CARE HOMES FOR OLDER PEOPLE
Exmouth House 12 Long Causeway Exmouth Devon EX8 1TS Lead Inspector
Anita Sutcliffe Unannounced Inspection 25th July 2005 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. Exmouth House D54-D06 S21936 V232750 ExmouthHouse August Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Exmouth House Address 12 Long Causeway, Exmouth, Devon, EX8 ITS 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) 01395 275926 01395 269084 Somerset Redstone Trust Ms Kathleen M Betts Care Home 31 Category(ies) of DE(E) Dementia - over 65 (31) registration, with number of places Exmouth House D54-D06 S21936 V232750 ExmouthHouse August Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Home may admit one named person, aged under 65 in the category of DE Dementia 2. The maximum number of persons including that of the named individual will remain at 31. 3. At the termination of the placement of the named individual the registered person will inform the commission and the particulars and conditions of this registration will revert to those held on 14 July 2003 Date of last inspection 16 March 2005 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 home is supported by the district nursing service. 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. Exmouth House D54-D06 S21936 V232750 ExmouthHouse August Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection visit took place on a Monday afternoon over 4 hours. Prior to the inspection the home had completed a CSCI information questionnaire; 9 service users (residents) and 1 family member had provided opinion of the home. The majority of the inspection visit was spent talking to residents in the lounge, television room, walking around the home and in their rooms. Catering staff, care staff and the deputy manager gave information. Medicine arrangements were examined, and complaints and care records read. Parts of the home were visited, including the enclosed garden, kitchen and the food storage area. The home had its full complement of 31 residents. CSCI information leaflets, with contact details, were left around the home. What the service does well: What has improved since the last inspection? What they could do better:
The kitchen floors and walls were not clean enough. The food storage area was very clean. Kitchen staff said that they are currently reviewing the cleaning schedule for the kitchen. Residents who were able to contribute their views about the home, could not think of anything the home could do better.
Exmouth House D54-D06 S21936 V232750 ExmouthHouse August Stage 4.doc Version 1.40 Page 6 Staff felt that all residents should have the opportunity to have outings. They were concerned that those with no family or friends to assist are disadvantaged. 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. Exmouth House D54-D06 S21936 V232750 ExmouthHouse August Stage 4.doc Version 1.40 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 Exmouth House D54-D06 S21936 V232750 ExmouthHouse August Stage 4.doc Version 1.40 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) 1 Prospective residents have the information necessary to know about the home and what it has to offer. EVIDENCE: A recently admitted resident had been supplied with the home’s Statement of Purpose and Service User’s Guide. These had recently been updated. They provide a lot of information about the home. Exmouth House D54-D06 S21936 V232750 ExmouthHouse August Stage 4.doc Version 1.40 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) 9 Medication at the home is well managed. EVIDENCE: There have been some small but important changes to ensure safety when handling medicines. Records seen were clear and storage was very orderly. Exmouth House D54-D06 S21936 V232750 ExmouthHouse August Stage 4.doc Version 1.40 Page 10 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) 12,13,14 & 15 Residents are supported to have a fulfilled life. They benefit from a balanced and nutritious diet. EVIDENCE: Residents spoke about their experience of living at the home. Comments received included “you can do what you want but staff would advise you if necessary”. Interaction between staff and residents was observed as being friendly, unhurried and respectful. Residents have been surveyed about activities at the home and from this changes have been made. Activities include exercise, song and performance, pampering from a manicurist and cooking. Records show that a detailed social history is sought so that social, religious and cultural needs can be identified and met. One resident talked of meeting friends at a club, another of attendance at their church. Staff feel that residents without able family or friends to help them, do not have the opportunity to go out as much as they might like. Staff are rarely able to take residents out, and when a bus is hired they have to stay in it. This means that some are unable to visit the shops. Residents were complimentary about the food. There is always choice, special diets are catered for and the dining room is attractive.
Exmouth House D54-D06 S21936 V232750 ExmouthHouse August Stage 4.doc Version 1.40 Page 11 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 & 18 Residents benefit from the home’s approach to complaints and are protected from abuse. EVIDENCE: The complaints procedure is clearly displayed at the home’s entrance and included in literature on admission. Records showed that a complaint would be thoroughly investigated and actions would be taken to address concerns. Staff were clear in their understanding of abuse and their responsibility to the vulnerable adults in their care. A resident said she felt very safe at the home. Exmouth House D54-D06 S21936 V232750 ExmouthHouse August Stage 4.doc Version 1.40 Page 12 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 Kitchen cleaning is not adequate. EVIDENCE: Standard 19 was not inspected in full. Whilst talking to kitchen staff about the food provided it was noticed that the kitchen was not adequately cleaned. This was shown to the deputy manager. The food storage room was orderly and very clean. Kitchen staff said that the cleaning schedule was currently being reviewed. Exmouth House D54-D06 S21936 V232750 ExmouthHouse August Stage 4.doc Version 1.40 Page 13 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) These standards were not inspected on this occasion. EVIDENCE: Exmouth House D54-D06 S21936 V232750 ExmouthHouse August Stage 4.doc Version 1.40 Page 14 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) These standards were not inspected on this occasion. EVIDENCE: Exmouth House D54-D06 S21936 V232750 ExmouthHouse August Stage 4.doc Version 1.40 Page 15 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x x Exmouth House D54-D06 S21936 V232750 ExmouthHouse August Stage 4.doc Version 1.40 Page 16 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 19 Regulation 23(2)(d) Timescale for action The registered person shall 31 July having regard to the number and 2005 needs of the service users ensure that all parts of the home are kept clean. [This refers to a lack of cleanliness in the kitchen] Requirement 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 Good Practice Recommendations Exmouth House D54-D06 S21936 V232750 ExmouthHouse August Stage 4.doc Version 1.40 Page 17 Commission for Social Care Inspection Devon Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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