Care Home: Combe Lea Residential Care Home

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What the care home does well We noted throughout our visit to the home that there has been a significant change in terms of staff morale and this has resulted in a more positive and welcoming environment. Throughout the two days of our visit staff commented on the improvement in morale "we work much better now" "people respect each other" "morale is so much better". In our view this is the result of staff working through the difficult changes they had to make following the closure of previous homes and working with a new staff team and environment. One positive change has been to some extent the resolving of dissatisfaction from staff about their working arrangements in that previously they have had to work on both floors of the home rather then focus on one specific unit i.e. Gardiners Row or Willow. Staff now have the option of working the majority of their shifts (75%) on one floor only. Importantly this in our view will improve the continuity of care particularly on Gardeners Row where individuals have dementia. Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 An improved Care Plan format has resulted in better information about the individuals care needs and provided a more person centred approach with life story information though as noted in the report and below there remain areas for improvement. Individuals we spoke with were mixed about the level of activities available in the home however it is hoped that this will improve with the availability of an activities organiser. It was clearly part of the staff`s routine to sit and chat with individuals and this was observed by the inspector during the visit to the home. This helps in creating a more informal and friendly environment. In talking with individuals who live in the home they commented on the approach of staff and how "caring and friendly" they are and there was a real sense from talking with staff that they have a real commitment to providing quality care. Individual`s comments to the inspector illustrated the positive views of the service provided: "it was the right choice for me definitely" (coming to live at Coombe Lea) "I don`t think there could be anywhere better" What has improved since the last inspection? We made a number of requirements at our last inspection and looked at these as part of this inspection to see if the improvements we requested have been made. We found that the home has addressed the areas we identified and this has resulted in improved arrangements for supervising staff, medication arrangements are more robust (though still needs some improvement). We also found improvements in care planning, quality assurance and getting the views of others about the quality of care provided in the home. What the care home could do better: We have identified a number of areas which require improvement and have made requirements about these issues. Firstly care planning whilst improving still has areas of weakness such as risk assessments which clearly state the area of risk and measures to be taken in response to the risk. Secondly the recording of the use of "as required" medication must be improved in that there needs to be more information about the circumstances of its use so that individuals receive the medication appropriately. Staff are also then clear about its use and situations where it is reasonable andCombe Lea Residential Care HomeDS0000071555.V376798.R01.S.doc Version 5.2 legitimate to use thereby protecting the individuals from misuse of medication which can be seen as detrimental or be used in-appropriately. The recording of medication must be more robust so that there is written evidence that prescribed medication has indeed been given to the individual as required. We have also highlighted the need to further improve the environment to make it more suited for the individuals specifically those with dementia that live in the home. The home needs to provide items, which one would expect to see, and which in our view influence the homeliness of the environment i.e. clocks, ornaments. Key inspection report CARE HOMES FOR OLDER PEOPLE Combe Lea Residential Care Home Midsomer Norton Community Resource Centre Orchard Vale Midsomer Norton Radstock BA3 2RD Lead Inspector John Clarke Key Unannounced Inspection 2nd July 2009 09:00 DS0000071555.V376798.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Combe Lea Residential Care Home Address Midsomer Norton Community Resource Centre Orchard Vale Midsomer Norton Radstock BA3 2RD 01225 396338 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) ketrine_cooper@bathnes.gov.uk Bath & N E Somerset Social Services Mrs Ketrine Margaret Cooper Care Home 30 Category(ies) of Dementia (15), Old age, not falling within any registration, with number other category (15) of places Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) - maximum of 15 places 2. Dementia (Code DE) - maximum of 15 places The maximum number of service users who can be accommodated is 30. 