Inspection on 26/06/06 for Magnolia House, Exmouth

This inspection was carried out on 26th June 2006.

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

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

Other inspections for this house

Magnolia House, Exmouth 18/08/09

Magnolia House, Exmouth 20/08/08

Magnolia House, Exmouth 15/06/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Magnolia House, Exmouth 40 - 42 Morton Road Exmouth Devon EX8 1BA Lead Inspector Caroline Rowland-Lapwood Key Unannounced 26th June 2006 10:00 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 Magnolia House, Exmouth DS0000021974.V294753.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. Magnolia House, Exmouth DS0000021974.V294753.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.V294753.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd February 2006 Brief Description of the Service: Magnolia House provides 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. Parking is on the road. Accommodation is arranged over three floors. All rooms are singles and 12 of these have en suite facilities. There are two lounges and two dining rooms on the ground floor. A passenger lift accesses all floors. A small sitting area is available to the front of the building and a small courtyard area to the rear which has been made accessible to service users. Information received from the home in May 2006 indicates that the current fees are £322-£420 weekly. Services not included in this fee are hairdressing, chiropody, papers and magazines. CSCI Inspection reports are available upon request; the summary of the latest report is given to prospective residents. Magnolia House, Exmouth DS0000021974.V294753.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on the 26th June 2006 and took approximately 6 hours. The manager was present throughout the inspection. Seven members of staff, eleven residents were observed, some were able to be consulted with and their views on the home discussed. The inspector prior to the visit sent out a number of questionnaires seeking people’s views on the home. Four questionnaires completed by residents, one from members of staff, three from GP’s, one from a district nurse and three from care managers were returned. A tour of the building was made and a number of records inspected. This included residents’ care plans, staff recruitment files, fire safety records, general homes policies and the pre-inspection questionnaire. This is a document, which the home sends to the regulation inspector before the inspection, which provides current detail of the home. What the service does well: The home has a group of staff many of which have worked there for several years providing continuity of care. They are keen to ensure the well being and comfort of the residents and were observed treating them with great respect and kindness. All the residents that were able to express an opinion said that staff were very good and that they were happy living at the home. The home works hard to meet individual needs with regard to meals and mealtimes, for instance the lunch time meals are now staggered to enable those residents that need assistance with eating enough time to ensure that their lunch is enjoyed and not rushed or hurried. The staff team manage the daily activities well and provide opportunities for residents to maintain links with the local community. Outside entertainers also visit the home on a regular basis. The home was immaculately clean throughout. Magnolia House, Exmouth DS0000021974.V294753.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Staff have not completed appropriate induction training. All staff must have this training to ensure the safety and well being of the residents. Staff recruitment procedures are not always robust therefore compromising residents’ safety. Five of the twenty-three care staff employed have achieved the NVQ level 2 or above in care. The standard expected was 50 qualified to this level by 2005. The home is still trying to achieve this so as to confirm staff competence. Complaints received must be recorded and responded to in the proper timescales. The home must write to prospective service users to confirm whether or not they can meet their needs. All service users or their representative should be involved in their care planning process. Some issues with regard to medication are still outstanding from the previous inspection; this is mainly due to the lack of training courses available. However, these issues must be addressed as a matter of urgency as service user and staff welfare and not safeguarded. Safety throughout the home is poor. There are radiators that remain uncovered, windows on the upper floors with no restrictors fitted and fire doors were seen wedged open. This seriously compromises residents’ safety. Some parts of the home were not free from offensive odours. Magnolia House, Exmouth DS0000021974.V294753.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. Magnolia House, Exmouth DS0000021974.V294753.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.V294753.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. Resident’s benefit from good admission and assessment practice, which ensures that the home is able to meet their needs. However, some improvements must be made to clarify whether or not the home can meet the individual needs prior to admission. Intermediate care is not provided at Magnolia House. EVIDENCE: Residents and their relatives said that they chose Magnolia by visiting and being given lots of information about the home prior to admission. The Manager visits prospective residents before admission in their own homes or hospital prior to admission. Pre admission assessments were seen to support this information. They contained comprehensive information to confirm whether the home could meet the assessed needs of the individual. Once this Magnolia House, Exmouth DS0000021974.V294753.R01.S.doc Version 5.2 Page 10 assessment has been done and a decision made the home must write to the prospective resident to confirm the outcome. Magnolia House, Exmouth DS0000021974.V294753.