Inspection on 10/08/09 for Amelia House

This is the latest available inspection report for this service, carried out on 10th August 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Amelia House 16/05/06

Amelia House 11/11/05

Amelia House 17/05/05

Amelia House 30/11/04

Amelia House 11/05/04

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Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Amelia House Pocombe Bridge Exeter Devon EX2 9SX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rachel Fleet     Date: 1 0 0 8 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 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. 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 Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Amelia House Pocombe Bridge Exeter Devon EX2 9SX 01392213631 01392213631 AmeliaHouseRes@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Nuala Baxendale,Mr Alan Baxendale care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 19. 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) Dementia (Code DE) Date of last inspection Brief description of the care home Amelia House is registered to accommodate up to 19 people aged 65 and over, including people with dementia (but not other forms of mental disorder). The home cannot provide nursing care other than through local NHS community nursing services. The home is near the A30 on the edge of Exeter, in a rural location with attractive views. It is a detached house approached via a steep drive, with a car parking area, and level access via the back door. There are level terraces at the front and back Care Homes for Older People Page 4 of 37 Over 65 0 19 19 0 Brief description of the care home where people may sit, and a pleasant but steep garden leading down to the road. Bedrooms are on the ground and first floors, each floor also having a dining room and a lounge, with a stair lift between floors. All bedrooms are for single occupation. Current fees range from £390 - 440 per week, depending on care needs as well as facilities provided. Fees include staff escorts to hospital appointments, activities or entertainments at the home, and basic toiletries. Costs of the following are not included in the fees: newspapers, dry cleaning, toiletries other than those offered by the home, clothing and other personal effects. Our previous inspection reports are available from the homes office on request. Our last Key Inspection was on 6 July 2007. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection reported on below took place as part of our usual inspection programme. Our unannounced visit to the home lasted 12 hours on a week day, which included time spent with the owners, Mr & Mrs Baxendale, discussing our findings at the end of the day. They and their staff assisted us fully through the day. Prior to this visit, the home had returned a questionnaire (the Annual Quality Assurance Assessment, or AQAA), about the service they offered and any plans for the future. This included general information about the people living at the home and the staff, some assessment of what the home does well, and any plans for improving the service. Before our visit, 10 of our surveys for people who lived at the home and 10 staff surveys were sent to the home. Surveys were returned from 5 people living at the home, 3 of who were helped by their families to complete them; 5 surveys were Care Homes for Older People Page 6 of 37 returned from care staff. Of 9 surveys sent to a range of community-based health or social care professionals, 0 were returned. Surveys were generally positive about the home. No-one indicated in their survey that they wished to speak to us. There were 18 people living at the home at the time of our visit. Several people could not give us their views in depth, because of communication difficulties caused by dementia. Because of this, we sat for a while in the lounges to observe any activity there, which helps us get a sense of peoples well-being and how staff support them. We met individually with 6 people, around the home, as well as with groups in communal areas. The inspection also incorporated case-tracking of 3 people living at the home, including men and women, new residents, and people with more complex physical needs. Case-tracking involved looking into these peoples care in more detail by meeting them, checking their care records and related documentation (pre-admission assessments, etc.), talking with staff, and observation of care or support these people received. We spoke with 2 care staff. We followed up matters from and arising since our last inspection, the AQAA and surveys. Records seen included those relating to staff, health and safety, and quality assurance. Our tour of the home included the kitchen and laundry, as well as peoples bedrooms. Information from these sources, and from communication with or about the service since our last inspection, is included in this report. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 37 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. Care Homes for Older People Page 9 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear information about the home, with good identification of prospective residents needs prior to admission to the home, helps to ensure that the home is suitable for those who go to live there. The home does not offer intermediate care. Evidence: Amelia House has a clearly written Statement of Purpose which is very informative about the service provided, including the fees charged. It is supplied to prospective residents and their representatives, and a copy is available on request from the office. All of the five surveys returned by or on behalf of people who lived at the home said they had received enough information to decide if the home was the right place for them, before they moved in. We case-tracked someone who had been admitted to the home since our last Care Homes for Older People Page 11 of 37 Evidence: inspection. The home had obtained an assessment of the persons care needs from Social Services care management staff, as well as carrying out their own assessment, before they were offered a place at the home. The Manager always meets prospective residents, and their relatives or representatives, as part of the assessment process. In the absence of any such advocates, the home tries to speak with community professionals such as district nurses who may be supporting the person. The homes assessment for this person included their faith needs, interests or hobbies (although not in enough detail to give a full picture of the individuals preferences), and how they managed with various activities of daily living. Accommodation is offered only if the Manager is confident of the homes suitability to meet the persons needs. In one more complex case, we noted that the home had specifically clarified that the person was not deemed to need a nursing home environment, as part of their assessment. The offer of a place is made in writing when the person or family are acting independently, without support from Social Services. We saw a trial period of a month is offered as part of individuals occupancy agreement, to give people time to decide whether this is the right place for them. We spoke with some people who had moved into the home relatively recently. They were very happy with their accommodation and how they had been received by staff. Care Homes for Older People Page 12 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs are generally well met currently. However, unsafe medication practises and care planning that is not person-centred creates a risk that peoples individual, diverse and changing needs may not be met appropriately, consistently and safely in the longer term. Evidence: We looked at care plans, and associated records, for three people. One care plan had an indication of the persons level of independence, abilities and strengths, as well as what help they needed. A care plan for someone else said the person liked to dress smartly, their dietary likes and preferences were given, etc. Other care plans were less person-centred in detail. One persons Mobility care plan said Carer helps to walk without indicating the distance they could walk, if they could use stairs, etc. Their Continence care plan said Carer taking to toilet to change pads without saying if the person could indicate they needed attention, how often they should be assisted, etc. Care Homes for Older People Page 13 of 37 Evidence: There was no indication whether two people practised a faith or not. When we asked staff how they knew if people had faith needs, they said they would talk to the person, or observe if they had a holy book, but this may not be sufficient if people could not communicate well because of a cognitive deficit. Some peoples preferred bedtimes and rising times were not recorded. Staff told us these were discussed verbally. Peoples wishes about their care should they become seriously ill or die were not recorded. This meant, for example, that there was no clear information as to whether people had advance directives, and no other guidance relating to resuscitation of individuals if they collapsed. Peoples capacity to make decisions for themselves was not noted. The AQAA said that peoples families were now more involved in the planning of their care. This was not clear from the care plans we saw, but two surveys completed by relatives said the home kept them well informed about the person at the home or maintained good communication. A third relative felt communication on visits could be problematic but used email contact to get the information they wanted. The Baxendales confirmed that they regularly phone relatives to keep them updated as necessary. Records of care given and the individuals day or their wellbeing were recorded intermittently - less than once a week in some cases. This meant staff did not always have good information on which to evaluate how successfully the care planned was meeting individuals needs. Several care records we looked at were undated, so staff could not be certain how up-to-date the information was. Care notes for one person included that they were constipated, but their care plan did not address this, and there was no mention of it in subsequent care notes. The person told us it was still a problem for them. The care plan we were given indicated they walked when currently they had to be moved with a hoist, and was out of date in other ways. One person we case-tracked, who had no family representative, had no life story recorded, but each staff member we talked with had been told something by the person about their past. Recording such information would help staff understand and support the person as an individual, promote appropriate conversation with them, etc. Care notes said very little about how the persons social needs were being met on a daily basis. Two other people had detailed life-stories, obtained with help from the persons family, and staff