20th August 2008 Date of last inspection Brief Description of the Service: Coombe Lea is part of Bath & North East Somerset new care provision. Coombe Lea Care Home is located within a purpose built resource centre named Midsomer Norton Community Resource Centre. The purpose built centre will also include day services for older people, supported living scheme. The home provides respite and day care support to individuals living in the community. The home accommodates 30 individuals over two floors with 15 individuals whose primary care need relates to dementia on the first floor (Gardners Row) and 15 individuals on the second floor (Willow View) whose care needs are around personal care. Each floor is made up of 15 single rooms each with en-suite facilities (showers), some rooms are fitted with ceiling track hoists, each floor having communal lounge areas and communal assisted bathrooms. There is a separate lounge/dining room on each floor with kitchen servery. On each floor there are separate small seating areas at the end of corridors. There is direct access to the garden from the first floor lounge and lift access from the second floor. There is a garden room and hairdressing salon on the ground floor. The philosophy of care (from home’s Statement of Purpose) stated: We will assist you to live life to the full, helping you to make decisions for Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 5 yourself, even this involves an element of risk. We aim to ensure that living in a residential setting is a positive experience, ensuring each resident retains their rights as citizens. We encourage and welcome you to have your say in the things that effect your daily life. We aim to provide personal/emotional care and support within a friendly environment enabling residents to maintain maximum independence. Fees from 6th April 2008 Gardners Row £677.00 Willow View £654.00 All Inclusive other then health services such as chiropody, dentist, optician. Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. This was an unannounced inspection of the home which took place over two days. On the first day we looked at the care arrangements for those individuals who live on Willow View and then on the second day Gardners Row where individuals who have dementia are cared for. We spent an hour and a half observing staff and individuals on Gardners Row. This was to help us in making a judgement about the interaction between individuals and staff. There was also an opportunity to talk with individuals who live in the home to get their views quality of care they receive. We also spoke to staff about working in the home and what they thought about the quality of the care they provided. We looked at a number of records relating to the care provided in the home these included care plans, daily records, and medication. We also looked at staffing, training and had an opportunity to talk with individuals who live and work at Coombe Lea. As part of this inspection we sent Have Your Say questionnaires to the home and we received responses from 5 individuals who live in the home and 10 from staff members. The manager also completed their Annual Quality Assurance Assessment (AQAA), which told us about the improvements and issues that the home has addressed over the past year. We have used the information from the questionnaire and AQAA to help us in making a judgment about the quality of the care provided at Coombe Lea. What the service does well: We noted throughout our visit to the home that there has been a significant change in terms of staff morale and this has resulted in a more positive and welcoming environment. Throughout the two days of our visit staff commented on the improvement in morale we work much better now people respect each other morale is so much better. In our view this is the result of staff working through the difficult changes they had to make following the closure of previous homes and working with a new staff team and environment. One positive change has been to some extent the resolving of dissatisfaction from staff about their working arrangements in that previously they have had to work on both floors of the home rather then focus on one specific unit i.e. Gardiners Row or Willow. Staff now have the option of working the majority of their shifts (75 ) on one floor only. Importantly this in our view will improve the continuity of care particularly on Gardeners Row where individuals have dementia. Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 7 An improved Care Plan format has resulted in better information about the individuals care needs and provided a more person centred approach with life story information though as noted in the report and below there remain areas for improvement. Individuals we spoke with were mixed about the level of activities available in the home however it is hoped that this will improve with the availability of an activities organiser. It was clearly part of the staffs routine to sit and chat with individuals and this was observed by the inspector during the visit to the home. This helps in creating a more informal and friendly environment. In talking with individuals who live in the home they commented on the approach of staff and how caring and friendly they are and there was a real sense from talking with staff that they have a real commitment to providing quality care. Individuals comments to the inspector illustrated the positive views of the service provided: it was the right choice for me definitely (coming to live at Coombe Lea) I dont think there could be anywhere better What has improved since the last inspection? What they could do better: We have identified a number of areas which require improvement and have made requirements about these issues. Firstly care planning whilst improving still has areas of weakness such as risk assessments which clearly state the area of risk and measures to be taken in response to the risk. Secondly the recording of the use of as required medication must be improved in that there needs to be more information about the circumstances of its use so that individuals receive the medication appropriately. Staff are also then clear about its use and situations where it is reasonable and Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 8 legitimate to use thereby protecting the individuals from misuse of medication which can be seen as detrimental or be used in-appropriately. The recording of medication must be more robust so that there is written evidence that prescribed medication has indeed been given to the individual as required. We have also highlighted the need to further improve the environment to make it more suited for the individuals specifically those with dementia that live in the home. The home needs to provide items, which one would expect to see, and which in our view influence the homeliness of the environment i.e. clocks, ornaments. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 9 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 Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home undertakes pre-admission assessment so that they can make an informed judgement as to their ability to meet the identified health and social care needs of the individual. EVIDENCE: We looked at a number of Care Needs Assessments which had been completed by the home before the admission of the individual. They provided good information about the health and social care needs of the individual including daily care needs, communication and risks. A copy of the local authority assessment had also been obtained by the home and in one instance we looked at a psychiatric assessment. Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 11 For those individuals we looked at there was a letter that had been sent confirming the home was able to meet their needs and date of admission. Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience Good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this 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. Arrangements for managing resident’s medication makes sure that resident’s health needs are protected. However the shortfalls in care planning and administering of medication and associated records potentially place individuals living in the home at risk of harm. There needs to be more robust recording and monitioring of records by the manager to make sure that practice is as required. 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: Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 13 We looked at a number of care plans for individuals living on Gardiners Row and Willow. A new Care Plan format was introduced two months ago. A fall screening tool is used by the home. End of Life Plans are to be developed. Care Plans included Daily Programme (divided into periods of the day) providing detailed tasks associated with daily living and routines of the individual. In one instance this identified that the individual Prefers shower in morning and sometimes bath at night and daily record showed that this was the case. We also spoke to the individual who confirmed this was part of my routine. For another individual the care plan noted that likes small meals too big a plate will put ……. off her meal. At lunchtime it was noted that the individual was asked whether she wanted a small meal and it was given on smaller plate. Risk assessments had been completed and reviewed as part of the care plan review (monthly). For one individual this was about the risk of them leaving the building however there was no indication as part of the risk assessment as to actions to take to alleviate (strategy to distract?) the risk. For the same individual there was no risk assessment about their agitation and aggression, which had been recorded. However for another individual a risk assessment had been completed regarding their behaviour and how to respond. There were risk assessments completed relating to risk of fall, checking of water temperatures and where individuals were self-medicating. Moving and Handling Action plans had been completed for three of the seven care plans and initial risk assessments to identify any associated moving and handling risks are completed. Weight records had not been completed for one individual weekly as stated in their care plan which had identified poor diet as a risk area for that individual (a food and fluid chart was being kept) dates recorded of weight 05/02,3/03,28/03,12/04,06/06. For one individual there was no record of their weight on admission to the home. For another person their care plan said they should be weighed monthly but records showed this had only happened once. There was no weight recorded for another individual. The home is not using a nutritional assessment tool at present to identify individuals who are at risk however we were advised that MUST is being introduced. The home completes Dependency Assessment tool for individuals to help in establishing level of care and any changes in care needs. Individuals who live in the home have access to the full range of community health services: chiropody, community nurses and opticians and records we examined evidenced these services being provided. We also spoke to one individual about the health care they receive specifically whether they were able to see the doctor when they wish. They told us I only have to ask to see the doctor and its done very satisfied with the care I get here. We looked at the medication arrangements for both Gardiner Row and Willow. On Willow there were a number of individuals who are prescribed sedative or anxiety relieving medication. Instructions as to the administering of such Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 14 medication was limited: when required for agitation when required. For one individual however it stated 1/2 tab when required for agitation to be given 30min before personal care if necessary. In this individuals care plan there was risk assessment about their aggressive behaviour and refusing personal care. The administering records for Willow were looked at for the period 09/0629/06. We found that for one individual there were three gaps (no evidence medication had been given) for another 16 gaps and for one individual who was prescribed eye ointment there were 22 occasions when no evidence or signature that this had been given. We also found changes made to MARS sheets but no signature of the staff member who had written the change. The controlled drug (CD) register was checked and records had