ‘affected areas’ were not recorded. Boxed and bottled items were dated on opening as a precaution against using the item beyond its expiry date, and also provided a good means of conducting audits. Random audits were carried out on four specific boxed medications, and a slight discrepancy was identified in one case. There were a small number of dosages in deficit of what there should have been at that particular point in time. It was thought that the explanation for this was a signature omission for one of the dosages administered two days previously. Staff were consistently observed being polite, courteous and sensitive in their approaches to residents. Care was delivered discreetly in the privacy of individuals’ bedrooms and bathrooms. Care planning, the home’s policies, and staff training direct them towards respecting residents’ privacy and dignity at all times. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living in this home have good opportunities to remain as socially active as they are able and choose, and also have a nutritious diet that offers choice and variety. EVIDENCE: The Coombs has a designated social activities coordinator who works in the home on two days of the week. In addition to this care staff are being motivated to undertake social activity responsibilities for residents also. Residents have been consulted about their past interests, hobbies, preferences and ideas for social activity, and records of activity and of those participating are kept. There is a varied social programme here, which includes group activity to suit varying likes and abilities, and outside pursuits and entertainments. In addition to this, social engagement is offered with those who do not wish, or are not able to participate on a group basis, on a one to one basis. The The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 15 coordinator’s view was that communication and social contact was equally as important for residents as actual activity. Extra care and support was being given to one particular resident whose disability made it difficult for her to participate fully and freely. One partially sighted resident had the benefit of talking books, and a large print book library leaves books at the home. One particular resident enjoys going out to shops with a member of the staff when they go, and some are involved in the planning and use of a greenhouse that is being erected for those residents with a particular interest in gardening. Some residents go out regularly, some using community facilities, and religious services to suit the different denominations currently observed in the home are held. Families and friends are welcomed into the life of the home, and there are no restrictions placed upon them. Visitors commented that the staff keep them well informed and ‘in touch’, and that they felt they were properly consulted and kept up to date with things. One resident commented that the staff were ‘very good to her and her daughter too’. Another said that the home was ‘extremely supportive towards residents and their families’. Residents were spending their time more or less as they pleased, although some were more reliant on the staff to assist them. An overwhelming majority spoke positively about life in the home and the social opportunities, although one said that she did experience difficulty with participation due to her disability, and one visitor said that they felt there were not enough social activities for people, and that they rarely saw the coordinator. Residents are supported to maintain as much independence and control over their lives as they are able, and this was evident through the way in which certain residents were enjoying a good level of autonomy and pursuing their chosen way of life. Advocacy information, plus other useful information about advisory and support services was readily available. Some visitors commented that staff are respectful of people’s choices, and that residents are indeed able to live the way they prefer. Residents are offered a choice with their meals also, and are consulted each day about their choices for lunch and supper. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 16 The service of the mid day meal was observed on this visit. The majority of residents sat in one of the dining rooms with a few preferring to remain in their bedrooms. Everyone was given the chance to eat their meal in a relaxed unhurried manner. Meals were well presented, and were served individually from a heated trolley in each dining room. Individual choices were observed, and further to this staff were heard repeatedly offering additional choices to people in a variety of ways. Staff gave discreet assistance where it was needed. The food was hot, and looked very nutritious, wholesome and appealing. Special diets were observed where relevant. Residents commented very favourably on the food they had, confirming they had choice, variety and quality. The kitchen was seen during the lunchtime preparations. Although clearly very busy, it was well organised. The relatively new chef was well informed about the needs of the residents, and had records of individual preferences, special diets and choices. The kitchen area and storage was clean, with all appropriate catering records well maintained. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home are able to express their concerns and are generally reassured by the home’s complaints procedure, are protected against abuse and have their rights protected. EVIDENCE: A comprehensive Complaints Procedure has been prepared for The Coombs, a copy of which is provided to each prospective resident and/or relatives along with other information about the home. The written procedure is also displayed prominently in each part of the home. The home has a good system for addressing any concerns that are raised, with appropriate recording when necessary, however there have been no complaints raised in recent months. Residents said that staff were very receptive to any concerns, and said that staff were ready to listen and help at all times. Visitors said much the same, confirming that staff always respond appropriately. There was just one exception to this however, whose experience had been slightly different. This visitor said that ‘the manager was good at sorting out The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 18 problems straight away with the minimum of fuss, but that ‘although the nurses were brilliant, staff don’t always listen and act on what’s said’. The home provides fully documented policies to address all forms of abuse, which are readily available for staff to read. Abuse issues are covered in the induction training programme, which each newly appointed member of staff attends, and all staff have attended specific adult protection training in the last year, with more planned. Staff spoken to demonstrated a good awareness of the protection and rights of those living in the home, and were very sensitive and respectful towards people. Residents and visitors to the home indicated their complete confidence in the management and staff at the home. POVA (Protection of Vulnerable Adults) legislation has been correctly followed at The Coombs during the recruitment of staff. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home are provided with very comfortable and pleasant accommodation, which is suitable and safe to meet their needs. EVIDENCE: The Coombs provides accommodation in an old, grade II listed, character filled property, which has been adapted, furnished and decorated to a very good standard. The main house accommodates sixteen residents, and has a large, well appointed communal lounge, and assisted toilet and bathing facilities. The home also comprises three purpose built eight bedded units, known as lodges, which are each connected and integral to the home. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 20 Each unit has its own lounge, dining room and assisted bathing facilities, and provides quite cosy, inclusive accommodation for the small number in each. Three double rooms are being used to provide single accommodation at present, given that there is no-one currently wanting to share. Not all rooms have en-suite facilities. All areas are reasonably light, are accessible and well maintained. Beech Lodge is quite dim however, due to a bank of earth and trees outside its windows; even with overhead lighting on some of the rooms still did not appear very light. This was also seen in at least one of the rooms in the house, where there are high ceilings. Additional lighting was available in each room however. A committed maintenance person is employed at the home, and meticulous maintenance and safety checks were carried out, with thorough and detailed records kept. Since the last inspection redecoration has been ongoing, and new, attractive and practical flooring has been laid in the dining room. A new call bell system, assisted variable height bath, and fire safety panel have been provided. The home has had finances approved to repair and upgrade the garden paths in the near future, in order to make them more accessible to all, and to have a summerhouse put in the garden. With the due consideration needed towards the forthcoming implementation of the Smoking Regulations, smoking in the area between two of the lodges has been stopped, and in the fine weather smokers were using the patio outside to smoke whilst the home considers its options to comply with this particular piece of new legislation. Residents and their families to whom this is particularly relevant have been consulted and involved in this process. The home was immaculately clean, and all areas were fresh and odour free. Many of the residents commented on how clean the home was, with one saying that there were ‘never any smells’. There were good infection control measures here, with liquid soap, paper hand towels, hand sanitising gels, gloves and aprons widely available. All grades of clinical waste were safely managed. The laundry room was extremely well organised, and was also immaculate. Washing machines are capable of disinfecting any foul laundry. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 21 There were sluicing facilities in each part of the home, with a disinfector on each floor of the main house. All chemicals were safely stored when not in use. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home receive care from a stable and competent workforce, and can generally feel reassured by the recruitment checks carried out on new staff. EVIDENCE: The vast majority of residents and visitors felt that there was normally an adequate number of staff on duty to provide care for them, although there were a few isolated comments that the home sometimes seems short of staff, and could do with more. All comments were extremely positive about the existing staff and the way in which they looked after the residents. One person said that ‘it was the staff that made this home’. Another said that the staff were ‘cheerful and helpful’. Relationships were evidently good between the staff and the residents, with friendly and positive interactions between them witnessed. During the course of this visit, staff were certainly working very efficiently and were responding to residents’ needs and call bells very promptly. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 23 Rotas show that there is one registered nurse on duty at all times, with seven care staff in the morning, and five care staff in the afternoon and evening, and two overnight. A solid ancillary team of cleaning, catering, maintenance, administration and laundry staff very ably supports the care and nursing team. The core staff team is very stable, with many having worked at the home for several years. The home is making very good progress with the National Vocational Qualification (NVQ) training programme for care staff. There were eleven care staff qualified to at least level 2 at this time, with two others about to finish their award. There were two others currently on an NVQ course with a local college, and a further two were just starting on the Young Apprenticeship scheme. There were plans for another two to start their NVQ award as soon as possible. Personnel files relating to five members of staff who had been recruited in recent months were inspected. In each instance, the prospective employee had completed an application form providing details of their employment history, although in one case full dates would have been an improvement rather than just the year. Medical information had been provided. Two written references had been provided in each case, including one from the last employer. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. In just one case the applicant had not completed the criminal convictions declaration as is required, and the interview notes showed that this omission had not been followed up during the interview process. There is a designated training coordinator in the home, and records of all training undertaken by staff were kept, although there were certain lapses in this identified, which the training coordinator resolved to address straight away. The training programme for staff comprised mandatory and optional training subjects. Certificates of learning were maintained for each member of staff in their own personal training and development file, and each worker had been issued with the General Social Care Council Code of Conduct. Newer staff had received induction training, and there were comments from some of them about the good level of support and supervision they had received during that time. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 24 Induction training is delivered on a set day at a training centre before work commences, and using a programme designed for use when actually working in the home. It is also delivered via an electronic induction-learning package that provides training in six modules, each of which incorporates the Common Induction Standards for care staff, including Principles of Care, Roles and Organisation, Health and Safety, Communication, Abuse and Neglect, and developing as a Worker. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people living in this home benefit from efficient, open and respectful management, in which a qualified and competent manager effectively monitors quality and standards. EVIDENCE: The manager has been managing The Coombs for ten years and is a first level nurse. She has achieved the equivalent of the Registered Manager’s Award, and is registered with CSCI for her role. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 26 She demonstrates good leadership and a committed, focussed management style. It was noted that she is very approachable to residents, visitors and staff, and ensures that she remains accessible as much as she can. The manager is very competently supported by a very conscientious deputy manager, and together they share a very productive working relationship that benefits all living and working at the home. There is a strong focus on monitoring the quality of the care and services at The Coombs, with a clear intention to make improvements wherever the need is identified. A range of quality monitoring systems is used to aid this process. Annual quality monitoring survey forms were issued to residents and their families last year, and these sought their views and experiences of the care, facilities and services; a good number of responses were received. Actions needed to address any issues of concern were addressed through a written action plan, drawn up on the basis of the collated results. Comments and suggestions cards are placed in the entrance hall for anyone to use if they wish. A residents’ meeting is organised regularly to which their families are also invited, and this gives them a further opportunity to have their say about the way their home is run, and to give feedback on their views of the services. The Coombs conducts a range of its own internal quality audits in areas such as care planning, medications and the environment. External auditors have also assessed the home, and it is to the home’s credit that it has been awarded the ISO 9000 Quality Award. Many residents have placed personal money and valuables in the home’s main safe for safekeeping. Clear and transparent records for each person, which included transaction details, running totals, and receipts, were seen. Residents or their representative can sign to acknowledge transactions, but where this had not been possible in the majority of cases, two staff members had signed the record to witness on behalf of the resident. A regular audit was recorded on each of the records. There was evidence that health and safety issues are addressed well in this home, with written policies, procedures and risk assessments and provision of necessary equipment. There is a small health and safety committee, who meet regularly. Staff have received thorough training in fire safety, with the content of the training recorded. Senior staff have also attended Fire Marshall training with the local fire department. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 27 Staff have received training in first aid; one of the specialist senior care leader has also undertaken the more comprehensive 4 day course. First aid equipment is provided in the home. Accident records were seen for certain events that were identified during the case tracking exercise. A full fire safety risk assessment throughout the whole building has been undertaken by an external assessor, with due regard to revised fire safety regulations. Hot water temperatures are regularly checked for safe levels, and regular Legionella checks on the water supply have also been carried out, with the appropriate control measures in place. All the necessary safety checks and maintenance of utilities and equipment are undertaken in a timely fashion, and meticulous records are kept in these areas. The building is secure, with coded door entries in a number of locations. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 28 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 3 X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 4 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 4 X 4 X 3 X X 3 The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 29 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 OP9 Regulation 13(2) Requirement Directions for the use of external preparations and eye drops must be clearly recorded on the medication administration chart. This will ensure that all people living in the home who have these preparations prescribed will receive their medications correctly. The manager must ensure that each prospective worker completes a criminal conviction declaration as part of their application process, so as to promote robust screening for the protection of those living in the home. Timescale for action 31/07/07 2 OP29 19(1.b) Schedule 2 (2) 31/07/07 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 The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 30 1 OP9 The use of medications prescribed for use ‘as necessary’ or ‘as directed to affected areas’ should be linked to a written plan of care, as this will help to promote a clear understanding of each preparation’s use. The Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Coombs DS0000064579.V335012.R01.S.doc Version 5.2 Page 32 - 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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