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Individual needs are recognised and met through comprehensive care planning arrangements. Medication is generally well managed but attention is still needed in one area, (staff training) which impacts on safety for the residents. Residents are treated with respect. EVIDENCE: All residents have an individual plan of care. Each of these contains information pertinent to meeting residents’ needs. Staff have a sound knowledge of the individual needs and preferences of residents. Plans are kept up to date and are reviewed frequently. However, residents and relatives are not always involved in reviewing these. Several of the relatives confirmed that they were aware of the care plans and had seen them. Magnolia House, Exmouth DS0000021974.V294753.R01.S.doc Version 5.2 Page 12 Feedback from healthcare professionals also showed that they were aware of the care plans in place and contributed to them as required. Records confirmed that the home calls on health care professionals as required; on the day of the inspection an optician was visiting several residents for a routine eye check. Medication is generally managed well with the exception of staff receiving appropriate training. Medicines given were signed for appropriately. Staff were seen talking and laughing with residents in a warm and friendly way, the relatives that commented said that the staff were kind and respectful. Some comments made were “ they try their best” and “ they help me whenever I need it”. Staff were witnessed knocking on bedroom doors and respecting residents’ privacy. Magnolia House, Exmouth DS0000021974.V294753.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Social needs and meals are generally well managed. Residents are able to maintain control over their daily lives. Residents receive a nutritious, varied diet, which meets individual choice and healthcare requirements. EVIDENCE: A variety of activities are provided by the home. Some form of activity takes place every day. On the day of the inspection a member of staff was playing bingo with four residents in the dining room. Another resident was out at a day centre. Every Tuesday a lady comes in and provides a session in musical movement and activity. Some residents that were able to comment said they enjoyed the activities others said it was not for them. All confirmed that they were able to decide for themselves whether to take part or not. Magnolia House, Exmouth DS0000021974.V294753.R01.S.doc Version 5.2 Page 14 Many residents said they enjoyed being in their own rooms listening to the radio or watching the television. Residents are supported to maintain their religious beliefs by staff at the home and a record of individual wishes is kept in the care plans. All the residents that were able to confirm that they were able to get up and go to bed when they requested. Residents said that their visitors were always made welcome and that there were no restrictions on visiting. All five relatives that were spoken with confirmed this; one said, “It’s a joy to visit”. The menu is quite varied. Residents’ comments on the food included: “lovely food” and “the food is excellent”. The lunchtime is broken into two servings. Those that need help with eating have their meal first so that they may enjoy their meal and get the help they need without being rushed. This was observed and staff were seen feeding residents in a kind and sensitive way. This is to be commended. Magnolia House, Exmouth DS0000021974.V294753.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. Residents are safeguarded from abuse. The home has a satisfactory complaints process. EVIDENCE: Five staff that were spoken with were able to confirm that they were about to have adult protection training and were aware of the whistle blowing procedure. Training records confirmed this. Staff demonstrated a good understanding of abuse and they knew what to do if they suspected any. There is a complaints procedure displayed in the dining room and in the hallway of the home, which informs the residents and their visitors of how and to whom to complain. Magnolia House, Exmouth DS0000021974.V294753.R01.S.doc Version 5.2 Page 16 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): 19 & 26 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to the service. Although the overall quality rating is adequate, areas of residents’ safety is poor. Residents’ safety is compromised due to poor Health & Safety management (see standard 38). The service provides a homely environment, which is very clean. However, not all areas are free form offensive odours. EVIDENCE: On a tour of the building all areas seen were very clean comfortable and homely looking. In general the home was clean and fresh smelling, however a few areas were identified as having offensive odours. This was discussed with Magnolia House, Exmouth DS0000021974.V294753.R01.S.doc Version 5.2 Page 17 the care manager who agreed that carpets needed to be replaced in order to rectify the matter. Fire doors were seen wedged open. Upper floor windows were unrestricted and could open very wide, many had low windowsills too which make a significant hazard. Many of the radiators throughout the home have been covered or have low temperature surfaces. However, there are still several that are not covered that pose a risk to residents of scalding. Magnolia House, Exmouth DS0000021974.V294753.R01.S.doc Version 5.2 Page 18 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): 