been completed as required with two staff signatures and we also checked the stock and found this was as recorded. We looked at the administering records on Gardiners Row and found these to be accurate with no gaps in recording. The CD register had been completed as required and stock was checked and found to be as stated. As part of the individual care plan there was nothing to tell staff about the medication being taken, it purpose and possible side effects. Staff have undertaken medication training and we spoke to one staff member about an individuals medication and she was able to tell us the nature of the medication and reasons it had been prescribed. We spoke with a number of individuals about the approach of staff particularly if they felt they were treated with respect and they told us: always staff always treat me well I have no complaints about the staff. We also observed staff and they were always sensitive in their approach and where individuals were distressed or confused they were able to respond in a positive manner. During the period we sat and observed on Willow staff were involved in an activity however there were those who were at time disorientated or dont know what to do where do I go. Staff responded well to these situations and were calm and re-assuring. Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this 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: We looked at the arrangements for providing activities and noted that an improvement is the appointment of an Activities Organiser though at present this is only for 11 hours but hopefully to be increased. On both floors there were organised activities including reading group, pamper day, knitting circle and memory games. Outside entertainers come into the home and trips have been arranged to local and further a field places of interest such as Weymouth, Chew Valley. Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 16 On the day of our visit to Willow we sat in the lounge for a period of time when staff were doing a quiz (though it was noted the television remained on throughout the time the quiz was taking place) Staff were very involved in assisting individuals in participating and were supportive and encouraging of those that took part in the quiz. Individuals we spoke with about the activities organised in the home gave a mixed view not much of that not a lot, enough for me. One individual who responded to our questionnaire said wanted more activities to make the brain work and another said under What the home could do better? more daytime activities such as board games etc, card games and lightly physical games such as ball games. Questionnaire respondents said too Does the home arrange activities that you can take part in? Always 1 Usually 3 Sometimes 1. One individual told us staff have time to sit and chat. The home has an open visiting policy and we spoke to individuals about having visitors and they told us they make my family very welcome when they come and see me, another individual said, the home is very friendly and welcoming. We asked individuals about their daily lives and specifically whether they could choose how they spend their time. They told us its up to me I pretty much do as I like. One individual who spends a lot of their time in their room told us the staff dont worry they realise its my choice. We asked one individual who needed help to get up in the morning what staff would do if they said they didnt want to get up it wouldnt be a problem they would come back later. Staff told us we try to make it their home its up to the residents what they do its their home. We looked at the menu and there was a varied choice of meals available and the chef told us they had updated the menu to reflect the season and made changes from comments made by individuals. Those individuals we spoke with about the meals told us very good always a choice no complaints about the food food is excellent always very acceptable. However one individual told us its fairly good but could be improved with more personal choice. The respondents to our questionnaire when asked Do you like the meals in the home? Said always 2 and usually 3. One individual said, at mealtimes would like to sit with the same people on the same table. We observed meal being served on both days of our visit and individuals were always offered a choice. On Willow (where individuals have dementia) it was noted that individuals were shown the meals available this is good practice and unlike our previous visit there were tablecloths and condiments on the table. It was observed that staff were attentive and supported individuals with their meal in a sensitive and quiet unobtrusive way. There was a relaxed and unhurried atmosphere and staff were generally available though at one point there were no staff members in the dining room. We also observed staff wearing protective gloves Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 17 when serving meals yet they had not gone into the kitchen. We question the need and effectiveness of this practice particularly when they are serving a number of individuals at the same time. Being served your meal by someone wearing blue latex gloves does in the inspectors view appear rather impersonal and institutional. Further from an infection control perspective it would fail in that the gloves are not changed between each contact. Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this 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: We spoke with individuals about what they would do if they were unhappy about the service they received. They told us tell the staff girls come and talk if things are not working out. We asked if individuals felt they were listened too by staff and management yes you can always talk to the manager she (the manager) is very good. The home has a complaints procedure in place and this is made available to individuals and people we spoke with said they know we can make a complaint if I wanted too. All of the respondents to our questionnaire said they knew how to make a formal complaint. The home has concerns and dissatisfaction book and a number of individuals have raised issues with the home about medication, cleanliness, and choice of Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 19 meals. From our discussion with the manager these have all been resolved satisfactory. There is a policy and procedure about Safeguarding Adults and staff have undertaken training around abuse and records we looked at confirmed this. We spoke to staff about their knowledge of abuse and what they would do if they had any concerns about individual being abuse. They illustrated a good understanding of the nature of abuse and how to response. Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe and hygienic environment for people who live in the home and staff. People who live and work in the home benefit from a warm, welcoming and well-maintained environment. However there remains areas for improvement to make the environment more suited for the people that live in the home particularly Gardiners Row where individuals with dementia live. EVIDENCE: In walking around the home it was evident that there is a good standard of cleanliness though this has been an issue with a shortage of domestic staff and this was commented on by staff we spoke with. However we were advised that a housekeeper has now been employed which will address the shortfall. Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 21 Individuals we spoke with said the home was always nice and clean though one person told us in the main clean, could be better at times. Respondents to our questionnaire when asked Is the home fresh and clean? Said 2 always 2 usually 1 sometimes. Being a new home facilities such as rooms, bathrooms and communal areas are of a high standard. However it was noted that despite some effort being made to improve the homeliness and make the home a less sterile/new environment there was lack of attention to detail. For example there were no clocks in the lounge areas and the only clock, which was in the dining room (indeed there was a total lack of clocks throughout the home other then those that individuals may or may not have in their room) whilst decorative was not practical in terms of being clearly visible. A cabinet in one of the lounges was empty and again there was a lack of stimulation in terms of decorative items and pictures, which could evoke memories and stimulate conversation such as local scenes. Individuals rooms have nameplates and pictures though the inspector would question how effective these are in orientating individuals to their room. The use of memory boxes (attached outside of the individuals room) would provide an alternative method in addition to photos, name etc. Memory boxes and orientation boards placed around the home can also be stimulating and provide interest. In both lounge areas where it would appear the majority of individuals spend their time there was no radio or music player. Research has shown that where individuals have dementia memories associated with music remain longer then other memories and can evoke active and stimulating responses. It is in the paying attention to these details, which in the inspectors view will result in a more homely, stimulating, and particularly for those with dementia supportive environment. It is surprising to find after one year of opening no clocks in the home. An area of improvement is the planned provision of a balcony on the second floor which will mean individuals will have access to the outside without having to use the life or wait for staff to be available to take them to the garden which the staff try and do whenever possible. The home has infection control procedure in place and staff are provided with protective clothing and these were being used by staff at the time of our visit. Staff have received infection control training and records we looked at confirmed this. Combe Lea Residential Care Home DS0000071555.V376798.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements in the home are generally satisfactory so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. EVIDENCE: The home has Senior Support workers who generally work on the same floor this provides greater continuity of management and helps in making sure there is consistency of care and management. As noted in this report staff arrangements have changed recently with care staff now having option of working 75 of their shifts on the same unit. This is a positive step and indeed we received a number of comments form staff who completed the staff survey saying how this would ensure continuity, familiarity for clients and family and staff would be more happy in their work and would work better as a team and I feel working on both floors has a detrimental effect on clients as they have different staff group on nearly every shift. Many clients especially those with dementia benefit from continuity of care with familiar staff with which they feel comfortable and trust. Staff also told us on our visit the improvement this would make and that they felt morale had improved we are working better as a team. Morale has also improved because of the time Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 23 that has now elapsed since the opening of the home and staff told us its more settled now things have sorted out, more settled now more respect for each other. Individuals we spoke with were all very positive about the staff in the home staff here 100 staff respectful only have to ask and they do it if I want anything they get it for me very kind, always very helpful get the care I need. Respondents to our questionnaire said that