knew about these. Mental health assessments for two people identified they could be aggressive. They Care Homes for Older People Page 14 of 37 Evidence: didnt include if this was related to any triggers, such as a medical/physical condition, but staff we spoke with suggested some of these considerations. There was no guidance on how staff should respond, which would promote consistent and appropriate care, or if other relevant professionals were supporting this person in relation to such needs. Staff surveyed said they were given up to date information about the people they supported. Those we spoke with said they were told about people, as well as being able to read their care plan. When we asked them about the people we were casetracking, they knew their physical care needs as reflected in the individuals care plan or as described by the individual when we spoke with them. They described some of peoples routines, which we observed during our visit. Surveys from people who lived at the home said they always or usually got the care or support they needed, including medical care. One person said contacting medical help was something the home did well. Those we case-tracked had seen their GP recently. There was evidence of input from Community Psychiatric Nurses. A chiropodist visited regularly. Staff told us that people were seen in their bedroom, meeting a recommendation made at our last visit that people were seen in privacy for such care. We queried that someone with diabetes was paying for a chiropodist when free NHS provision should be available. A care plan indicated someone was to have an annual eye-test but the record for this was blank, as was someone elses. They had lived at the home for over 18 months. A staff escort is provided free of charge if people go to a hospital appointment. There was a clear record of staff actions in relation to someone who had a healing pressure sore, showing they noted a problem very early on, contacting community nurses promptly then and since. Two people whose care plans indicated that they were at risk of pressure sores were sitting on pressure-relieving cushions when we met them, and had pressure-relieving mattress on their beds. It was very positive to see that peoples nutritional assessment included consideration of religious or cultural needs. One persons assessment identified they were losing weight, but the associated Plan of Intervention was blank. We saw peoples weights were generally recorded monthly, the home having sit on weighing scales. The Baxendales said that if people were found to be losing weight, they reported this to the persons GP, who then involved other professionals necessary. Staff reiterated this, naming people who were currently prescribed nutritional supplements, as shown on medication charts. Care Homes for Older People Page 15 of 37 Evidence: We looked at medication systems and records. When we looked at medication administration charts for those we case-tracked, we identified some issues with these records. Handwritten directions had not been signed and dated to verify the accuracy of the entry and provide a good audit trail. Where analgesia was prescribed, it was not always clear what pain (site, etc.) the medication was prescribed for. Where skin creams were prescribed, care plans did not always include these treatments. In one case, someone was prescribed 3 skin creams, for different purposes. Staff we spoke with gave differing explanations of where these creams were to be applied. Where medication was prescribed for use when required there was no guidance for staff on when and how it should be used. Two medications had not been signed for. Staff told us one had been discontinued, but the chart had not been altered to reflect this, and administration of the other was noted in the office diary instead. Where a variable dose was prescribed, staff had not recorded the dose given. A recommendation was made at our last inspection that doses be recorded, so that staff can properly evaluate the effectiveness of the medication and to provide an audit trail. The controlled drug store cupboard was not secured according to all current requirements, and we advised the Baxendales to seek advice. A controlled drug had not been dated on opening, which would have enabled staff to monitor its shelf-life as indicated by the manufacturer. A controlled drug, not used for some time, was not included in the current register when use of the previous book stopped. There was a fridge solely for medication needing cool storage. Its temperature was not recorded, which would evidence medication was being stored correctly. An eye cream was not dated on its first use;the homes medication policy said this should be done. We saw the blister packs of medications carried into the dining room, which staff told us was usual practise, for medication administration. This meant there was no means of storing them safely should staff need to attend to another matter urgently. Someone living at the home with their partner said staff were Very good and very unobtrusive, when we asked if staff respected their privacy. Doors had privacy locks. We saw staff assist people cheerfully yet discretely and respectfully. They knocked before entering peoples rooms. We discussed with the Baxendales that incopads were visible in bedrooms, which does not promote peoples dignity. People looked well cared for. Basic toiletries are included in the homes fees, thus ensuring people can always have their personal care