Inspection on 20/06/06 for Exebank [Warren View]

This inspection was carried out on 20th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Exebank [Warren View] 16/02/06

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 Michelle Oliver Key Unannounced Inspection 20th June 2006 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 Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 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.V292102.R01.S.doc Version 5.2 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 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.V292102.R01.S.doc Version 5.2 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 16th February 2006 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 intermediate 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. Information received from the home indicates that there is no charge for those people admitted for Intermediate Care service. Those needing respite care are financially assessed. Services that residents pay for independently includes newspapers and magazines, hairdressing, continence aids and medical requisites, toiletries, chiropody, confectionery and stationery. Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Tuesday 20th June over a period of eight hours. During the inspection the inspector case tracked 3 residents. This helps the inspector to understand the experiences of people using the service. A number of other residents were met and spoken with during the course of the day. The inspector also spent a considerable time observing the care and attention given to residents by staff. Several staff were spoken with during the day, including care staff, occupational therapist, registered manager and an assistant manager. One relative was also spoken with during the inspection. Prior to the inspection 20 surveys were sent to residents to obtain their views of the service provided; 15 were returned. Comments were in the main satisfactory with the majority of the respondents confirming that they ‘usually’ receive the care and support they need. 20 members of staff were sent surveys in order to hear their confidential views; 8 were returned. The staff responses indicate that staff feel supported in their role. 1 response was received from a local doctor, 2 from a local community nursing service and 2 from relatives of residents at the home. All responses were positive about the care given at Exebank. The inspector toured the premises and a sample of records were inspected, including care plans, medication records/procedures, staff recruitment files, and fire safety records. The manager had completed a pre-inspection questionnaire and the inspector appreciated the input of the manager throughout this inspection. The outcome of the inspection was discussed with the manager at the completion of the inspection. What the service does well: Residents are provided with a friendly and comfortable environment where they are supported and encouraged to maintain or regain their health and independence. A high standard of hygiene is maintained at the home. Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 Page 6 Residents were all very happy with the care they receive at the home. Comments received included “An excellent facility, very happy here, “There’s an excellent atmosphere, everyone getting on well with the others whether staff or clients” and “I am being very well looked after What has improved since the last 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. Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 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.V292102.R01.S.doc Version 5.2 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): OP3 & 6 Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. Residents benefit from good admission practice, which ensures that the home is able to meet their needs. Residents admitted for intermediate care are helped to maximise their independence and return home. EVIDENCE: 3 residents’ plans of care were looked at during this inspection, including a resident’s who has lived at the home for several years. Residents are generally admitted to the home either for a period of respite, to allow their carers a period of rest, or for rehabilitation. An assessment of care needs is undertaken for all residents admitted for rehabilitation before they move to the home. Pre admission assessments are not undertaken by staff at the home, this is generally undertaken before discharge from hospital. Individual plans of care are developed based upon the assessments. The manager was concerned that at times insufficient information was available, Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 Page 9 particularly for emergency admissions. At the time of this visit the home was expecting a resident to be admitted but shortly before they were due to arrive the home was told the resident would need equipment that the home was unable to provide at such short notice [although staff spent considerable time trying to do so] 2 staff questionnaires stated that there are occasions when people are admitted with needs that they are able to meet. All of the residents spoken to at the time of this visit said that they had been given enough information about Exebank before they agreed to move to the home. 4 questionnaires received from residents stated that they had not been given enough information about Exebank before they agreed to be admitted. 1 stated that the decision had been made by the hospital but that “it was the right one”. Another questionnaire stated that “ Exebank is an automatic stage of preparing to go home again after being in hospital. It is a delightful place to be”. Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 Page 10 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): OP 7, 8, 9 & 10. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. Individual care plans have been developed for all residents and most aspects of health; personal and social care needs are identified. Attention is needed in one area. Medication is generally well managed. Residents’ privacy and dignity are met and promoted by the staff and management at the home. EVIDENCE: Care plans for residents admitted for rehabilitation or for respite care are comprehensive and provide information to enable staff to meet residents identified care needs. Information relating to the only long stay resident currently living at the home were not as comprehensive and a care plan for another resident did not include details to enable all staff to be aware of actions to be taken in the event of a particular medical emergency. However, when spoken to all staff responded positively about the action that would be taken and all knew the long stay residents’ needs and how care was given in Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 Page 11 an individual professional manner. Details such as these need to be recorded so that all staff are aware and that changes can be monitored. This will further ensure that individual, person centred care is a priority at the home. Many service users manage their own medication. Lockable facilities are provided in their rooms to ensure safe storage of their medication. Medicines kept on residents’ behalf are stored safely and only staff who have undertaken specific training in safe handling of medicines manage them. During a tour of the building several open containers of creams/ ointments with no indication of the date of opening/expiry were seen in resident’s rooms. Creams and ointments deteriorate once opened. Current practice puts residents at risk of infection and decreases the effectiveness of the cream. Residents’ privacy and dignity are met and promoted by the staff and management at the home. Comments in residents’ questionnaires included “I am being very well looked after”, “the care I have had has been superb, caring, kindly and firm”; “all staff are happy and helpful. Nothing is too much trouble Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 Page 12 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): OP 12, 13, 14 & 15. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. Social needs and meals are generally well managed. A varied balanced diet is provided served in a pleasant atmosphere. Residents are encouraged to maintain contact with their families or friends as they wish and to take control of their lives during their stay at Exebank. EVIDENCE: Current residents spoke about routines, including exercises, practice using the stairs, planned to restore their health were regularly carried out. During this visit residents were enjoying chatting to each other, socialising in either of the comfortable lounges, reading newspapers and books, watching TV programmes of their choice or simply enjoying the stunning views of the estuary. Residents and visitors confirmed that they were welcome at the home whenever they wished. Daily activities include individual therapy sessions, daily exercise sessions, occasional sing a longs, quizzes, bingo, donkey visits and musicians. Residents Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 Page 13 are encouraged and supported to maintain their religious beliefs and a Communion service is held monthly at the home. All residents spoken to were very satisfied with the standard of food at the home one saying the food is “Very good, good variety, well cooked”. Residents are offered a choice of meal at both main meals. Specialist diets are well catered for at Exebank. During this visit a resident was told the choices for lunch, declined both and was able to describe exactly what he “fancied”. Two dining rooms are provided on each floor where residents were seen enjoying their meal and socialising. Both are homely and comfortable. A kitchenette is also available where residents may prepare their own meal if they choose. Residents are encouraged and supported to maintain their independence, however for those needing assistance this is provided in a sensitive way. A questionnaire received for a resident commented “usually enjoy the food, helpings too big” another “ 5pm is a bit too early for the last meal of the day”. Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 Page 14 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): OP16 & 18. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. The home has a satisfactory complaints process. Staff have a good knowledge and understanding of the forms of abuse thereby ensuring that residents are protected at the home. EVIDENCE: Records of incidents recorded indicate that all issues are taken seriously and dealt with promptly. Residents confirmed that they feel comfortable discussing any concerns with staff at Exebank. 12 questionnaires returned by residents confirmed that they always, or usually, know how to make a complaint, however a relative was not aware of the home’s complaint procedure. A copy of the home’s complaint procedure is available in each resident’s room. All staff confirmed that they were aware of the procedure and where a copy of the procedure was available if asked by residents or visitors. There was nothing to suggest that residents are anything other than well cared for at Exebank. Residents said that they “always felt safe” and that “staff were very kind and gentle”. Staff have undertaken Adult Protection training since the last inspection and were able to discuss different forms of abuse. They all said that they would not hesitate to report any suspicion of poor practice. Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 Page 15 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): OP19 & 26. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. Residents benefit from living in a home that is very clean, fresh and where hygiene is well managed. EVIDENCE: At the time of this unannounced inspection the home was exceptionally clean fresh and comfortable. Staff have access to protective clothing, hand washing facilities and hand cleansing gel. All returned questionnaires stated how clean the home is at all times The laundry facilities were well organised. A person is employed to take care of residents’ laundry and the cleanliness of the room. All residents were well dressed at the time of this visit and several said that their clothes are well looked after. Three residents commented that although their clothes are clearly marked with their names they have “lost” some items of clothing and there Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 Page 16 have been occasions when they have been given other residents’ clothing by mistake. They also said that “staff try very hard to sort this out”. Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 Page 17 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): OP 27, 28, 29, & 30 Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. The number of staff on duty throughout the day and night meets residents’ personal and health needs. Service users benefit from staff who are qualified and competent. Service users are protected by robust recruitment practice at Exebank. EVIDENCE: The number of staff on duty throughout the day and night meets residents’ personal and health needs. The manager aims to have 4 carers on duty between 7.30am-2pm, 2 carers between 2pm-4.30pm, 3 carers between 4.30-9.30 and 2 carers and a night care officer between 8pm-8am, on each of the two floors. The manager and an assistant manager are on duty during the day. Residents spoken with confirmed that their needs were met in a timely way. The inspector saw staff responding to residents’ bells swiftly throughout the day. Residents and relatives confirmed that staff were kind and helpful but “always busy”. Information received from the manager, prior to the inspection, indicates that 48 of staff hold NVQ 2 or above. This will protect residents by ensuring that they are cared for by competent staff. The home is committed to providing Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 Page 18 training and since the last inspection training undertaken includes medication, fire safety, manual handling, risk assessment and Protection of Vulnerable Adults. Individual records are kept of training undertaken by staff ensuring that updates or gaps in training can be easily identified. Staff at the home are eager to undertake training and were able to highlight their individual needs during this visit. Three staff recruitment files were looked at during this visit. The documentation was consistent with evidence of a safe and robust recruitment process being carried out before a person is employed at Exebank. This protects residents, as only people who have undergone this robust procedure will be employed to work at their home. All newly employed staff undergo a period of training when they start working at the home. This period of induction consists of 2.5 days formal training plus in house training. The time taken to complete this training will depend on past experience and individual ability. One staff induction training record was looked at, which included the input of the individual staff member. Training is not considered to have been completed unless the staff member agrees that they understand and have received enough information to allow them to carry out their duties. All the staff are polite and cheerful. A resident commented that they were “happy with the care when I first spent time at the home, came back for further rehab. when well enough” Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 Page 19 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): OP 31, 33, 35, & 38. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. The home is well managed, run in the bet interest of service users, and their health and safety are properly attended to. EVIDENCE: Residents and staff benefit from the experience and competence of the current manager. Comments received from both staff and residents included “she gives clear guidance”, “ she is very approachable and always listens” and “ the home is very well run”. 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 residents’ meetings are held, both providing an opportunity for the manager to give and receive information Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 Page 20 about the home. This ensures that standards of health, social care and welfare needs will be maintained and a programme of continuing improvement developed at the home. Residents will benefit by being assured that the home is working towards delivering high standards of care. Residents’ records are securely stored and would be made available to them, or their representative with their consent. Records show that staff undertake training in the prevention of fire and fire alarms have been carried out regularly. Emergency lighting tests, although undertaken regularly, were not being undertaken as recommended, that is monthly. An assessment of identified hazards and associated risk relating to the environment, including fire hazards, has been undertaken which contribute towards ensuring that Exebank is a safe place to live. Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 Page 21 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 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 Page 22 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. 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. Refer to Standard OP3 Good Practice Recommendations New residents should only be admitted to the home on the basis of a full assessment being undertaken on which the home can assess whether they are able to fully meet their individual needs. The service user’s plan sets out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service user are met. A procedure to ensure that the date beyond which creams/ ointments should not be used should be developed. Emergency lighting should be tested according to the recommendation included in the home’s fire log book. 2. OP7 3. 4. OP9 OP38 Exebank [Warren View] DS0000039189.V292102.R01.S.doc Version 5.2 Page 23 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.V292102.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!