staff are always available when I need them. We looked at the worked staffing rota for period of 5 weeks and found that generally there are 4/5 care staff working across the home am and 5 pm with 3 waking night (two on Gardiners Row). In addition there is the Senior Support worker on duty on each am and pm shift. We looked at the training records and matrix, which is in place to assist in identifying training needs of staff. This showed that the majority of staff have received the necessary mandatory training: moving and handling, fire, health and safety, safeguarding (5 staff including one senior had not completed the later). Recently staff attended infection control training and now 30 of the support staff (of 58) have attended this training. Senior staff have all attended medication training and the majority of staff have also attended one day dementia training. No further dementia training has been arranged. A staff member is due to undertake Moving and Handling assessor and trainer for training staff. All Senior Support workers have completed Mental Capacity/Deprivation Of Liberty training. Staff told us excellent training facilities good training for staff lots of training provided. Twenty-one staff have completed NVQ professional qualification at Level 2 or 3 with 3 staff currently undertaking this qualification. Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36,38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good opportunities for individuals who live in the home 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 has extensive experience of working in a care home setting and has undertaken the required level of training. We spoke to individuals who live in the home about how they found her as a manager and they told us Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 25 someone you can talk too shes around in the home. There was a mixed response from staff when asked about the manager and management of the home: if we have a problem she will try hard to deal with it on the floors a lot dont have much to do with her though know shes there if I want to speak to her about anything. However we received in our questionnaire comments from two staff members who said at times unapproachable due to her manner can sometimes feel invisible feel sometimes my manager is not very approachable. However it is also noted that staff told us she is very committed to what she does passionate always has lots of ideas. These comments were discussed with the manager at the time of our visit and were acknowledged by her. We looked at questionnaires, which had been sent to individuals who live in the home, relatives and professionals. These had provided positive comments about the quality of care in the home generally Good or Excellent. Comments included: Thought would be very unhappy but very happy Couldnt wish for anything better First class meals Need more activities. We are well satisfied with the care and attention that is shown (relative) I am so grateful to the carers for their dedication…. Must be applauded for the standard of care residents receive. (Relative) There is steady improvement particularly as staff groups stabilise (Professional) The home holds regular Resident Meetings and these have been used to discuss any concerns, suggestions that individuals may have in relation to the life of the home such as meals and activities. They are also an important opportunity to inform individuals who live in the home of any changes. We looked at health and safety records relating to fire and found that staff have participated in regular fire drills and evacuations. The fire system has been serviced regularly as had equipment in the home. Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action 1 OP7 13 (4) c The manager to make sure unnecessary risks to the health and safety of the individual are identified and so far as possible eliminated. (This refers to need to undertake risk assessment fully identifying ways of identifying triggers and how these can be avoided or how identified behaviour should be responded to.) 30/09/09 2. OP9 13 (2) The manager to make sure there are arrangements for the recording, handling, safe administration of medicines received in the home. (This refers to the need to keep accurate recording where administering of medication, improved information as to circumstances where as required medication is given, where changes made on administering sheet in writing this to be signed by member of DS0000071555.V376798.R01.S.doc 19/08/09 Combe Lea Residential Care Home Version 5.2 Page 28 staff.) 3 OP7 12 (1) a The manager to make sure that the care home is conducted so as to promote and make proper provision for the health and welfare of individuals who live in the home. (This refers to the need to make sure that where there is an identified risk of weight loss and need for regular monitoring of weight that this is undertaken.) The manager to make sure the physical design and layout of the home meets the needs of individuals. (This refers to the need to make environmental changes to meet the specific needs of those with dementia and others who live in the home to improve the environment in terms of essential and homely elements of life such as clocks, decorative items, orientation boards.) 18/08/09 4 OP19 23 (2) 30/10/09 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 OP30 Good Practice Recommendations Improve the quality of Dementia training and thereby raise the awareness and skills of staff to enable a more specialised service. Training such as Yesterday, Today and Tomorrow provided by the Alzheimers Society. DS0000071555.V376798.R01.S.doc Version 5.2 Page 29 Combe Lea Residential Care Home Combe Lea Residential Care Home DS0000071555.V376798.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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