Inspection on 02/04/07 for Exmouth House

This inspection was carried out on 2nd April 2007.

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

Exmouth House 02/02/06

Exmouth House 25/07/05

Exmouth House 16/03/05

Exmouth House 10/08/04

Similar services:

Fairfields Country Rest Home

Fairfax House

Claremont Nursing Home

Doveridge Care Home

Dunmore

Chatsworth

Dunraven Lodge

Eastleigh Care Homes, South Molton

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

CARE HOMES FOR OLDER PEOPLE Exmouth House 12 Long Causeway Exmouth Devon EX8 1TS Lead Inspector Caroline Rowland-Lapwood Unannounced Inspection 2nd April 2007 09:00 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 Exmouth House DS0000021936.V327391.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. Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Exmouth House Address 12 Long Causeway Exmouth Devon EX8 1TS 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 275926 01395 269084 www.srtrust.co.uk Somerset Redstone Trust Angela Mary Till Care Home 31 Category(ies) of Dementia - over 65 years of age (31) registration, with number of places Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd February 2006 Brief Description of the Service: Exmouth House provides accommodation with personal care for up to 31 older people who may also have dementia. It is situated in a residential area of Exmouth close to the local health centre, hospital and schools. The registered provider is Somerset Redstone Trust. The property is a detached, extended building. Bedroom accommodation for service users is on the ground, first and second floors. All rooms are single occupancy. There is a passenger lift to both floors. A communal lounge, conservatory and dining room are situated on the ground floor. There is an enclosed garden area to the rear of the building and a car park at the front. CSCI inspection reports are available upon request. At the time of the inspection fees ranged from £363-£500 per week Exmouth House DS0000021936.V327391.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 seven and a half hours to complete. During this time the inspector case tracked 3 residents, which helps us to understand the experiences of people using the service. A number of other residents (10) were met and spoke with during the course of the day. Most of the residents have limited verbal communications skills due to dementia and therefore observations of interactions with staff were made throughout the day. The inspector spoke with 8 members of staff including the team leader, care staff, and ancillary staff. There were 31 residents living at the home. Several weeks before this inspection a pre-inspection questionnaire was sent to the home. The completed form was returned to the Commission, and from this information questionnaires were sent to residents, staff and visiting professionals. Completed questionnaires were received from 2 professionals, 5 relatives and 7 staff. Comments were also received from one relative. Records relating to recruitment, training, health and safety and maintenance were looked at and a tour of the premises was taken. Staff were very helpful on the day of the inspection and a lot of positive discussions, advice and suggestions took place throughout the inspection. The atmosphere in the home was warm, welcoming and friendly. What the service does well: The home has good procedures in place to carefully assess any prospective new residents before they move in, therefore ensuring that the home is suitable and will meet their needs. Menus seen during the inspection showed that the home provides nutritious and balanced meals to suit all individual dietary needs and preferences. Residents are given plenty of choice. Medicines are stored, administered and recorded in a safe manner. The building lends itself well to care for people with dementia or physical disability. Wheelchair bound residents are able to move around unaided; the long corridors provide distance for people who like to wander. Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 6 Staff records seen during the inspection showed that the home follows satisfactory recruitment procedures, including receipt of satisfactory references and criminal records checks before new staff are confirmed in post. New staff receive good induction training when they begin work. Ongoing training has been provided on relevant health and safety topics. Good procedures are in place to regularly check on the quality of the services and facilities and to ensure continuous improvements are made. The manager, senior staff and many care staff are attentive and caring. They understand how to provide emotional support and well being to the very vulnerable people in their care. The ethos of the home is to provide personcentred, individual care. Residents are encouraged to live the lifestyle that suits them, this only being limited with thought, agreement and in the best interest of themselves or the safety of others at the home. What has improved since the last inspection? What they could do better: Whilst there is a good system of care planning in place not all care plans are complete. Reviews are taking place for some but not all. One bedroom was found to be very cold on the day of the inspection. There was an unguarded portable heater in the room, which if left on could cause considerable harm if someone was to touch or fall against it. Measures must be taken to ensure that all rooms are kept at a desirable temperature using a safe method of heating. Some areas of the home were not free from offensive odours. Carpets in the corridors were stained and in one place posed a trip hazard as they had been left unstuck where a radiator had been previously removed. Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 8 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 Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments of residents prior to admission ensure that staff have enough information in order to know and meet their needs. Residents have enough information about the home before they move in. The home does not provide intermediate care. EVIDENCE: In order to help prospective residents to make a decision about where they live, they are, where possible, invited to come and look around the home. Before moving in to the home all prospective residents have their needs assessed to ensure that the home can meet their needs. Information is gathered from the prospective resident, family, and health and social care Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 10 professionals. The team leader confirmed that she has visited prospective residents with the manager prior to them visiting the home. The staff described how each new admission to the home is made welcome and helped to settle in. Staff say they have enough information about each new resident and are prepared for their admission. In staff surveys four members of staff said they were always introduced to new residents, two said never and one said sometimes. In addition there is a guide to the home detailing the services available and the ethos of the home. This guide contains important information and it is given to all new residents. Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents get the care they need in a way that suits them. However this is not consistently reflected in the written care plan, which could potentially place residents at risk of receiving inconsistent care. The healthcare needs of residents are well met with evidence of multidisciplinary involvement. The systems for the management and administration of medications are good and ensure that residents’ medication needs are met safely. Personal support is offered in such a way as to protect and promote residents’ rights to privacy and dignity. EVIDENCE: Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 12 The care plans are currently being updated and not all are complete. The inspector looked at three care plans in depth. Of those that are complete they are written in a way that makes them easy for staff to read and understand. Each direction regarding care is generally accompanied by an explanation to help staff understand why they are carrying out care in a certain way. There is evidence that residents are involved in their care planning as they include information about the resident’s preferences, normal routines, likes and dislikes. Staff report that they have easy access to care plans and that information is given to them during handover. Team leaders review the plans on a monthly basis but not all were completed. Staffs’ knowledge about care plans is good and as a result the quality of care delivered is consistently high. There is good evidence that health and social care professionals are appropriately referred to and involved with residents care; and that residents have their healthcare needs met. This includes involving the chiropodist, dentist, doctor, district nurse and community psychiatric nurse. A relative said ‘my mothers is looked after well’. One healthcare professional said ‘Exmouth House provides a good level of care and support for their residents’. Systems for managing medications are good. There is a system for ordering, receiving, storing and returning medicines, which is well understood by staff and followed to ensure safety. Staff receive training in managing medications and records checked are up to date. Staff demonstrated a good understanding of how they can help residents to maintain dignity and how they can ensure residents have privacy. For example all care is given in private and residents wear their own clothes at all times. ‘ Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from varied organised and spontaneous activities, and from an ethos that promotes their rights to have control over their own lives. Residents benefit from contact with their family and friends, which is encouraged and supported by the home. Residents enjoy a balanced diet which takes into account the likes and dislikes of most individuals. EVIDENCE: Residents described the flexible routine at the home; one said, “I can get up when I like ”, another said, “I can do what I like”. The inspector saw several examples of where staff worked to ensure residents’ wishes were met. Since the last inspection the home has employed an experienced member of staff as the activities co-ordinator who provides 20 hours a week of group and individual activities. On the day of the inspection several residents were seen Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 14 wearing the Easter bonnets they had made for the Easter parade that had taken place at the home the previous weekend. All the residents that were able to said that they had enjoyed the Easter activities. Several residents were seen reading the daily newspaper and two others were knitting in the lounge. One resident’s survey said ‘they would enjoy being able to go out more’ and one professional said that improvement could be made with social activities especially around ‘activities outside of the home’. The menu is quite varied. Residents’ comments on food included: “very good” and “very nice”. Specialist diets are provided if required so that health care needs can be met. Residents eat in the attractively laid dining room; meals are served in two sittings, the first being for those residents who may need assistance with eating so that they have more time and are not rushed. There is a good choice offered for each meal a day in advance. The mealtime was observed and staff were seen quietly moving around the dining room giving assistance where needed. All the residents seemed to enjoy their meal on the day. Relatives and friends were seen visiting the home throughout the day. They were made welcome and the atmosphere was relaxed and friendly. Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints process with evidence that complaints are listened to and acted upon. Residents are safeguarded from abuse. EVIDENCE: All relatives responding with surveys felt that staff listen and act on what they say. All knew who to speak with should they have any concerns or complaints. A good record of complaints and outcomes is kept. No complaints have been received by CSCI since the last inspection. Staff receive training in the protection of vulnerable adults and demonstrate a good knowledge of abuse and what to do if this were alleged or witnessed. Staff surveys indicate that all staff that responded are aware of adult protection procedures. Residents say they feel safe and, based upon observations made by the inspector, clearly have relaxed relationships with the staff. Risk assessments have been completed and consent has been sought prior to the use of bed-rails, which is good practice. Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 16 Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is very well maintained, warm and clean and upgrading is a continual process. The grounds are equally safe and well maintained. The positive aspects of the home are slightly undermined by the odour in certain areas of the home. EVIDENCE: The home has a well-maintained environment, which provides aids and equipment to meet the care needs of elderly people. The home was really clean throughout. However, some areas were malodorous. This was discussed with the manager and whilst the home does Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 18 cope extremely well we agreed that these areas must be addressed and new carpets purchased if necessary. The home is decorated to a very good standard. The communal areas are very nice. There is ongoing decoration programme, residents’ benefit from pleasant surroundings. The laundry facilities are well organised. The garden looked well cared for. Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number of staff on duty throughout the day and night meet residents’ personal and health needs. Training and recruitment practices ensures residents are protected from potential abuse. EVIDENCE: The home operates a good recruitment procedure. Three staff files were looked at; all were up to date and contained pertinent information relevant to their employment and for the protection of residents, for example police checks and references were obtained. All newly employed staff undergo a period of training when they start working at the home to enable them to get to know the residents, the homes philosophy of care, safety procedures, all procedures and the general layout of the home there was documentary evidence to support this. In surveys returned by relatives one said staff ‘always’ had the right skills to care for their relative, three said ‘usually’ and one said ‘sometimes’. One Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 20 person commented that they had difficulty communicating with some of the overseas staff because of the different accents. One relative said about the staff “my mother has superb attention from staff with her priorities always being attended to”. In surveys staff said they are never asked to care for people outside their area of expertise, that they feel they are well trained and supported to carry out their role and that they have enough time to provide the care required. Approximately 84 of care staff are trained to NVQ level 2 or above and specialist training is provided. Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from an experienced manager. Residents’ are involved in the running of the home. There are systems are in place to ensure that residents’ personal monies are correctly managed. Systems are in place to promote the safety and health of residents and staff. EVIDENCE: Residents and staff benefit from the experience and competence of the Registered Manager and the senior management of the company who work Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 22 hard to continually improve and keep standards high. Since the last inspection the home has sent out questionnaires to residents, relatives and other stakeholders in the community (e.g. GPs, District Nurses and voluntary organisation staff) in order to obtain their views of the service. The completed questionnaires are audited and actions made to improve the service. The monies held on behalf of three residents were checked. The system used is secure, clear and auditable. Prior to the inspection the manager of Exmouth House provided the commission with information about their policies and maintenance checks and controls. These appear to be in order. Mandatory training, including first aid, fire prevention, food hygiene and manual handling is provided for all staff, as is some specialist training as required. Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 23 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 3 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 2 2 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 Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 24 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. 2. Standard OP7 OP25 Regulation 15(2)(b) 23(p) Requirement Timescale for action 31/05/07 3 OP26 16(k) The Registered person must keep all service users’ plan under review. Suitable heating which is safe for 30/09/07 service users must be provided in all parts of the home (bedrooms) All parts of the home must be 31/05/07 kept free from offensive odours. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Exmouth House DS0000021936.V327391.R01.S.doc Version 5.2 Page 26 - 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. 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