CARE HOMES FOR OLDER PEOPLE
The Coombs Sparrow Hill Coleford Gloucestershire GL16 8QE Lead Inspector
Eleanor Fox Unannounced 23 June 2005, 09:30 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 Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Coombs Address Sparrow Hill Coleford Gloucestershire GL16 8QE 01594 833200 01594 837615 manager.thecoombs@osjctglos.co.uk The Orders of St John Care Trust 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 Gillian Shaw Care Home 40 Category(ies) of OP old age (40) registration, with number of places The Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: To accommodate one named service user under the age of 65 years. This person no longer lives at the Home and this condition will now be removed from the Certificate of Registration Date of last inspection 26/1/05 Brief Description of the Service: The Coombs provides accommodation for up to 40 service users who require nursing and personal care. It is an attractive property, situated within its own spacious private grounds. It lies within easy reach of the town of Coleford. The Coombs comprises of a main house, a listed property, where accommodation for up to 16 service users is provided on two floors, accessed by a shaft lift; plus 3 additional small lodges, known as Holly, Oak and Beech, in which there is accommodation for a further 24 service users, 8 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 service users in the summer months. The Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection over a period of 6 hours. It consisted of a full tour of the property; inspection of a selection of written care records; recruitment files and other available documents; plus discussions with the Deputy Manager, the Administrator and members of staff working in the Home. The inspector also had the opportunity to talk to fourteen of the residents and to one relative who was in the Home during her visit. Management of the Home has recently become the responsibility of The Orders of St John Care Trust; the Commission for Social Care Inspection has fully processed their application for registration. What the service does well: What has improved since the last inspection?
The Home has now fully implemented staff supervision processes, ensuring that employees receive the support they require to carry out their duties efficiently. Five of the residents particularly commented on the kindness and competence of the staff caring for them. The Coombs D51_D03_64579_The Coombs_V233506_230605_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 Coombs D51_D03_64579_The Coombs_V233506_230605_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 Coombs D51_D03_64579_The Coombs_V233506_230605_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) 1,5 and 6 The provision of comprehensive literature about the Home plus an invitation to visit the premises enables prospective residents to make an informed decision regarding their admission and gives them assurance that their needs will be met. EVIDENCE: A copy of the Statement of Purpose plus additional helpful information is available in the front hall of the Home. One visitor was reading the file while waiting to see her relative. She commented that she found the content interesting and easy to read. Although one resident had been unable to visit the Coombs prior to her admission because she was in hospital, she did say that members of her family had been to see various homes in the neighbourhood and had selected this one partly because of the reception they had received. The lady had been reassured to hear their description of the premises and to see all the literature, which had been provided about the home. The Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 Page 9 Members of staff confirmed that emergency admissions are not normally accepted at the Coombs. There were no available empty beds. Intermediate care is not provided in this Home. The Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 Page 10 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 and 10 Residents’ healthcare needs are fully identified and addressed appropriately. They are treated with respect by staff in the Home. EVIDENCE: A detailed plan of care is prepared for each person living at the Coombs, based on a full assessment of their care needs. These are reviewed and updated in a timely fashion. The wife of one gentleman commented that she is kept fully informed about her husband’s progress and has been given the opportunity to discuss aspects of his care. Specialist support and advice has been provided for one resident who has special healthcare needs. Members of staff have received specific training in the care of this person. An occupational therapist visited another resident to arrange appropriate seating equipment. Other healthcare needs are addressed as appropriate. The Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 Page 11 The Home has a written commitment to maintaining residents’ privacy and dignity; this is outlined in the Statement of Purpose. Members of staff knocked on doors prior to entry and spoke to residents in a friendly but respectful fashion. One resident commented on how welcoming the staff had been to her but that “she enjoyed her own private time in her bedroom”. The staff respect her wishes. The Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 Page 12 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, 14 and 15 Opportunities are provided for varied and stimulating activities and social contacts, as desired. A good choice and variety of meals ensures residents receive a nutritious and balanced diet. EVIDENCE: A full programme of activities is provided at the home, including trips out to places of interest. The residents have the benefit of their own bus to assist with transport. As it was an extremely hot day, the planned physical activity was cancelled and a group of people were enjoying a reminiscence session with the aid of old newspapers. Excellent personal profiles are recorded but there are only limited details documented about any participation in activities or any benefits noted. There were a number of visitors in the Home. Some chatted in the privacy of their bedrooms; others preferred to meet in one of the many communal areas.
The Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 Page 13 Each person is given encouragement to personalise their bedroom as they wish. One lady was proud to show off her some of her treasured possessions. The Home has recently employed a new chef; she is now preparing new menus, with the assistance of the residents and members of staff. Records show that residents receive a good variety and choice of food. Special dietary requirements are addressed appropriately. On the day of the visit, some residents were still enjoying an unhurried breakfast at 10.30; others had chosen to eat their meal much earlier. They were given sensitive assistance with their food, if required. The Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17 and 18 There are arrangements in place to ensure that residents’ legal rights are protected and that they are protected from abuse. EVIDENCE: Residents have been included on the Electoral Register; one person confirmed that he had registered a vote at the recent Election. Information on Advocacy Support is included in the Statement of Purpose file at the front door. Members of staff have received formal training in recognising abuse. The Home complies fully with the new regulations addressing the ‘Protection of Vulnerable Adults’. The Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 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 standard(s) 19, 25 and 26 A safe and well maintained environment provides residents with a good standard of comfortable accommodation. EVIDENCE: The entire Home is well maintained and furnished with strong comfortable furniture to meet the needs of the residents. The gardens are particularly attractive, providing a pleasant outlook from the building and a comfortable area for residents to sit and enjoy the good weather. One lady was most enthusiastic about the garden. She said: “Its such a lovely garden. I like to walk outside as often as possible.” Appropriate action had been taken to address a major leak in the front hall of the Home. Alternative access was arranged and maintenance engineers summoned urgently. No residents, staff or visitors were at risk. The Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 Page 16 The handyman provided records to show that hot water is stored at a safe temperature to prevent the risk of Legionella. He also checks and records the temperature of the hot water at all outlets. The entire Home was cool and well ventilated despite the warm weather conditions. The Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 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 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) 27,28 and 29 Skill mix and staffing numbers are only just adequate to meet the needs of the residents living in the Home. Good development opportunities ensure that members of staff are competent to undertake their duties and therefore meet the service users’ needs. Recruitment processes are in place to ensure the protection of residents living at The Coombs. EVIDENCE: There were thirty-seven residents living in the Home. One had recently returned from hospital and four more were unwell. In the morning, the Deputy Manager and seven carers were in the Home to look after the people living there; one nurse and five carers were due to be on duty in the evening; with a nurse and two carers working at the Coombs overnight. Due to the geography of the Home and the added concern of a recent incident during the night, it was reported that staff would feel more secure if the Home reverted to providing an extra member of staff on night duty. Of the twenty-three carers employed, nine have already achieved NVQ, level 2 and three are now working towards NVQ, level 3. Two more carers are enrolling to commence the training shortly. The Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 Page 18 Ten people have been employed at the Home since the last inspection. Personnel files showed that correct employment processes had been followed and full clearances had been obtained. Clear interview notes are maintained. The Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 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 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) 31, 35, 36 and 38 Robust management systems ensure that the financial interests, and the health, safety and welfare of people using the service are safeguarded. EVIDENCE: The Registered Manager, an experienced trained nurse, has now successfully completed the Registered Manager’s Award. The Home looks after the personal monies for the majority of the residents. These are kept in individual secure storage and it was observed that accurate records are maintained. The Manager has introduced a matrix system to monitor supervision processes; these are now undertaken in a timely fashion. Line Managers have received formal training in the processes. Full records are maintained.
The Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 Page 20 There are records in the Home to show that all necessary maintenance is undertaken in a timely fashion. Members of staff have received training in Fire Safety, Manual Handling, First Aid, Food Hygiene and Health and Safety. The handyman found that some equipment provided for one resident by her family was electrically unsafe. The equipment was removed and the family notified. The Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x 3 3 3 x x x 3 3 x 3 The Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 Page 22 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 Regulation Requirement Timescale for action 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 12 Good Practice Recommendations It is recommended that residents participation in activities be fully recorded and any special benefits noted The Coombs D51_D03_64579_The Coombs_V233506_230605_Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit 1210 Lansdown Court Brockworth Business Park Gloucester GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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