Inspection on 22/03/07 for The Homestead

This inspection was carried out on 22nd March 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

The Homestead 23/02/06

The Homestead 13/09/05

The Homestead 03/02/05

The Homestead 18/08/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Homestead 6 Elwyn Road Exmouth Devon EX8 2EL Lead Inspector Jo Walsh Key Unannounced Inspection 22nd March 2007 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 The Homestead DS0000022056.V325183.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. The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Homestead Address 6 Elwyn Road Exmouth Devon EX8 2EL 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 263778 01395 273371 call.us@homesteadhomes.co.uk Homestead Homes Ltd Mrs Hazel Joan Neville Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24), Physical disability over 65 years of age of places (24) The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd February 2006 Brief Description of the Service: The Homestead is a detached Edwardian house set in large well kept gardens in a residential area of Exmouth close to shops and all local facilities. Accommodation is provided in 18 single bedrooms, 15 of which have en suite facilities, and 3 double bedrooms with en suite facilities. There are 2 lounges, and a dining room. One of the lounges provides day care facilities for residents and people who live elsewhere and visit the home for the day. There is also a small quiet sitting area plus a large entrance conservatory with a couple of chairs where some service users enjoy sitting. The home provides personal care for up to 24 older people who may also have a physical disability. There are waking staff on duty at night. The home places a high priority in providing a wide range of activities and outings to suit all interests. The range of fee are from £392 to £499 per week and do not include hairdressing, chiropody, papers and magazines and accompanied hospital visits. A copy of this inspection report is made available to visitors, staff and residents in the home. The Homestead DS0000022056.V325183.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 a weekday in March and lasted for approximately six hours. The main focus of the inspection was to seek the views of the residents and get their opinion on what life is like at The Homestead. To this end all residents were sent a survey prior to the inspection and 7 were returned. All of these had positive feedback. During the inspection 8 residents were spoken to and two were case tracked. This means they were spoken to at length about their experiences of living at the home, and their records relating to their care and medications were also looked at. Staff were also asked about these individuals and what their understanding of their needs were. This helps to get a clear picture of how care and support is provided and what records are in place to assist staff to provide quality and consistent care. Surveys were sent to some relatives and to visiting health care professionals and their comments are included in the report. The registered manager and registered providers were present during the inspection and spent some time providing information to inform the process. In addition they were asked to complete a pre inspection questionnaire, which gives details of staffing, training and how they maintain their premises and equipment. This information helps to inform the inspection process. The inspector was made very welcome throughout the day and would like to thanks the staff and residents for their helpfulness in completing this inspection. What the service does well: The Homestead provides individuals with a very homely and well maintained environment. The level of cleanliness within the home is exceptionally high and the staff are to be commended for their care and attention in this area. Residents’ personal, health care and social needs are well met by a team of staff who are trained and supported to do their job. Residents spoke highly about the care and support they receive and comments included ‘I have nothing but praise for the staff, they look after us very well.’ ‘Staff are wonderful, kind, caring. They work very hard and I think they are great.’ Staff treat residents with respect and dignity and include them in decision making within the home. Residents said they had helped to choose new décor for the lounge and discussed what they wanted in menus during residents meetings. The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 6 The home works hard to provide a range of meals that suits individual preferences and choices. There is always two choices of main meal and special diets can be catered for. Residents expressed a high level of satisfaction about the meals. One resident said that they had included things that ensure their particular needs were catered for. Another said ‘’it’s like a hotel here, except you can have a glass of wine, but you don’t get billed for it’’ Systems are in place to ensure that there is a robust recruitment process that protect residents. Staff have clear policies, procedures and training to ensure they understand residents’ needs and the protection of their rights. Residents are given opportunities to have their say about the home via surveys, residents meetings and one to one discussions with staff. This helps to inform the homes quality assurance plan, looking at what improvements can be made to improve the quality of care provided. Some residents and relatives are on the home’s management committee and are involved in the decision making about the running of the home. What has improved since the last inspection? What they could do better: The home have met all previous requirements and recommendations. They will be reviewing their quality of care and practices via their quality assurance systems. This includes; registered provider monthly unannounced visits, regular meetings with residents and surveys to residents and relevant stakeholders. The Homestead DS0000022056.V325183.