attended to properly. The AQAA Care Homes for Older People Page 16 of 37 Evidence: told us that staff use activities such as hand massage and manicures to ensure people get personal care (such as nailcare) that they need. The home has a visiting hairdresser. Care Homes for Older People Page 17 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 social life within this home is relaxed and pleasant, although some people are still to benefit from ongoing developments in the provision of suitable activities or other opportunities for fulfilment. People are given choice and control in their daily lives, and enjoy the wholesome and varied meals provided. Evidence: During our visit, people seemed relaxed and very at home, moving between rooms, engaging with staff, and some finding jobs such as washing up cups with staff in the kitchen when it wasnt busy in that area. Staff gave people nail care during the day. We were told that four people took newspapers, which the home had to fetch daily for them since they were too far from a newsagent to get them delivered. Communal rooms had bookcases with a range of books. The television was on in one lounge during our visit, with at least 7 people in the room. Three people were seated alongside the television, so couldnt see the picture if they wished to. It was left on throughout an activity that took place during the morning. No-one appeared to be watching a programme after lunch, and when we asked if it was something people usually watched, they said it was not. Care Homes for Older People Page 18 of 37 Evidence: The AQAA referred to the homes quality assurance surveys, saying the surveys reflected that people were satisfied with the activities provided by the home. In our surveys, the topic of Activities was the least positively responded to subject, with 2 people saying Always, 1 saying usually, and 2 people saying Dont know when asked if the home arranged activities that the person could take part in. One person commented their relative felt they were alone in their room for long periods of time, with no opportunity for a conversation. We spoke with someone who stayed in their bedroom who also said staff didnt come in to chat, which they said they would welcome in certain circumstances. Their Activity chart in their care plan included interests this person told us about, and they told us that staff supported them to enjoy these interests (which did not require a staff presence), although their daily care notes said little to reflect that this persons social needs were being met. Staff informed us that one carer had particular responsibility for activities such as cards, ball games and music. The AQAA had told us that an activities co-ordinator had been appointed, after Mrs Baxendale and a carer had undertaken an activity course, and that the home currently aimed to provide 20 minutes of recreational one-to-one time daily with each person living at the home. This was in addition to the time spent with individuals by the Baxendales, who told us that they regularly visit and chat with all residents of the home. They also told us that they are addressing the matter of record-keeping, since care notes did not always reflect staff time spent with individuals, etc. During our visit, the activities co-ordinator spent time with 7 people in a lounge, singing, playing catching games and skittles, whilst making sure to involve and encourage everyone present. Everyone responded positively, with some looking as though they were enjoying this greatly, voicing support for others as they took turns and with much laughter in the room. We were also told people who stayed in their bedrooms were visited too - with card games or painting, etc. in line with their interests. One relative said they were not aware of any in house activities to keep people occupied. We were told that a poster is put up just before a planned activity, to notify people. Tai chi, exercise classes run by an external organisation (N.E.L.E.) and musical entertainments took place regularly. One-to-one outings took place sometimes, if staff had to go out somewhere. One person went out to church, although staff confirmed that a service was held at the home monthly also. Someone else went to the British Legion club. Peoples rooms were personalised with their own possessions, making them Care Homes for Older People Page 19 of 37 Evidence: individualised. The homes contract in the Service User Guide said visitors were welcome at any time, and could have a meal at the home for a small charge. Birthdays and other special occasions were celebrated, with visitors particularly welcomed. The Baxendales told us they try to be at the home if they know family visitors are making a special journey (from a distance, for example) to see their relative at the home, so that they can talk with them if they wish. People surveyed said they always or usually enjoyed the meals provided, and one person thought food was something the home did well. Those we spoke with said they enjoyed the food, or it was Very Good. The Baxendales said they sourced local produce as much as possible. We saw fresh vegetables and fresh herbs in the kitchen among other food stores. Fruit was available outside the dining room, where there was also a water dispenser and a board showing, in writing, what was for lunch - roast chicken. The current weeks menu included strawberries and cream, as well as traditional main courses such as cottage pie, two roast dinners, faggots, steak and