Inspection on 16/02/06 for Exebank [Warren View]

This inspection was carried out on 16th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Exebank [Warren View] 20/06/06

Exebank [Warren View] 13/09/05

Exebank [Warren View] 28/02/05

Exebank [Warren View] 17/08/04

Exebank [Warren View] 09/03/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Exebank [Warren View] Mudbank Lane Exmouth Devon EX8 3EG Lead Inspector Anita Sutcliffe Unannounced Inspection 08:45 16 & 21 February 2006 th st 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 Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 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. Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Exebank [Warren View] Address Mudbank Lane Exmouth Devon EX8 3EG 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) 01395 271692 01395 222854 deirdre.jennings@devon.gov.uk Devon County Council Mrs Deirdre Susan Jennings Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (28), Physical disability (2), Physical disability of places over 65 years of age (10), Sensory impairment (2), Sensory Impairment over 65 years of age (2) Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This registration allows the admission of up to 2 persons aged 50 and over in the category of SI Sensory Impairment This registration allows the admission of up to 2 persons aged 50 and over in the category of PD Physical Disability Date of last inspection Brief Description of the Service: Exebank is a detached purpose built Local Authority home which provides care for up to 30 people over the age of 50 years, who may have a sensory or physical disability. The accommodation is arranged on two floors, each having two long corridors with bedrooms on both sides. There are two lounges, dining areas and communal bathroom facilities including a sluice room on each floor. All bedrooms are single, with 24 below 10 square metres. 8 bedrooms are approximately 14 square metres, and one room has an en suite facility. Each floor has a specialised purpose. On the ground floor respite care (for those whose carers need a break) and recuperative care are provided. There is one long stay service user on this floor, but it is not intended to provide long term care for any other service users in the future. On the first floor there is accommodation for physically frail service users who need help to improve their skills and level of independence. There is level access to the building and service users are able to enjoy the grounds, with pleasant lawns and patio area and outstanding views across the Exe estuary. A day centre shares the same building but has a separate entrance. Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The mainly unannounced inspection began at 08:45 and took place over two days taking 7 hours. Several key standards were inspected, and progress on the requirement made at the last inspection to the home was assessed. Prior to the inspection the home completed a CSCI questionnaire, which provided up to date information about the home and the service provided. During the visit most service users and some visitors were met. Aspects of the care of three service users were examined in detail. Service users were joined for lunch, all of the home visited and care, fire safety, recruitment, training and induction records examined and menus and staffing rotas seen. The registered manager was available throughout the inspection. Staff were helpful and informative. CSCI information and contact details were left at the home for service users to make use of if they wish. What the service does well: What has improved since the last inspection? What they could do better: Neither service users nor staff could think of anything that the home could improve. Managing medication with such a fast ‘turn over’ of service users increases the possibility of error. Although diligently approached the management of Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 Page 6 medication could be improved in several ways so that the risk of error is reduced or removed. This includes the procedure for checking medication into the home, the taking and recording of information when a change of medication is necessary, the clarity of recording and the use and disposal of medicines. 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. Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 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 Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 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): Not inspected on this occasion. EVIDENCE: Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 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): 9 The system used for the recording and handling of medicine to be administered to the service users had the potential to place them at risk. EVIDENCE: Many service users manage their own medication, for which they are provided a lockable storage space within their room. Risk from self-medication is assessed and well managed at the home. Medicines kept on service users’ behalf are stored safely and staff receive training in how to handle medicines. The fast turn over of service users increases the risk of medication error. Staff said they were also frustrated by having to ‘chase’ information from GP surgeries or hospitals, or receive it verbally rather than in writing, thus increasing risk further. The CSCI Pharmacist Inspector has now been made aware of this concern. Areas where medication practice was unsafe were: the removal of a label so that medication could be used for a service user to whom it was not prescribed and did not belong, in this case paracetamol; crossing out and making changes Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 Page 10 on the medication administration chart which left unclear instruction; hand written entries and a single staff member checking medication into the home; no record of who checked medication into the home and on what date, and discarded tablets not being returned to pharmacy within a reasonable timescale. Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 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, 13, 14 & 15 Service users are able to maintain control over their daily lives. Their experiences at the home match their expectations and wishes. Service users receive a nutritious varied diet, which meets individual choice and health care requirements. EVIDENCE: Service users confirmed that routines planned to restore their health were regularly carried out. These include exercises and practice using the stairs. There is a strong and well-developed ethos of person centred care. Service users were seen enjoying newspapers, word games, socialising and enjoying the stunning view of the estuary. They benefit from a visiting shop, hairdresser, occasional trips on the minibus and the home’s entertainment systems. The many visitors confirmed that they knew of no visiting restrictions. Tea making facilities are available for their use. Staff talked of the twice monthly Communion service held, but one resident said she was unaware these took place, and records of religious interest were not consistent. This was discussed with the manager who agreed that this Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 Page 12 should be improved, but confirmed that service users were always assisted to follow their faith. Service user meetings provide the opportunity to discuss what is liked or disliked at the home, covering topics such as food, activities and entertainment. Service users were very pleased with the standard of food at the home describing it as “almost the same as home cooking”. Individual choice is catered for and requests are met; a resident was pleased that the small portion she prefers was always provided. There is a choice of meal at each sitting, and specialist diets are well catered for. The kitchen is adept at meeting needs despite the fast turn over of service users due to the nature of the home. The two small dining rooms on each floor provide a homely space for service users to meet and talk. There is also a kitchenette where service users may choose to prepare their own meal. Independence is encouraged regarding the preparation and eating of food, but assistance is available and provided in a sensitive way. The home provides a varied menu to ensure that individual tastes are met and the diet is nutritious. The vegetarian option sampled by the inspector was well presented and tasty. Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 Page 13 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 the following standard(s): Not inspected on this occasion. EVIDENCE: Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 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): 26 The home is very clean, fresh and hygiene is very well managed. EVIDENCE: The home pays exceptional attention to cleanliness and the prevention of infection, and encourages visitors to do the same. To this end there is a good supply of protective clothing, hand washing facilities and hand cleansing gel. The home was spotlessly clean and information about cleanliness was posted for all within the building to read. Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 Page 15 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 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): 28, 29 & 30 Service users benefit from staff who are qualified and competent. Service users are protected by robust recruitment practice. EVIDENCE: Most care staff have many years experience. They receive structured induction when new and then on-going regular training. Staff are encouraged to undertake the NVQ qualifications in care and the home has now achieved 50 of care staff with the qualification to level 2 or above, thus further ensuring service user safety and well being. All service users spoken with were very satisfied with the care they received. The recruitment records of two recently employed staff, and discussion with one of them, confirmed that staff are only employed following thorough safety checks to ensure they are suitable to work with vulnerable adults. Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 Page 16 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, 32, 33, 35 & 38 The home is well managed, run in the bet interest of service users, and their health and safety are properly attended to. EVIDENCE: The home benefits from the experience and competence of the registered manager with tasks clearly delegated, and responsibilities understood by unit managers, therapists and care staff. A Service user said: “The whole place is well run”, another said: “The service is first class”. Both service users and staff talked of the friendliness and cooperation within the home. The quality of the service provided by the home is checked using regular quality survey questionnaires, results of which are audited by the manager and providers, the Local Authority. Staff and service users’ meetings are held, both providing an opportunity for the manager to give and receive information about the home. Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 Page 17 Service users are encouraged and supported to look after their own financial affairs. However, secure storage is provided for money and valuables, which are correctly managed in service users’ best interest. The home is well maintained, hygiene very well addressed and staff well trained in health and safety. Equipment is serviced, clean and in good working order. Health and safety signs are clearly displayed and staff were able to demonstrate their knowledge, and example being domestic staff and the use of cleaning chemicals. Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 Page 18 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. 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 X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X 4 STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? YES 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 OP9 Regulation 13(2) Requirement The Registered person shall make arrangements for the recording, handling safe keeping, safe administration and disposal of medicines received into the care home. (This relates to: • an unlabelled medication in the medicines trolley – timescale of 30/09/05 not met. • the administering of a medicine to a person to whom it was not prescribed, this being paracetamol. • storage of discarded medicines longer than appropriate • unclear record keeping – crossing previous entries out • no signature or date when checking medicines into the home) Timescale for action 31/03/06 Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 Page 20 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 OP9 Good Practice Recommendations It is recommended that for all hand-written entries on MAR charts they are signed and dated by the person making the entry and that this is then checked and signed by a second person. It is recommended that for all dose changes a new entry is created on the MAR chart and that the existing entry is not simply amended. It is recommended that all information received, which affects what medicines are to be given, only be done so in writing, and not verbally. 2. 3. OP9 OP9 Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Exebank [Warren View] DS0000039189.V257200.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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