CARE HOMES FOR OLDER PEOPLE
Amelia House Pocombe Bridge Exeter Devon EX2 9SX Lead Inspector
Mark Sharman Announced 17/05/05 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 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 D54-D07 S3640 Amelia House V213651 170505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Amelia House Address Amelia House, Pocombe Bridge, Exeter, Devon, EX2 9SX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01392 213631 01392 213631 alanmichaelbax@tiscali.co.uk Mrs Nuala BaxendaleMr 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 D54-D07 S3640 Amelia House V213651 170505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 30/11/04 Brief Description of the Service: Amelia House is registered to accommodate up to 18 people aged 65 and over, including people with dementia. The home is near the A30 on the edge of Exeter, in a rural location with very 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 on to outside terraces from both floors. The owners accommodation directly adjoins the home. Amelia House D54-D07 S3640 Amelia House V213651 170505 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection lasting nearly eight hours. A completed preinspection questionnaire was received before the inspection, and also five comment cards were received from residents and five from relatives. Six of the residents and five staff were interviewed, and an inspection of the whole building was made. What the service does well: What has improved since the last inspection?
The requirements made at the last inspection have been complied with. This includes the fitting of suitable locks to all bedroom doors. This means that residents can now lock their door if they wish and are able, or if they are away from the home (for example in hospital) their room can be kept locked. The radiators accessible to residents have been covered, which eliminates the risk of a resident being burnt in the event of a fall. A satisfaction survey has now been carried out among residents and their relatives, and the responses have been analysed. This will enable the owners
Amelia House D54-D07 S3640 Amelia House V213651 170505 Stage 4.doc Version 1.20 Page 6 to see what services are regarded as good, and in what areas improvements may be needed. An induction pack for new staff has been introduced as required, which will ensure that new staff receive basic training in key areas of their work. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Amelia House D54-D07 S3640 Amelia House V213651 170505 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Amelia House D54-D07 S3640 Amelia House V213651 170505 Stage 4.doc Version 1.20 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 standard(s) 3. Standard 6 is inapplicable. Prospective residents’ needs are assessed prior to admission to the home. EVIDENCE: From discussion with the home owners it is clear that they are careful to establish what a prospective new resident’s needs are before making a decision about admission. Some of the residents’ files which were inspected contained assessments from local authority care managers, one contained an assessment from hospital nursing staff, and the home’s own assessments made prior to admission. Amelia House D54-D07 S3640 Amelia House V213651 170505 Stage 4.doc Version 1.20 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 standard(s) 7, 8 and 9. Residents’ health care needs are well met and there is a safe system for administering medication to them. Their health/physical care needs are set out in individual plans of care, although these were variable as to the clarity of this information. EVIDENCE: All residents are registered with general practitioners. Many of the residents have restricted mobility, and regular services are provided by a visiting optician, dentist, chiropodist and district nursing service. There was evidence of this in the residents’ care records. One of the residents who has lived in the home for many years said that “if anybody’s ill they always get a doctor”. The district nursing service has been involved with one of the newer residents, and are involved with pressure are care. For this purpose the home has two special mattresses (which were seen) and other equipment. Due to levels of confusion it is not appropriate for the current residents to manage their own medication. The medication cupboard and associated records were inspected. The last report (22/3/05) from the home’s supplying pharmacist was seen and was satisfactory. He confirmed that the staff who administer medication have attended his accredited training.