kidney, etc. The teatime menu included sandwiches and soup, salad, and beans on toast, etc. We saw dining tables at lunchtime had cloths (although some were very creased), table mats, and cruets for salt and pepper, which people used. Music was put on outside the dining room. It thus did not interfere with conversation in the dining room, but was clearly enjoyed by some of those in the dining room, who sang along at times. People were seated 2-3 at a table, leaving room for staff to assist them. Staff engaged with people at close quarters rather than calling across to them. People who tried to leave during the meal were sensitively assisted to return for the next course. Staff helped people one at a time to complete their meal, with a drink, if necessary. However, they remained standing for this, so were unable to speak face to face and make eye contact with those they were helping. We discussed this with the Baxendales. A staff member also circulated, helping people discretely to cut up their food, and using gentle touch as they passed to reassure people. One person was assisted if they stopped helping themselves. Crockery and cups were varied, and provided according to individuals needs, with some adapted for people with disabilities. A minority of people were given a tabbard to protect their clothes, as seemed appropriate. Staff generally engaged with people as they served the plated meals, although they didnt always say what the meal was. We heard staff ask if people had finished their Care Homes for Older People Page 20 of 37 Evidence: meal before taking their plate, but not specifically if they wanted a second helping. Someone we spoke with, who enjoyed the meal, didnt know what it was, adding it was some sort of meat. One person seemed to have difficulty understanding one of the staff, but staff took time to make themselves understood. People were asked if they wanted more to drink, although the majority were just offered juice rather than being offered a choice or being told what flavour the squash was. We noted one person was given a glass of water, which they thanked the staff for. Staff we spoke with later about the matter of enabling choice told us they said they offered people a choice verbally, asking them in the morning. At the time that the meal was served, people could refuse and would be given an alternative. They also told us everyone liked the orange squash - which some people confirmed with us - except for one person who liked water. People looked as though they were enjoying the meal, and ate everything up in spite of the large portions served. Care Homes for Older People Page 21 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that that their concerns will be heard, and they are protected from harm by a caring staff team. Evidence: The homes written complaints procedure was given to prospective and new residents, and was displayed in the hallway in the centre of the home. It included a phone number that people could use to contact the Baxendales, timescales for a response, etc. Mrs Baxendale said she would ensure copies were updated with our new contact details. All surveys completed for people who lived at the home said the respondent knew how to make a formal complaint (with relatives acting on behalf of residents in some cases). Asked if there was someone they could speak to informally if they were not happy, 3 said Always and 2 left this blank. We have not received any complaints about the home since our last inspection. People who were able to answer our questions said they felt able to ask staff if they needed anything, or tell staff if something was wrong or not as they wished. The AQAA said that the home had not received any complaints since our last inspection, but intended to train staff on dealing with peoples concerns. All surveys we received from staff said that they knew what to do if someone had concerns about the home. Care Homes for Older People Page 22 of 37 Evidence: Those less able to communicate verbally looked at ease with staff, approaching them freely when they encountered them around the home or seeking them out specifically. We saw staff stop and give them their time on such occasions, assisting politely with their requests or trying to clarify what the person wanted if they could not communicate this clearly verbally. Given the scenario of an assault occurring in the home, staff said they would inform a GP and the POVA team. Two staff did not know where to find contact details for the latter, who are now known as the safeguarding team and who are part of the local authority. We found the homes safeguarding policy included the local authoritys contact details for reporting concerns or allegations, should staff wish to speak to someone external to the home. This information has been added following a recommendation at our last inspection. The Baxendales said they would ensure all staff knew where to find required contact details. The AQAA indicated that the home recognises that robust staff recruitment procedures are important in protecting peoples welfare. We saw completed property lists in individuals care records; these included valuable items. Care Homes for Older People Page 23 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have clean, homely accommodation and they are benefiting from ongoing improvements to the environment. Evidence: A variety of sitting areas have been created around the home. Besides a lounge downstairs, a lounge-diner and a conservatory upstairs, with