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Archived: Coombe Lodge Care Home

Overall: Inadequate read more about inspection ratings

Nash Lee End, Wendover, Aylesbury, Buckinghamshire, HP22 6BH (01296) 696944

Provided and run by:
Irvine Care Limited

Important: The provider of this service changed. See old profile

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Background to this inspection

Updated 8 June 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We undertook an unannounced focused inspection of Coombe Lodge Care Home on 20 & 21 May 2015. This inspection was done to check that improvements to meet legal requirements planned by the provider after our 18 and 19 March 2015 inspection had been made. The team inspected the service against three of the five questions we ask about services: Is the service safe? Is the service effective? Is the service caring? This is because the service was not meeting some legal requirements.

The inspection was undertaken by two inspectors. During our inspection we spoke with the peripatetic manager from the home and met with three other of the provider’s managers. We looked at 12 people’s care plans and associated care records. We spoke with ten staff including agency nurses, care staff and the chef. We spoke with three relatives and a friend of someone living in the home.

Before the inspection we reviewed previous inspection reports and other information we held about the home including notifications. Notifications are changes or events that occur at the service which the provider has a legal duty to inform us about. The local authority shared information with us about concerns they had received about the service.

We observed how care was provided to people, how they reacted and interacted with staff and their environment. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Overall inspection

Inadequate

Updated 8 June 2016

On the 18 and 19 March 2015 we carried out an unannounced comprehensive inspection of the service to follow up the four requirement actions. We found the improvements required at the service had not been made. We issued four requirement actions and four warning notices.

We undertook this focused inspection on 20 and 21 May 2015 to check the provider had improved and now met legal requirements of the warning notices. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Coombe Lodge Care Home on our website at www.cqc.org.uk

This inspection took place on the 20 and 21 May 2015. It was an unannounced inspection.

During the last inspection in March 2015 we had concerns about the care and welfare of people, including whether their nutritional needs were being met. We also had concerns about the numbers of staff and the lack of support for staff by the provider. The local authority also has concerns about the service and have been monitoring and working with the service provider to improve the quality of care provided. Many of the concerns we found during this inspection reflected the same concerns raised by the local authority staff who had been visiting the service since our last inspection in March 2015. During this inspection we found some improvement had been made in some areas.

Coombe Lodge Care Home provides nursing care for up to 60 people, including people living with dementia. The service has two units which provide nursing and dementia care. The service is set over two floors. At the time of this inspection, 25 people were living at the home.

There was no registered manager working at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The home had a temporary peripatetic manager in place.

We found improvements had been made to the accessibility of most people’s call bells. We found one person did not have their call bell accessible to them. Where people were unable to use the call bell staff checked their welfare regularly. Staffing levels had increased this resulted in more staff being available to observe people and to ensure their safety. The number of falls had decreased, and falls prevention technology such as alarm mats alerted staff to the whereabouts of people when they left their rooms. We found staff responded quickly.

We did not always observe good practice in the care of people. Staff were not always responsive to people’s needs. One person was positioned in such a way that the risk of falling out of bed was high. Staff did not respond positively when we asked them to assist the person, stating they would only reposition themselves again.

One person’s dentures were dirty, a staff member told us although they had tried to clean them without success they had placed them in the person’s mouth. One person, who ate with their fingers, dropped food on the floor and ate it. Staff did not meet their need for support.

Staff were not always aware of people’s wants and needs. They did not always engage with people in an appropriate or meaningful way. Whilst we did observe some positive interaction between staff and people, this was mainly when care was being provided. Staff told us they enjoyed working in the home, and some showed a caring and sensitive nature towards people.

Some activities were available to people but we did observe one person in bed all day without any music, television or stimulation. This meant their social needs were not being met.

Staff knew how to support most people with their food and hydration. Records showed people were eating well, and from our observations most people were encouraged to drink and eat to maintain their health and well-being.

Records related to the care being provided were confusing and difficult to locate. The provider was in the process of updating records and the systems used for care planning in order to streamline them. Care plans were not always up to date and accurate.

Staff told us they were being supported by the temporary peripatetic manager. In addition support was offered through training, coaching and meetings. Staff had also been given daily sheets to remind them of what the individual needs of people were; for example how often the person needed checking and how much support they needed with food and fluids amongst other things.

The provider told us they had made improvements since the last inspection but acknowledged the need for further improvements. They responded to our requests for information in a timely way.

We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We will report on the action taken at a later stage.