Amelia House D54-D07 S3640 Amelia House V213651 170505 Stage 4.doc Version 1.20 Page 10 A sample of individual plans of care was inspected. These included quite a lot of information, but specific actions to be taken by care staff to meet residents’ health and personal care needs were not clearly laid out in each case. They included a risk assessment and a mobility assessment. Amelia House D54-D07 S3640 Amelia House V213651 170505 Stage 4.doc Version 1.20 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 standard(s) 12, 13 and 14. There is a suitable range of activities available to the residents which is appropriate to their interests and abilities. They are helped to follow their own routines and make their own choices as far as they are able. EVIDENCE: The majority of more capable residents said they felt that enough activities were offered to them, which was confirmed by the comment cards received. These include monthly professional musical entertainment, fortnightly exercise sessions run by an external trainer, games and quizzes with staff. An exercise session (individual and group) was run on the morning of the inspection. Group outings are impracticable, but residents are taken out individually. For example one resident said that one of the staff took him to a VE day church service recently. Some church visitors hold a monthly meeting/service at the home for residents who are interested. Residents continue with hobbies and interests if they are able. For example one has continued to paint pictures, and Mr Baxendale is helping another to maintain his interest in woodwork. The residents said they get up and go to bed when they wish, which was confirmed by the staff. Some of the bedrooms have been personalised by their occupants and made quite cosy. Amelia House D54-D07 S3640 Amelia House V213651 170505 Stage 4.doc Version 1.20 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16. The home has a satisfactory complaints system which gives confidence to residents and relatives that complaints will be taken seriously. EVIDENCE: There is a complaint procedure which complies with the Standard, a copy of which was displayed on the notice board. The three residents who were asked said they were confident that any complaint they might have would be taken seriously by the home owners. In fact none of the residents expressed any complaint. Amelia House D54-D07 S3640 Amelia House V213651 170505 Stage 4.doc Version 1.20 Page 13 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 standard(s) 19, 22 and 24. Recent investment has significantly improved the home, creating a comfortable and safe environment for the residents. EVIDENCE: The home was warm and clean. Residents benefit from the fact that there is a lounge and dining room on both floors, and level access from both floors to outside terraces. This means that residents whose rooms are on the first floor may remain on that floor for their meals or to access outside if they wish. There is an ample amount of communal space where activities can take place or where residents can see their visitors. Bedroom doors have now been fitted with suitable locks. Most of the bedrooms are bright and comfortable, and residents said they were happy with them. Disability equipment includes a stair lift, assisted bath, call system, mobile hoist and other equipment. However an assessment of the premises has not yet been carried out by an occupational therapist in line with the Standard. Amelia House D54-D07 S3640 Amelia House V213651 170505 Stage 4.doc Version 1.20 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30. The staffing arrangements meet the residents’ needs, and the staff receive appropriate training for the work they do. The procedure for recruiting new staff is thorough and is designed to exclude people unsuitable to care for the vulnerable. EVIDENCE: The staffing rota was inspected. The more capable residents were asked about the availability of staff, and they said that there are enough staff on duty for their needs. The staff on duty also felt that staffing levels were satisfactory from their point of view. The home’s recruitment procedure was examined. No new staff have been recruited since the last inspection, but the staff files showed that the expected checks have been carried out. The Criminal Records Bureau disclosures for all the staff were available and were seen. A professionally produced induction pack is now in use for new staff. This has been used with all the newer staff, as required following the last inspection of the home. Also seen was the staff training file, which contains the training certificates. Amelia House D54-D07 S3640 Amelia House V213651 170505 Stage 4.doc Version 1.20 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36 and 38. The home is well managed by the resident owners, who give high priority to the residents’ interests. A responsible approach is taken to health and safety issues which affect the residents and the staff. The owners are in frequent contact with the staff, but supervision of staff has not been formalised. EVIDENCE: The residents are a vulnerable group of people, many of whom are significantly confused. The building is therefore secure. Recent work carried out includes the covering of all radiators, regulation of hot water temperature at wash basins, rectifying of electrical faults throughout the building (invoice seen), and the fitting of bedroom door locks (although not used by current residents). A recent environmental health officer’s report (28/4/05) concluded the premises were “satisfactory”. All staff have received training in core areas such as food hygiene, moving and handling, fire training, and first aid (for most). An annual
Amelia House D54-D07 S3640 Amelia House V213651 170505 Stage 4.doc Version 1.20 Page 16 health and safety audit of the home is carried out by an independent consultancy. Mr Baxendale manages the personal money of some residents, and a sample of these records (including receipts) was inspected and was found to be satisfactory. A satisfaction survey has been conducted with residents and relatives, and the responses have been analysed and collated. With regard to supervision of staff, the owners are in daily contact with the staff on duty and thus provide regular supervision. However this is not formal recorded supervision in line with the Standard. Amelia House D54-D07 S3640 Amelia House V213651 170505 Stage 4.doc Version 1.20 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 x x 2 x 3 x x STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 3 x 3 2 x 3 Amelia House D54-D07 S3640 Amelia House V213651 170505 Stage 4.doc Version 1.20 Page 18 No. Are there any outstanding requirements from the last inspection? 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 Regulation Requirement Timescale for action 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. 2. 3. Refer to Standard 7 36 22 Good Practice Recommendations The residents care plans should be reviewed so that important instructions to staff relating to health and personal care needs are made clearer. All care staff should receive formal recorded supervision at least six times per year. The premises and facilities should be assessed by an occupational therapist with specialist knowledge of the needs of elderly people. Amelia House D54-D07 S3640 Amelia House V213651 170505 Stage 4.doc Version 1.20 Page 19 Commission for Social Care Inspection 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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