settees and armchairs, there were one or two comfortable chairs placed in window recesses and the dining area. During our visit, we saw people using these various areas, although care needed to be taken that the conservatory didnt become a storage area. The communal rooms looked homely and comfortable. Dining chairs were on gliders, promoting peoples independence when using the tables. Bedroom doors had photographs and/or peoples first names on them, to help people identify their own room. Some bedrooms had lovely views, and some had access to paved areas outside. People who could answer our questions said they had sufficient lighting, heating and hot water in their rooms. Door locks had been fitted, such that residents can lock their own door from the inside for privacy by turning a knob, but may have a key to lock it from the outside if they are able to manage this. Lockable boxes are provided for individuals who wish to safekeep any items they value. Of surveys completed for people who lived at the home, when asked what the home Care Homes for Older People Page 24 of 37 Evidence: does well, one person commented about their relatives bedroom, Room is bright and airy...always clean and smells fresh. When asked what the home could do better, one commented The decor needs some updating. On our visit, we found that vacated bedrooms were being refurbished with new carpets, decor and furniture. We saw one such room and it looked very fresh, bright and pleasant. We noted two occupied rooms where curtains needed attention, and one where the view was partly impaired by condensation in the double glazing. Staff reported that repairs were attended to in a timely way, as did people we asked. We noted that if couples were accommodated at the home, they were each given a room since bedrooms are intended for single occupancy, but they could then choose how they wished to use that space. They could use one as a shared bedroom, for example. One person told us they took a shower, which they preferred, rather than a bath. We saw this was a level access shower. En suite toilets had rails around them, for example, though other toilets appeared to have less in the way of aids to independence. Toilets and bathrooms had been made homely and welcoming through use of colour and tiles. We noted one bathroom had no heater in it, or means of checking the room temperature, which Mr. Baxendale said he would look into. Outside areas and the gardens looked in need of some attention. Mr Baxendale told us that the poor weather had hindered all his efforts outdoors, and the home is currently in discussion with the local council regarding the tree roots that are damaging the homes driveway. The home has a large laundry room. The laundry walls, though not smooth, have a coating of washable paint. The washing machines did not have a visible indication of temperatures associated with washes, but staff were clear which programmes were used for different types of laundry. They also told us a specific machine was used for all soiled laundry, with plastic bags used to contain soiled washing as it was carried to the laundry. Staff told us there were laundry baskets for transporting other washing to the laundry. On occasions, we saw staff carrying washing in their hands, to the laundry, which is not good practise as it can increase airborne contamination. There were no hand-wash facilities, so staff went to a nearby bathroom to wash their hands. We saw staff using disposable gloves and aprons, which they told us were freely available. The AQAA stated that of 11 staff, 8 had had training on infection control. Generally, the home looked clean. We noted dust accumulating under radiator covers Care Homes for Older People Page 25 of 37 Evidence: - these areas will need to be included in the regular cleaning schedules. One bedroom was very odorous, which Mr Baxendale said he had tried to address in various ways. We suggested he continue to seek further professional advice. Staff confirmed that the care assistant responsible for cooking each day did not provide personal care that day. The kitchen looked clean, with a tiled floor, fly-screens at the window, and an automatic dishwasher. Fridges looked clean inside. Care Homes for Older People Page 26 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 staffing and staff training arrangements meet peoples needs. Evidence of fully robust recruitment practises is lacking, although action has been taken to try to ensure only suitable people are employed to care for those living at the home. Evidence: When we arrived there were 4 senior carers and 1 other care assistant, to look after 18 people, the great majority of who had dementia. Mr. & Mrs. Baxendale were informed of our visit and came to the home, assisting us throughout the day. There were 3 carers on duty in the afternoon. Overnight, there was 1 carer with another carer on call. Staff confirmed that this meant there was one person on duty 8pm-8am to assist people, but were clear that people went to bed when they wanted and not at a time that suited the staff. People living at the home, who we asked, told us their call bell was answered sufficiently quickly if they rang it. Care staff were responsible for all domestic duties also, with most of the cleaning carried out in the mornings. The home is trying to recruit a cook. Staff we spoke with had worked at the home for some years. The AQAA stated that no agency staff had been employed in the last three months. This promotes