Archived: Coombe Lodge Care Home

The provider sent us an action plan which outlined how they intended to become compliant.

We returned to the service on the 23 September 2014 to check if improvements had been made.

Below is a summary of what we found. The summary describes what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found people were not protected against the risks associated with medicines as the provider did not have appropriate arrangements in place to manage medicines. During our visit, we found two people's topical creams were recorded as not available. One person's cream was recorded as not available from the 14 August 2014 to 29 August 2014. The provider did not have arrangements in place to ensure the correct stock and replacement of creams when they ran out. We found improvements had been made on the top floor of the service, however the medication management and recording of creams on the ground floor was poor. This meant people were placed at risk as they could not be sure their prescribed creams were available.

This meant the service was not safe.

Below is a summary of what we found. The summary describes what people used the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found most people were protected against the risk of harm in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. Where people were assessed as lacking capacity, appropriate procedures were followed to ensure arrangements were in people's best interests and in line with the correct legal framework. However, we found in one case the person's capacity had not been assessed where it was deemed they may be deprived of their liberty.

During our visits we found people were placed at risk from unsafe medication practices. We found people were exposed to risks associated with topical creams, for example, we found one person had a topical cream in their room which had expired a year ago. We also found creams prescribed for specific people were used for people who were not prescribed them. This meant people could not be sure that their medication was administered and handled safely.

We found poor infection control practices during our visits which placed people at risk. We found one sluice did not have a lock on and contained hazardous substances which people could access. We saw one person's wash bowl was placed in their toilet bowl. We found the communal kitchens used to prepare food and drinks were unsanitary.

This meant the service was not safe.

Is the service effective?

We found regular audits were undertaken and highlighted actions where improvements were needed. However, the ineffectiveness of these audits was highlighted during our visits when we raised concerns which the provider was aware of through their own audits, but had not taken any action to address them. We found supervisions were generic and not effective in promoting staff professional development. We saw regular team meetings took place involving staff at all levels. We spoke with relatives who told us they felt they would like to be more involved in their loved ones care than what was provided.

This meant the service was not effective.

Is the service caring?

During our visits we saw people's dignity was lacking. We saw people in beds for long periods of time not covered over to respect their privacy and dignity. We found staff did not always knock on people's doors before entering their rooms or explaining why they were entering their rooms. We saw one person to be distressed and shouting. We heard a staff member tell them 'be quiet.' We also saw inappropriate use of the phrase 'darling' instead of calling people by their preferred names. Although activities were undertaken during the day, we found activities to be selective. For example, activities were only available to people whose name was on the list.

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This meant the service was not caring.

Is the service responsive?

During our visit we saw one person was not very well and had a suspected stroke. We saw the service was responsive in calling the ambulance and providing staff members to sit with the person until the ambulance arrived.

We found the provider was not responsive to our concerns around medication as the same issues had been identified at another local home (run by the provider) the month previously by the commission. During our second visit, we found the communal kitchen to still be dirty.

We raised concerns about people not being provided drinks in their rooms as there were people within the service who would pick up drinks and throw them. We were advised that this had been noted but not addressed. We also had concerns around the lack of call bells and plans in place to ensure people's needs were met.

This meant the service was not responsive.

Is the service well-led?

At the time of our visits, the registered manager was not present. We spoke with the regional manager who was covering for the registered manager and the interim manager of the home. They showed us regular quality monitoring visits and action plans where the provider had highlighted areas for improvement, however we found these were ineffective. For example, the last monitoring report highlighted many of the issues we raised during our visits, however these had not been addressed. We found audits did not reflect our observations and were ineffective at highlighting serious concerns around medication.

This meant the service was not well-led.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well-led?

This is a summary of what we found -

Is the service safe?

There were enough qualified, skilled and experienced staff to meet people's needs. We spoke with a range of staff as part of our visit. Staff were knowledgeable about people's needs and felt supported in their roles. We saw staffing rotas were maintained at the home. These showed nurses and healthcare assistants were provided 24 hours a day to support people.

Staff had guidance and training on effective infection control measures, to help stop the spread of infection. Laundry was managed well and housekeeping staff were provided with the necessary items to keep the building clean. Senior management were aware of the problem in managing malodours where people had urinated in inappropriate places. This was receiving attention to improve the environment for people.

The Food Standards Agency awarded the home their highest 5 star rating in March this year. This reflected very good standards of food hygiene and food preparation at the home.

CQC monitors the operation of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The manager told us about applications they had needed to submit to deprive people of their liberty. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This ensured there were proper safeguards in place.

Is the service effective?

Care plans had been written for each person. These outlined the care and support people needed to meet their needs. Staff had reviewed information regularly, to make sure it took account of people's changing circumstances.

Risk assessments had been written for a range of situations. For example, moving people, the likelihood of falls, developing pressure damage and malnutrition. These assessments had been kept up to date and information was reviewed on a regular basis. This helped reduce or control the potential for people to experience harm.

People had access to external healthcare professionals and specialist advice, such as GPs, community psychiatric nurses, tissue viability nurses and stoma care nurses. Notes were kept of the outcome of any visits or appointments, to maintain a record of advice or follow up care that was required. This helped people keep healthy and well.

Is the service caring?

We spent time observing the routines of the service around lunchtime and again in the afternoon. We heard staff were respectful and gave people choices. For example, 'Would you like to sit here, or here?' and 'Can I put this apron on you?' People were given a choice of food and drink. One member of staff asked, 'What would you like for lunch? There's chicken and rice or pasty and mashed potato.' People's choices were provided for them and they were given time to eat their meal without rushing. Staff consistently asked 'Have you finished?' before clearing plates away. We noted staff kept a record of which person had been given which course of the meal, as they went along. This ensured everyone was given enough food and drink to meet their nutritional needs.

We spoke with two visitors about their experiences of care and if they had any concerns. Both said they were pleased with the standards of care their relatives received at the home. One said 'I'm here a lot and I've not got any concerns. Mum's always kept clean and tidy.' Another said 'I'm very pleased with his care. I'm made to feel welcome and I've not got any concerns.'

Is the service responsive?

People were made aware of the complaints system. We saw a copy was displayed in the entrance hall, along with other information about the service. The relatives and staff we spoke with during our visit did not express any concerns about the home. We were able to see records were kept where anyone had raised issues about standards of care. This included where people who used the service had been able to express concerns. In each case, the action taken had been recorded.

Is the service well-led?

The provider had an effective system to regularly assess and monitor the quality of service that people received. This included a range of audits repeated throughout the year. Examples included medication practice, people's weights, nutrition, the environment, frequency of staff supervision and infection control practice. The home's regional manager visited each month and carried out a comprehensive assessment of the standards of care. Where any issues arose, an action plan was put in place to address them.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. The care plans we checked showed risk assessments were in place and reviewed regularly. There was a fire safety risk assessment to ensure appropriate arrangements were in place to guard against the risk of fire at the home.

We observed the lunchtime period. We saw people received appropriate support to meet their nutritional needs. Their weight was monitored and any concerns were reported to the GP. Staff and people we spoke with provided positive feedback about standards of meals at the home.

The premises were suitable for people with disabilities. Bedrooms were single occupancy. The building was kept warm, well lit and there was good ventilation. The premises complied with fire safety standards.

Equipment had been provided to help meet the needs of people with disabilities. This had been serviced to ensure it was safe to use. Staff told us and records confirmed they received training in moving and handling. This enabled them to assist people safely and prevent injury.

We found there were robust recruitment practices in place. This included obtaining written references, checking for criminal convictions and ensuring nurses were registered with the Nursing and Midwifery Council.