Inspection on 18/08/09 for Magnolia House, Exmouth

This inspection was carried out on 18th August 2009.

CQC found this care home to be providing an Good service.

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

Magnolia House, Exmouth 20/08/08

Magnolia House, Exmouth 15/06/07

Magnolia House, Exmouth 26/06/06

Magnolia House, Exmouth 22/02/06

Magnolia House, Exmouth 13/07/05

Magnolia House, Exmouth 14/02/05

Magnolia House, Exmouth 13/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Magnolia House, Exmouth 40 - 42 Morton Road Exmouth Devon EX8 1BA Lead Inspector Sue Dewis Key Unannounced Inspection 18th August 2009 10:15 DS0000021974.V378078.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Magnolia House, Exmouth Address 40 - 42 Morton Road Exmouth Devon EX8 1BA 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 264338 01395 275824 t_keough@btconnect.com Ashgrove Care Company Limited Mr Thomas Duncan Keough Care Home 25 Category(ies) of Dementia (25), Physical disability over 65 years registration, with number of age (25) of places Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th August 2008 Brief Description of the Service: Magnolia House is registered to provide personal care for up to 25 older people who may also have a dementia type illness and/or a physical disability. It is situated close to the seafront and not far from the town centre of Exmouth. The property was formerly three large terraced houses, which have been converted and adapted. Accommodation is arranged over three floors, with a passenger lift giving access to all floors. All rooms are for single occupancy only with 12 having en suite facilities. There are two lounges and two dining rooms on the ground floor. There is a small outside sitting area available to the front of the building and a small courtyard area to the rear which has been made accessible to service users. Parking is on the road. Information received from the home indicates that the current fees are £391£480 weekly. Services not included in this fee are hairdressing, chiropody, newspapers and magazines. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk CSCI Inspection reports are available upon request with the summary of the latest report being given to people thinking of moving into the home. Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced visit took place over 8 hours, one day in the middle of August 2009. The home had been notified that a review of the home was due and had been asked to complete and return an AQAA (Annual Quality Assurance Assessment). This shows us how the home has managed the quality of the service provided over the previous year. It also confirms the dates of maintenance of equipment and what policies and procedures are in place. Information from this document was used to write this report. Although only one inspector undertook this inspection, throughout the report there will be reference to what we found and what we were told. This is because the report is written on behalf of the Care Quality Commission (CQC). During the inspection 3 people were case tracked. This involves looking at peoples individual plans of care, and, where possible speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process CQC likes to ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to some people living at the home, and some staff. At the time of writing the report, responses had been received from 7 people living at the home, all of which had been completed for them by a representative and 3 staff. Their comments and views have been included in this report and helped us to make a judgement about the service provided. During the inspection 7 people living at the home were spoken with in a group setting after lunch, as well as observing staff and people living at the home throughout the day. We also spoke with 4 staff the owners and the care manager. A full tour of the communal areas of the building was made and a sample of records was looked at, including medications, care plans and staff files. All key standards were inspected. The home has recently highlighted a concern about a member of their staff and this is being progressed through the Safeguarding Adults Procedure. Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.2 Page 6 What the service does well: Magnolia House is well managed and provides a safe, comfortable and homely place in which individuals can live their lives. Everyone looked clean and well cared for. There is a good assessment process that assures people thinking of moving into the home that their needs will be met. Everyone living at the home has a care plan that sets out their needs. Staffing levels are sufficient to meet the needs of people currently living at the home and staff are well trained. People living at the home said that staff were helpful and friendly. Many positive comments were received from individuals via surveys including, ‘I’m pleased with everything the home does’ and ‘The staff are conscientious and caring and know each resident’s care needs and as far as I can see everyone is treated with dignity and respect’. Staff said that they felt well supported by management and each other. Staff said via survey forms, that the home ‘Is clean and tidy and provides excellent training’. Another said when asked what the home does well ‘It is warm and friendly’. Another staff commented ‘There is a good atmosphere and the residents seem settled and content’. There was evidence of good multi-disciplinary working with other professionals and records were well maintained. People felt that meals were very good and there is always an alternative if people dont want what is on the menu. What has improved since the last inspection? What they could do better: Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.2 Page 7 Though some areas for improvement were identified, none were deemed to pose a significant risk to the health, safety and well being of those living and working at the home. For example the home should ensure that care plans show clear information about how to meet people’s social interaction needs so that these can be met. They should ensure that care plans provide detail to staff on how to manage behaviours. They should also ensure that daily notes evidence where identified needs have been met. The home should ensure the building is maintained to a standard that continues to provide people with a comfortable and homely place to live. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Magnolia House, Exmouth DS0000021974.V378078.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 Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good assessment and admission process in place, which means that people thinking of moving into the home can be sure that their needs will be met. EVIDENCE: The Statement of Purpose for the home is contained with the brochure that is sent to people on request, or given to people when they look around the home. We were also told that a new Service user Guide is being prepared and that it will also be available in large print and audio formats. The care manager explained the admission process from when she first receives a referral. She said that she, and another member of staff will go to see the individual in their own home or hospital and complete an assessment Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 Page 10 form. The care manager also told us that she will also collect as much other information from as many people as possible. People are always invited to look around the home and were told to just visit at their convenience as the care manager feels it is important for people to see the home at any time. Admission records that were looked at showed evidence of good assessments and risk assessments undertaken prior to the person moving in. The home writes to people to confirm that their assessed needs can be met before they move in. The home does not provide intermediate care. Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Everyone who lives at the home has a care plan which provides staff with information to enable them to meet peoples health and social care needs on a day to day basis. The management of medication is good and ensures people receive their medication as prescribed. EVIDENCE: The home uses the Standex care planning system. The care manager told us that the home is planning to change the care plans in the very near future. The care plans of three people living at the home were looked at. All three contained evidence of detailed assessments including nutrition and moving and Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 Page 12 handling as well as more generalised assessments relating to personal care needs. The plans contained good detail of the individuals assessed needs and there were good directions to staff on how needs should be met. For example one care plan stated when an individual begins to use inappropriate language staff should ‘sit with X and reassure them, offer a warm drink and use distraction techniques such as the radio/TV’. It was clear through discussions with staff that they knew the people they care for very well and knew how best to meet to meet their needs. However, none of the care plans focused on mental health needs and how these affected people’s lives, for example why and how they needed assistance with personal care or maintaining independence. Any information that was detailed was brief with no information about how this was to be used to maintain people’s wellbeing. Daily notes rarely mentioned how the person was other than in physical terms such as ‘awake all night’ but not how this was managed or supported, and they did not always evidence where identified needs had been met. For example there was a lot of ‘all pc given’. There were also several ‘X was verbally loud’, but no detail of what action staff took in response to this behaviour. Another plan said that someone ‘remains in their room now’ with no clear reasons or ways to manage this other than ‘left in chair’ or ‘left in room’. The care manager told us that she is aware of these matters and will be dealing with them. There was evidence that care plans had been reviewed regularly and updated as needed, there was also some evidence to show that the individual or their representative had been included in the care planning process. However, care plans are kept in the main office with care staff having easy access to them. There was evidence on file that peoples health care needs were being met, and that a range of health care professionals visited the home, including GPs and District Nurses. For example, it was possible to see where GPs had visited people following requests from the home. However, we were told that there had been difficulties in arranging for District Nurses to visit the home when needed and that Continence assessments were taking up to 18 months to be completed. There is a policy and procedure for the administration of medicines. The home does not have a homely remedies policy as no-one is given un-prescribed medication. No-one is currently being supported to look after their own medicines. All medicines were seen to be stored correctly and staff were seen administering them appropriately and signing the MAR (Medication Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 Page 13 Administration Record) as needed. We were told that all staff who administer medication have received appropriate training and that no-one administers medication until they have had this training. However, handwritten entries to the MAR sheet must be double signed to confirm the entry