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. The Homestead DS0000022056.V325183.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 The Homestead DS0000022056.V325183.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 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 a good admission and assessment process, which ensures that the home can meet their needs. EVIDENCE: The pre admission assessment information was seen for the two newest residents. The registered manager explained that she would, where possible visits the individual in their home, or hospital and talk to them about what they needed support with and if appropriate talk to their carers to get a clear picture. This information is then used to help develop the care plan. Staff spoken to confirmed they are given information about new residents to help them plan for their care. The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ care is well planned, providing staff with information they need to meet residents’ needs. Residents’ health needs are met and supported by the appropriate involvement of other health professionals. There are good systems for managing medications. Staff and the management team promote residents’ privacy and dignity. EVIDENCE: Three care plans were looked at in some detail. They clearly identify individuals’ needs and preferences in respect of how they would like their care and support delivered. This information is being further enhanced with the introduction of a new care plan that links needs with short term goals and action plans for staff to follow. This will ensure that staff provided consistent and good quality care. The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 11 Health care needs are clearly recorded and plans show that health care professionals are called in when needed. Residents spoken to confirmed that they can see their general practitioner when needed and that they have a visiting chiropodist, optician and the district nurses see individuals for wound care and other specialist nursing tasks. One resident said they were supported to get to their appointments with the hospital. One resident spoken to said that staff were very caring and particularly when they had had periods of ill health Three comment cards were received from general practitioners and all gave positive responses about the care and support provided at The Homestead. Residents said they were well cared for, comments included ‘I have nothing but praise for the staff, they look after us very well.’ ‘Staff are wonderful, kind, caring. They work very hard and I think they are great.’ The homes medication storage and recording system was looked at during this inspection. The medication are received weekly and these are checked and recorded on the medication records. Staff have training on medication procedures and their competencies are checked on a regular basis. Residents who wish to self medicate have a risk assessment completed to ensure they can do this safely. This is kept under review as part of their care planning monthly review process. Residents who self medicate are provided with lockable storage in their rooms. Staff spoken to were aware of the need to treat residents with respect and knew of ways of protecting their privacy. They were seen to knock on residents’ bedroom doors and speak to residents respectfully. Residents and staff confirmed that when general practitioners or nurses visited they were able to receive their treatment in a private place. The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Routines are flexible and social activities meet residents’ expectations and preferences. 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 individuals. EVIDENCE: The routines of the home appear flexible to suit residents’ needs and wishes. Residents spoken to said that they decided what time they got up, where they spent their days and what time they went to bed. One resident said in their survey ‘whatever my request might be every carer will help me, I am very happy in the home’. On the day of the inspection some residents were sitting in the lounge, some in their rooms and a few were having a lay in. Staff spoken to said that they assist individuals to get up and go to bed at times that suit them and had a good understanding of individuals’ needs and their rights to make choices and The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 13 decisions. One relative survey commented ‘’ treats all their residents as individuals and makes them feel very at home- it has a very homely feel to the home.’’ Residents are supported to maintain contact with family and friends, one individual said that staff made a special effort to get them out to see their family on special occasions. Residents said they could have visitors whenever they wished and that they were made welcome with trays of tea. One resident said that ‘’staff could not be nicer, welcoming and kind.’’ One resident commented in their survey ‘This is a ‘home’, all visitors comment on this when they come, there is always a welcome.’ Residents can have their own phone lines installed or can have use of the homes phone. There is a cordless phone available, to ensure privacy. Mail is given to residents unopened. Family can stay in touch via e mail to the providers. The home offers a range of activities, both group and individual sessions, including occasion trips out for coffee and local places of interest. Residents spoken to mostly said they enjoyed the activities on offer and outings and activities were discussed at residents meetings. The registered manager said that where they are aware an individual has a particular interest or hobby, they would try to ensure this is accommodated. One relative survey said ‘’they provide extra activities and outings to involve as many people as possible.’’ One resident said ‘I do not like group activities, but very much enjoy being taken for walks around the gardens and avenues.’ The home provides a good choice and range of meals to suit all tastes and can cater for special diets. There is always a choice of at least two options for all meals and the main meal, lunchtime, is served with wine or sherry, main course, sweet and cheese board. Residents expressed a high level of satisfaction with the meals served and comments included ‘’it’s like a hotel here, except you can have a glass of wine, but you don’t get billed for it’’ ‘’the food is very good, you get lots of choice and there is always plenty of it’’ The lunchtime meal was served in a relaxed and unhurried manner and those needing some assistance was given help in a respectful and unobtrusive way. The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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 residents spoken with and those 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. Several residents said they could raise any concerns via the residents meetings No complaints have been received by CSCI since the last inspection. Staff spoken to were aware of what to do if they suspect abuse and reported they had had training in this area. The manager also said that new staff have some training in the protection of vulnerable adults as part of their induction. The homes recruitment practice ensures that all relevant checks are made on new staff to help protect residents. The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from living in a clean, well-maintained, comfortable home. EVIDENCE: The home is well maintained and provides aids and equipment to help staff meet the needs of elderly people. The home is exceptionally clean throughout and the staff are to be commended for their care and attention to ensuring residents have a clean and homely environment to enjoy and be comfortable in. Residents and relatives commented in their surveys about the cleanliness of the home. The registered providers have an ongoing programme of maintenance and renewal of the fabric of the building. They ensure that when décor is being changed, residents are included in the decision making. The communal lounge has recently been refurbished and the whole home is decorated and furnished to a high standard. The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 16 Since the last inspection a door has been added to the side of the building, this means staff do not have to go around the building to take laundry to the laundry room which is an outbuilding to the side of the main house. The home has good infection control policies and procedures and staff were observed to be using these to good effect to ensure residents are safeguarded from cross infection. Gloves and aprons are available in all parts of the home. The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. 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 needs of residents are met though the number and dedication of the staff. Staff are trained adequately to do their jobs. EVIDENCE: During the morning of the inspection there was three cleaners, three carers, the registered manager and a cook on duty for 23 residents. Residents spoken to said their needs were met in a timely fashion although one or two did comment that staff were busy and one said they needed more staff on duty. Information received from the manager, prior to the inspection, indicates that ten of the staff have NVQ 2 or above, this equates over 50 of care staff. This will protect residents by ensuring that they are cared for by competent staff. Staff spoken to and those who returned surveys said that they had good training opportunities to keep their skills and knowledge updated. Training includes aspects of health and safety to ensure residents and staff are kept safe with good working practices. The home operates a good recruitment procedure that clearly highlights the processes to be followed. Two staff recruitment files were looked at during the The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 18 visit. The documentation was consistent with evidence of a safe and robust recruitment process being carried out before a person is employed at the home. The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from an experienced manager, and 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: The registered manager is experienced and is in the process of completing her final part of the qualifications needed. She is able to demonstrate ongoing learning and has a good working relationships with staff, the providers and residents. Staff spoken to said they were able to talk to the manager and believed their opinion was valued. The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 20 The home has systems in place to ensure that the residents are able to have a say about the running of the home. There are regular residents meetings and four residents and some relatives sit on the management committee to help decide on all aspects of the running of the home. Surveys are used to check residents are happy with the quality of care and support provided and residents said they had been involved in deciding what menu choices the home has and new décor for communal areas. The home helps to manage some individual personal allowances and records in respect of these were looked at. The records and balances of money was correct and there appeared to be a good audit trail to ensure residents are safeguarded. Fire safety equipment, for example fire extinguishers, had been regularly serviced and the fire log showed regular checks and maintenance on emergency lighting and fire alarms. The pre-inspection questionnaire demonstrated that mandatory training was well managed at the home. Training records and discussion with staff confirmed this. The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 4 x 3 x x 3 The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 22 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. Refer to Standard Good Practice Recommendations The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton Devon 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 The Homestead DS0000022056.V325183.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!