27,28,29 & 30 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to the service. Staff are adequately trained and can meet residents needs. However, improvements are needed to provide induction training for all new staff. Staffing numbers are appropriate to the assessed needs of service users. The homes recruitment policy and practice is not robust and therefore does not adequately keep residents safe. EVIDENCE: On the morning of inspection there was the care manager, five care staff, a cook, domestic, laundry person and the maintenance man to care for twentyfour residents over three floors. Residents and relatives confirmed that there were generally enough staff on duty throughout the day. Training records showed that induction training is not carried out comprehensively nor immediately a member of staff starts employment. Therefore residents’ needs are not being met consistently or safely. Staff confirmed that they receive training, updates in some areas were planned for the following week, and these include the protection of vulnerable adults Magnolia House, Exmouth DS0000021974.V294753.R01.S.doc Version 5.2 Page 19 and moving and handling. Seven staff has recently completed a one-day First Aid course. Medication management training is planned for the future. Five of the twenty-three care staff employed have achieved the NVQ level 2 or above in care. The standard expected was 50 qualified to this level by 2005. The home is still trying to achieve this so as to confirm staff competence. Three staff files were looked at. They contained relevant information on each person. However, one file did not have copies of qualifications or a reference from the previous employer. This is essential to ensure the safety of residents. Magnolia House, Exmouth DS0000021974.V294753.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to the service. Residents’ financial interests are safeguarded at the home. The health and safety of residents is not fully promoted EVIDENCE: The care manager has begun working towards achieving the Registered Managers’ Award. The award helps ensure a competent approach to management of a care home. Residents’ welfare is the manager’s priority. She is experienced and highly thought of by residents and their family. All the relatives that were spoken with were very happy with her management of the home. Magnolia House, Exmouth DS0000021974.V294753.R01.S.doc Version 5.2 Page 21 In the past there has been an annual service user survey, seeking opinion on the home from residents and their family. A new survey is about to be sent out. No formalised staff supervision is in place; this is practice whereby staff are able to have a one to one meeting with their manager to discuss such things as training and development. The home does not keep monies for residents. Monthly accounts are sent out for any monies owed (newspapers etc) Equipment at the home is serviced and maintained. However, fire doors were seen wedged open, some radiators were not guarded and windows were not restricted on the upper floors. These issues pose a risk to residents especially to those who suffer from dementia. However, the care manager did take immediate steps to rectify these matters and was hopeful that work would be done in the very near future. Magnolia House, Exmouth DS0000021974.V294753.R01.S.doc Version 5.2 Page 22 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 2 X X N/A 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 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 1 Magnolia House, Exmouth DS0000021974.V294753.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP5 Regulation 14 (1)(d) Requirement Timescale for action 30/07/06 2. OP9 18(1) (c) The Registered person must confirm in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare. The registered person shall 21/09/06 ensure that persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform [This relates to staff administering medicines not receiving accredited training] The registered person shall 31/07/07 ensure that persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform (This relates to induction training). 3 OP30 18(1)(c) Magnolia House, Exmouth DS0000021974.V294753.R01.S.doc Version 5.2 Page 24 4 5 OP26 OP29 16(2)(k) 12(1)(a) 6 OP38 13(4)(c) 7 OP38 13(4)(c) 8 OP38 13(4)(c) The Registered person must keep the care home free from offensive odours. The Registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. (This relates to robust recruitment procedures including obtaining references from the previous employer, whenever possible). The Registered person shall ensure that unnecessary risks to the health and safety of service users are identified and as far as possible eliminated. (This relates to the fitting of window restrictors). The Registered person shall ensure that unnecessary risks to the health and safety of service users are identified and as far as possible eliminated. (This relates to hot surfaces, radiators and pipe work). The Registered person shall ensure that unnecessary risks to the health and safety of service users are identified and as far as possible eliminated. (This relates to fire doors being wedged open). 30/07/07 30/07/06 31/08/06 31/08/06 31/08/06 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 OP28 Good Practice Recommendations A minimum of 50 of staff should be trained to NVQ 2 (or equivalent). DS0000021974.V294753.R01.S.doc Version 5.2 Page 25 Magnolia House, Exmouth 2 OP36 All staff should receive formal supervision every six months. Magnolia House, Exmouth DS0000021974.V294753.R01.S.doc Version 5.2 Page 26 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 Magnolia House, Exmouth DS0000021974.V294753.R01.S.doc Version 5.2 Page 27 - 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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