CARE HOMES FOR OLDER PEOPLE
Amelia House Amelia House Pocombe Bridge Exeter Devon EX2 9SX Lead Inspector
Mark Sharman Unannounced Inspection 11th November 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Amelia House DS0000003640.V264796.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Amelia House DS0000003640.V264796.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Amelia House Address Amelia House Pocombe Bridge Exeter Devon EX2 9SX 01392 213631 01392 213631 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) Mrs Nuala Baxendale Mr Alan Baxendale Care Home 18 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (18) of places Amelia House DS0000003640.V264796.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17/5/05 Brief Description of the Service: Amelia House is registered to accommodate up to 18 people aged 65 and over, including people with dementia (but not other forms of mental disorder). 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 and has a car parking area. There are level terraces at the front and back and an attractive (but steep) garden. There are residents bedrooms on the ground and first floors, and also a dining room and lounge on both floors. Three of the bedrooms are double rooms but they are normally occupied singly. There is level access outside on to the terraces from both floors. The owners accommodation directly adjoins the home. Amelia House DS0000003640.V264796.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection and about four and a quarter hours were spent at the home. Six of the residents, four staff and one visiting relative were consulted, and Mrs Baxendale was also seen briefly. A sample of the home’s records was examined, and all of the communal areas and most of the bedrooms were seen. What the service does well: What has improved since the last inspection?
No requirements were made at the last inspection, and two of the recommendations made then have been adopted. One related to the desirability of recording supervision sessions with staff, thus making it easier to monitor staff development and training needs. The other recommendation was to commission an assessment of the premises and facilities by an occupational therapist, in view of the fact that some residents are very frail and have reduced mobility. This has now taken place, although it was not
Amelia House DS0000003640.V264796.R01.S.doc Version 5.0 Page 6 possible to see the resulting report at this inspection (a copy will be sent to the Commission for Social Care Inspection). What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Amelia House DS0000003640.V264796.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Amelia House DS0000003640.V264796.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these Standards was considered at this inspection. EVIDENCE: Amelia House DS0000003640.V264796.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10. There is a care planning system in place, but information on the residents’ care needs is not presented in a uniform and clear way. There is a safe system for administering medication. EVIDENCE: A sample of individual plans of care was inspected. These contained quite a lot of information, but actions to be taken by care staff to meet residents’ health care and personal care needs were not clearly laid out. The care plans inspected included a risk assessment and a mobility assessment. They contained review sheets which had been completed to April this year, but not since then. There is a written medication procedure. None of the current residents is selfmedicating, and indeed due to their confusion they are unable to manage their own medication reliably. The medication cupboard and medication administration recording sheets were inspected. The last report (22/3/05) from the home’s supplying pharmacist was satisfactory. One of the staff consulted, normally a night carer, confirmed that she had received medication training.
Amelia House DS0000003640.V264796.R01.S.doc Version 5.0 Page 10 The home has a policy on residents’ privacy, and during the inspection the staff were observed interacting with the residents with care and respect. Those residents capable of expressing their opinions were complimentary about the attitude of the staff. The double bedrooms are used as single rooms. Amelia House DS0000003640.V264796.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15. There is a suitable range of activities available to the residents which is appropriate to their interests and abilities. The standard of catering is commendable. EVIDENCE: The more capable residents said they felt that enough activities were offered to them. These include regular professional musical entertainment, fortnightly exercise sessions run by an external trainer, and games and quizzes with staff. Some church visitors hold a monthly meeting/service at the home for residents who are interested. One of the residents said that she had had a very enjoyable birthday party recently to which other residents’ relatives were also invited. Two comments were made that not many trips out are offered to the residents (although several of the current residents are unable to travel comfortably in a vehicle). Two cars are available to transport residents, and Mr Baxendale gave examples of residents being taken out either individually or in small groups. All of the residents and a visiting relative said that the meals provided are very good, which was confirmed by the staff. The menus displayed showed a good variety. There is normally something cooked at tea time as well as at midday. A bowl of fruit and a chilled water dispenser were available for residents in the hall.
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The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The home has a complaints system which gives confidence to residents and relatives that complaints will be taken seriously. There are satisfactory arrangements for protecting the residents from abuse. EVIDENCE: There is a complaint procedure which complies with the Standard, a copy of which was displayed on the notice board. The residents who were asked said they were confident that any complaint they might have would be dealt with by the home owners. In fact none of the residents expressed any complaint during the inspection. No complaint has been received by the Commission for Social Care Inspection since the last inspection. Amelia House DS0000003640.V264796.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. The home was clean, tidy and hygienic and generally well maintained, although some minor faults were apparent. EVIDENCE: The home is fairly well equipped, and disability equipment includes a stair lift, assisted bath, call system, mobile hoist and other equipment. An assessment of the premises and facilities has now been carried out by an occupational therapist in line with the Standard, and Mrs Baxendale will supply the Commission for Social Care Inspection with a copy of the report. The security of the windows in room 6 should be reviewed to minimise the risk of a fall from the window (Mr Baxendale has said that this window has been assessed by a health and safety consultancy company). The home was reasonably clean and residents said that this is normally the case, and there was no unpleasant odour in the rooms inspected. There are infection control policies in place. There is a spacious laundry room with a sluicing sink.
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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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 28. The staffing arrangements are satisfactory and meet the residents’ needs, although the NVQ training target has not yet been achieved. EVIDENCE: This was an unannounced inspection and there was an adequate number of staff on duty. The staff rota was inspected. The more capable residents consulted said that they felt sufficient staff are normally on duty, and this was confirmed by the staff spoken to. The residents were complimentary about the calibre of the staff, and indeed the staff on duty during this inspection were competent and kind. Currently one staff member is working towards NVQ level 2, and so the home is well short of the 50 NVQ target. Amelia House DS0000003640.V264796.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 36. The home is managed in a responsible way by the resident owners. They are in frequent contact with the staff, and supervision of staff has now been formalised. EVIDENCE: The owners have day to day responsibility for running the home, and have now had nearly 7 years experience of doing this. Mrs Baxendale has not yet completed the NVQ level 4 in management and care but is in the process of doing this, and the Standard will be fully met when she has completed (perhaps by next Spring). The owners live in adjoining premises and provide the sleeping-in cover at night. Supervision of staff is now recorded in a confidential diary (which was not available during the inspection and so was not examined).
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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 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x 3 x x x 3 STAFFING Standard No Score 27 3 28 1 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x x 3 x x Amelia House DS0000003640.V264796.R01.S.doc Version 5.0 Page 20 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. 1 Standard OP38 Regulation 13 Requirement The security of the windows in bedroom 6 must be reviewed to minimise the risk of a fall. Timescale for action 16/12/05 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 OP7 Good Practice Recommendations The care plans should make clear important instructions to staff relating to the residents’ health care and personal care needs, and the care plans should be reviewed monthly. Amelia House DS0000003640.V264796.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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