is correct. Topical creams should be marked with their date of opening so that they are not used after their disposal date thereby ensuring they remain effective. All people we saw during this visit looked well cared for, were treated with respect by the staff and their right to privacy was upheld. Personal care was seen to be offered in a discreet manner. Staff told us how they respect peoples privacy when helping them with personal care and we heard staff speaking with people in a kindly, friendly way. There was an obvious affection between staff and the people they care for. Many positive comments were received via survey forms that had been completed on behalf of individuals, by their representatives, including ‘My mother appears well fed and contented which is the most important thing’, I am happy with the care and support my mother is receiving’, ‘They keep me informed of any issues’ and ‘Always discuss issues, excellent caring staff who will always stop for a few minutes chat and reassurance.’ The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit indicates that in order to improve the service the home intends to provide staff with training on death, dying and bereavement and the Mental Capacity Act. Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Limited social interaction and activities are available, and there is not always daily variation for people living in the home. EVIDENCE: When we looked at people’s care plans we noted that there was very little social history detailed and even less detail about their likes and dislikes. This means that when staff are interacting with people they have little information about the person to use to stimulate conversation or help them pursue interests. We spent some time observing what people were doing throughout the day. The home does record people’s activities and stimulation but the records show that people mostly spend their day watching TV. Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 Page 15 When staff spoke to people there was a lovely, kind manner and obviously a good rapport but there was very little meaningful interaction with others for people living at the home other than during tasks. The home had employed an activities co-ordinator, but they have since left. Another person already working at the home now has responsibility in this area. There are activities and entertainments on offer, but these tend to be sporadic and there is little general social interaction built into people’s days. Activities and entertainments on offer include, Dramatherapy every two weeks, weekly exercises and a singer every 3 months. However, comments that were received via survey forms that had been completed on behalf of individuals, by their representatives included ‘There is a reliance on TV to ‘baby sit’’. Others indicated that activities were only available ‘sometimes’. The care manager told us that they home ensures people who wish to attend religious services can do so. They also told us how it had been identified that an individual can sometimes become restless when unoccupied, so she ensures at such times, that the person can help out in the kitchen drying dishes. This activity has been fully risk assessed and the individual is never left alone in the kitchen. We were told that this has significantly improved the quality of life for this individual and shows the benefit of regular planned stimulation and interaction. People told us that they can choose how and where they spend their time and routines within the home are flexible. The care manager and staff told us how they encourage people to make choices for themselves. We were told people decide what time they get up and go to bed, that there is always an alternative at meal times and that people can choose whether or not they join in with activities. The care manager told us that the home risk assesses all aspects of daily life in order to ensure any decisions made on behalf of people are made in their best interests. People living at the home who were able, told us that their family and friends can visit them at any time and that they are always made welcome. The care manager told us that families and friends had been invited to a coffee morning to start off regular meetings, so that people living at the home and their representatives can discuss any concerns or suggestions they may have. People told us that the food was very good and there was always plenty. We ate lunch with people in one of the dining areas and people were offered choices throughout the meal. The food was well presented and was nutritious and tasty. We were told that the cook prepares the menu daily and that vegetarian and diabetic meals are cooked if needed. Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 Page 16 The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit indicates that in order to improve the service the home intends to employ an activities co-ordinator and continue to increase the range of activities and outings. Also to provide staff with therapeutic activity training. Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good complaints procedure and people can be confident that their concerns will be listened to. Suitable procedures are in place to ensure that people are protected from abuse. EVIDENCE: There is a clear and simple complaints procedure in place to help people who may wish to, to raise concerns. A copy of which is displayed in the hallway. The care manager told us that there will also be a copy of the procedure in the new ‘Resident’s Handbook’ that she is preparing. The complaints record kept at the home show that no complaints were received by the home since our last visit. Any ‘moans and groans’ made by individuals are recorded on their care plans, showing outcomes. No complaints have been received by the Commission since the last visit. However, the home has recently highlighted a concern about a member of their staff and this is being progressed through the Safeguarding Adults Procedure. Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 Page 18 Some people living at the home who were spoken with during this visit were unsure about the home’s formal complaints procedure. However, those who we spoke with were able to tell us who they would tell if they were unhappy about anything, which was usually the care manager. Records show, and staff told us that they had now received training in Protection Of Vulnerable Adults (POVA) issues. All four staff that we spoke with were able to discuss differing forms of abuse and were able to tell us that placing a table in front of someone could be a means of restraining them. They all also said that they would report any suspicions they had to the care manager, and were able to tell us who they would report any concerns to, outside of the home. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit indicates that in order to improve the service the home intends to continue with training (In-House) and to update policies and procedures as required. Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 and 25 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the home generally provides a pleasant, comfortable and safe environment for those living in, working at and visiting the home, some improvements are needed. EVIDENCE: A full tour of the communal areas of the home was made and some individual bedrooms were looked at. All areas of the home were clean, well ventilated and there were no unpleasant odours. However, some areas of the home are starting to look ‘tired’ and in need of redecoration. The floor of one ensuite was noted as being in need of replacement and the care manager told us that this was to be looked at on the following Thursday. Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 Page 20 The owner told us that they plan to upgrade the home as soon as possible. The building consists of three terraced properties, only two of which are used for accommodation within the home. They plan use this space and to knock some of the smaller rooms together to make larger more accessible rooms and provide ensuite facilities. Communal areas consist of two comfortable lounges, a conservatory and two separate dining rooms. All areas are nicely furnished and decorated and have a comfortable, homely feel. The home can care for people who have some degree of dementia. However, while there are signs on doors indicating bathrooms and toilets there is no colour coding of areas or bedroom doors that may help people with a dementia. Peoples bedrooms contained many individual items and reflected the personality of the occupant. People told us that they had been able to bring things from their home when they had first moved in. There is limited outside space available to people, with only the small area at the front of the home being accessible. We discussed the possibility of making the small courtyard at the rear of the home more accessible. The public gardens and beach are only a short walk from the home and we saw people being taken there in wheelchairs during our visit. The home has a range of equipment available for staff and individuals including grab rails, handrails, standaids and hoists. Hand washing facilities are available in the laundry area. Liquid soap, gloves and paper towels were seen in people’s rooms to help prevent cross infection. Laundry facilities are suitable and good infection control measures were in place. Staff told us and records confirmed that they have received training in infection control procedures. Staff also told us that disposable gloves and aprons are freely available and they were seen using them appropriately. Many positive comments were received via survey forms that had been completed on behalf of individuals, by their representatives, including ‘Magnolia House has a warm and welcoming atmosphere with a number of different areas where residents can sit’. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit indicates that in order to improve the service the home intends to further improve front garden area - tables, flower pots, hanging baskets to make it visually attractive. To Provide better accommodation by integrating No 38 into the home. Change second floor bathroom into a wet room. Respond to comments about the home looking tired. Produce an action plan to redecorate and refurbish all areas of the home. Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A wide range of training is provided and the numbers and skill mix of staff on duty are sufficient to meet the needs of people currently living at the home. People are protected by recruitment procedures that ensure people who may be unsuitable to work with vulnerable people are not employed at the home. EVIDENCE: On the morning of the visit there were 6 care staff on duty plus the owner. The care manager came on duty to help with the inspection process. There was also a cook, a maintenance person and a domestic on duty, with care staff doing the laundry. These levels drop during the afternoon and evening to 5 and 4 care staff respectively. There are 2 waking care staff on duty each night. People that we spoke with felt that there were enough staff at the home to meet their needs. Care staff that were spoken with also said that they did not feel rushed and had the time to spend with people meeting their needs. The staff that we spoke with were able to tell us about the care needs of individuals and about how these needs were best met. Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 Page 22 Three staff files were looked at. All three files contained all the required information including satisfactory CRB (Criminal Records Bureau) checks, two written references and proof of identity. Records show and staff confirmed that they receive a wide variety of training, including Fire procedures, Moving and Handling, Food Hygiene, First Aid and Infection Control. Staff are also encouraged to work for NVQs (National Vocational Qualifications) and the AQAA (Annual Quality Assurance Assessment) submitted prior to the visit indicates that 13 staff currently have or are working towards NVQ level 2 or above. Most staff have received training in POVA (Protection Of Vulnerable Adults) issues although some staff need a refresher course in this area. Distance learning training for staff working with people with Dementia is also being provided and staff were able to tell us of how the course was helping them improve the care they give. All new staff receive a full induction in line with Skills for Care recommendations. Staff were praised by people living at the home when we spoke with them. Many positive comments were received via survey forms that had been completed on behalf of individuals, by their representatives, including ‘staff are caring and sympathetic’, ‘(staff) give time, laugh and joke with residents, listen to them’ and ‘…the nurses and carers at Magnolia House care about the old people with love and understanding’. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit indicates that in order to improve the service the home intends to continue with the constant process of updating training, to commence In-house training. To support all staff undertaking NVQ’s providing them with learning opportunities and allocated work time, and for the care manager to commence Diploma in Dementia with Bradford University(Sept 2010). Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed resulting in practices that promote and safeguard the health, safety and welfare of people who live and work in the home. EVIDENCE: The owner of the home Mr Keough is also currently the registered manager, although the day to day management of the home falls to the care manager. Mr Keough has the necessary skills and experience of managing a home as does the care manager. Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 Page 24 The home is managed efficiently and the care manager, owner and staff team work together well to create a homely environment for the people who live at the home. Staff that we spoke with during the visit told us that they felt supported by the care manager and owner to do a good job. Comments received from staff via survey forms included ‘I have found the support from the owner and care manager to be exceptional’. The home does not manage any monies on behalf of individuals. Individuals are billed each month for any items/services paid for by the home on their behalf, for example, hairdressing. The home has an annual quality assurance system in place that seeks to gain the views of people living at the home and their representatives. Questionnaires are sent out to people and from the responses charts are drawn up and a letter sent out to everyone saying what has been done about any areas of concern that were raised. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit, provided evidence that Magnolia House complies with health and safety legislation in relation to maintenance of equipment, storage of hazardous substances, fire precautions, health and safety checks and risk assessments. Policies and procedures are not always inspected during the visit but the information provided on the AQAA helps us form a judgement as to whether the home has the correct policies to keep people living and working at the home safe. Information provided by the home, evidenced that policies and procedures are in place and along with risk assessments are reviewed regularly and updated where necessary, to ensure they remain appropriate and reduce risks to people living and working at the home. We were told by the care manager that so that the risk of burning from hot surfaces is minimised, radiators within the home have been covered. However, some radiator covers have been damaged and are in need of repair. We were also told that all windows above ground floor level have been fitted with restrictors, in order to minimise the risk of anyone falling from these windows and that all taps are fitted with thermostats to minimise the risk of people being scalded. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit indicates that in order to improve the service the home intends to continue with staff training, to ensure regular review of risk assessments for all areas of the building, to continue to support staff fully with NVQ and training issues and to implement the new health and safety consultant’s package. Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 Page 25 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 X 3 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 Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 Page 26 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. 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 OP7 Good Practice Recommendations You should ensure that care plans show clear information about how to meet people’s social interaction needs so that these can be met. You should ensure that care plans provide detail to staff on how to manage behaviours. You should ensure that daily notes evidence where identified needs have been met. You should ensure the home is maintained to a standard that provides people with a comfortable and homely place to live. 2. 3. 4. OP7 OP7 OP19 Magnolia House, Exmouth DS0000021974.V378078.R01.S.doc Version 5.3 Page 27 Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.southwest@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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