consistency of care through a stable team of carers. The great majority of people who could answer us were happy with the staff, and felt safe with them. Care Homes for Older People Page 27 of 37 Evidence: We were told that 3 staff had been employed since our last visit, replacing 3 staff who had left. We looked at the relevant staff files. Proof of identity and timely police checks had been obtained. We found staff had been recruited through an agency, and references were photocopies addressed to To whom it may concern rather than to a specific person or address. The home had no evidence of individuals employment histories, or whether any gaps had been explained sufficiently; we did not find any statements as to the individuals mental and physical health. The Baxendales said they had employed the agency to carry out the necessary checks, and acknowledged they they had not kept full evidence of this information, or of further checks they carried out themselves. They had not recorded when they followed up the references by phone, and had returned medical records sent to them without keeping a copy, for example. It is the registered individuals responsibility to ensure that information required by regulation is available, in order to safeguard people at the home, even if a third party is involved. The AQAA suggested that of the 11 care staff employed none had an National Vocational Qualification (NVQ) Level 2 in Care, with 3 staff undertaking NVQ2 and one was taking NVQ4 in Care. However, during our visit, we met 2 care staff who had qualified as nurses in their country of origin. Mr Baxendale clarified that of 11 staff, 7 have a nursing qualification from their country of origin, and another staff member is a retired nurse. All staff surveys said they had sufficient up-to-date training and support to meet peoples diverse needs. The home uses an external training company who provide training materials and mark staff questionnaires on the various topics. Staff told us they had had updating or training in the last year on safeguarding, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, food hygiene, manual handling training. Their training records showed they had also had updates on infection control, and health and safety. New staff had completed an induction programme, including the nationally recognised Skills for Care Induction course. Care Homes for Older People Page 28 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Amelia House is run in the best interests of the people who live there, and with regard for the health and welfare of everyone at the home. Evidence: The Baxendales have now had about 10 years experience of running the home. They live in adjoining premises and provide sleeping-in cover at night. They are thus in regular contact with the people living at the home and their relatives, receiving continual feedback about the service provided. The Baxendales told us that one of the senior carers now worked as an Acting Manager whilst undertaking a course recommended for managers of care services (NVQ4 in Care). Staff told us there were no staff meetings specifically but matters were discussed as necessary and that this worked well. They said the Baxendales made themselves available to staff. All staff surveys said communication worked well within the home. Care Homes for Older People Page 29 of 37 Evidence: There was no-one living at the home who was subject to a deprivation of liberty authorisation, and we did not find that anyone was having their liberty deprived without an authorisation. The home sent out, annually, a Questionnaire on living in the home. We saw they had analysed this years results carefully, having had a relatively good return rate. This showed that respondents (some being residents, but the majority being relatives of those living at the home) were generally very satisfied or quite satisfied where they responded. As a result of the findings, the home is considering producing a newsletter to keep families better informed. A balanced sample of comments was included in the report produced, which will be displayed in the home for people to read. The Baxendales confirmed they did not act as appointee for anyone living at the home. Most people were invoiced in arrears for any expenses they incurred, such as for hairdressing and chiropody, with receipts available. Mr. Baxendale said it was agreed on a persons admission when the home would send the invoice, which included the transactions concerned. Where money had been handed to individuals, two signatures had been recorded to verify the transaction. Where cash was held by the home for one individual, we found the balance held matched the total shown on their records. Training records and the Baxendales confirmed that all staff had had recent fire safety training or updating. Staff told us that fire drills were held 3-monthly, with fire alarm bells tested regularly. Records kept by the home showed that fire alarms were tested weekly, but there was no record of in-house checks on fire extinguishers or emergency lighting; an external company serviced the fire safety systems 6-monthly. Where people were in rooms with open doors, we saw that they were held open by devices that release if the fire alarm sounds, allowing the door to shut for fire safety purposes. Individuals support needs in the event of a fire had not been recorded. Such information is important for proper fire risk assessment and management. The homes current fire risk assessment seemed relatively brief. Mr. Baxendale said he carries out the homes fire risk assessment and staff fire training, being updated himself for this role by an advisory company whose services the home used. We suggested he get further advice, contacting the local fire service as necessary. He has since confirmed that he has done this, arranging for them to visit the home. Care Homes for Older People Page 30 of 37 Evidence: Three senior carers on duty had had first aid training within the last year. Staff were able to tell us appropriate action they would take if someone had an epileptic fit. Accident records over the last 6 months showed low levels of falls. An Environmental Health Officer had inspected the home a year before our visit. The Baxendales told us a faulty fridge identified in the report had been replaced, and a faulty thermometer had since been replaced. Records of fridge temperatures showed they were being kept at levels required for safe food storage. Training records showed that the carers who were currently helping with the cooking had undertaken training in food hygiene. Staff we spoke with felt they had a safe working environment. We saw that equipment in peoples rooms that was used to move them had been serviced in the last year. The AQAA confirmed servicing of facilities such as gas and electrical appliance, etc. was up-to-date. There were records of water temperature checks and testing of portable electrical appliances available. Legonella testing was carried out by an external company. Mr. Baxendale said they did not check window restrictors regularly because these were integral to the design of the new windows that had been fitted. It would be good practise to record these checks, to evidence that risk management measures are still effective. Care Homes for Older People Page 31 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 You must ensure that there 10/12/2009 are effective arrangements for the recording and administration of medicines, especially regarding Recording all controlled drug stocks held in the home in the controlled drug register. That administration records and care plans reflect peoples current medications clearly, with clear indications of any discontinued medication. Evidencing through appropriate record-keeping that all medication, including topical preparations such as skin creams, is given at the prescribed frequency. Arrangements that ensure that there are clear directions available to members of staff, on how and when medicines prescribed to be used when Care Homes for Older People Page 33 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action required or Use as directed are to be used. Administration of variable dosage medication should be recorded, including the reason for giving the medication and the dose given. So that peoples medicines are managed safely, and their health needs are met. 2 9 13 You must ensure that there 10/12/2009 are effective arrangements for the storage of medicines, especially regarding:Arrangements must be made to ensure that all medicine cupboards are affixed in accordance with the current regulationsProvision of safe securable delivery/transport systems for medication administered to people living at the home.Staff adherence to the homes medication policies and manufacturers guidance for monitoring the storage life of medicines. Monitoring of the temperature of the medicines fridge to ensure items are being stored according to the manufacturers instructions. Care Homes for Older People Page 34 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action So that peoples medicines are managed safely, and their health needs are met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 It is recommended that you ensure everyone has a personcentred care plan that includes their strengths and abilities, that reflects their choices and ability to make decisions for themselves, that is sufficiently detailed to ensure individuals will get consistent care, and up-to-date so as to ensure peoples changing needs will be met. It is recommended that you ensure that daily care notes are sufficient to provide good evidence for the evaluation of planned care, and that observations made in daily care notes are used to revise care plans and inform care planning. It is recommended that handwritten directions on medication charts are signed and dated by accountable staff, including where medicines are discontinued, to verify the accuracy of the entry or the change made and promote a good audit trail for peoples medication. You should continue to develop the provision of suitable activities or other opportunities for fulfilment, so that each person living at the home benefits equally from individualised, meaningful and positive experiences that improve the quality of their daily lives. It is recommended you obtain and keep satisfactory information, as required by regulation regarding prospective employees, so you can evidence that they are suitable to work in the care home. It is recommended that you seek advice and clarification from the local fire authority on fire safety matters such as checks on fire equipment, and evacuation needs of individuals, particularly in relation to the sufficiency of the Page 35 of 37 2 7 3 9 4 12 5 29 6 38 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations homes fire risk assessment. Care Homes for Older People Page 36 of 37 Helpline: 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). 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