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Care Home: Amberwood Nursing Home

  • 231 Exeter Road Exmouth Devon EX8 3ED
  • Tel: 01395263540
  • Fax: 01395263540
  • Planned feature Advertise here!

  • Latitude: 50.631999969482
    Longitude: -3.4110000133514
  • Manager: Mrs Christine Mary Allsopp
  • Price p/w: ~
  • UK
  • Total Capacity: 24
  • Type: Care home with nursing
  • Provider: Alextour Limited
  • Ownership: Private
  • Care Home ID: 1702
Residents Needs:
Old age, not falling within any other category

Latest Inspection

This is the latest available inspection report for this service, carried out on 9th June 2010. CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

For extracts, read the latest CQC inspection for Amberwood Nursing Home.

What the care home does well Everyone who goes to live at the home has their needs assessed, and from this a plan of care is drawn up as to how those needs will be met. The individual for who the care plan was written and their advocates (such as their next-of-kin), as well as staff, have access to these plans. People are referred to other healthcare professionals, such as the chiropodist and the speech and language therapist, to ensure certain of their needs are met. The home is clean, with good infection control procedures are in place. It has a lounge with a large screen TV and a music centre, and accessible garden that people are enabled to sit out in. There is ongoing investment in the home regarding decor and nursing equipment. People enjoy a varied diet that meets their particular dietary needs. They can keep in touch with their family and friends. What has improved since the last inspection? We found much improvement since our last inspection, the most important of which was that people living at the home were happier with the care, support and attention they received than we found at our last inspection. People are treated with respect. Their diverse needs are better respected, with their needs generally met in a way that addresses equality. Their comments, requests and complaints are listened to, taken seriously and acted upon. They are benefiting from a management approach that is inclusive, and which includes strategies for enabling people living here to affect the way in which the service is delivered. People are benefiting from improvements in the daily life of the home which are aimed at meeting their individual interests, choices and wishes. They have the facilities and/or equipment they need to maximise their dignity, independence and safety - such as plate guards, hoists and accessible call bells. People are protected from abuse, in various ways. These include that staff are aware of locally agreed multi agency safeguarding procedures so that they can put these in place if needed. And staff recruitment procedures are robust, ensuring people are looked after by suitable individuals. People enjoy pleasant and homely accommodation. Since the last inspection, some new carpets have been fitted and re-decoration has been ongoing. Fire safety measures have been improved. What the care home could do better: The home gets information about prospective residents` needs, which could be more detailed to ensure that people who are offered a place and who choose to move in will be offered individualised care. Information about the home for prospective and current service users should be current or up to date. More comprehensive detail in individuals` care plans, daily records and reviews, along with more timely action by staff, would help to ensure that that people`s various needs will be met appropriately. People would benefit further if staff received more training and supervision, partly so that their more diverse or changing needs will be met. Various actions must be taken to ensure that people`s medications are managed safely and they receive medications as prescribed for them. More timely action to address any improvements needed in the environment would provide people with a well maintained home. Provision of assisted bathing facilities would give people more choice and opportunity to maintain their usual lifestyle. The home is currently being managed better than at our last inspection. However, an application must be made to the Care Quality Commission to register a manager for this home, to ensure good management and stability that will promote people`s continued welfare in the longterm. Key inspection report Care homes for older people Name: Address: Amberwood Nursing Home 231 Exeter Road Exmouth Devon EX8 3ED     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rachel Fleet     Date: 1 0 0 6 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 38 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Amberwood Nursing Home 231 Exeter Road Exmouth Devon EX8 3ED 01395263540 01395263540 amberwood1@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Alextour Limited Name of registered manager (if applicable) Mrs Christine Mary Allsopp Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Notice of Proposal to Grant Registration for staffing/environmental conditions of registration issued 13 May 1997 Date of last inspection Brief description of the care home Amberwood is registered to provide care and accommodation for up to 24 people over 65 years of age who may have general nursing needs. The home is a detached house on a main road into Exmouth. It has on-site parking, and is on a main bus route. The town has a train service. There is level access at its front entrance, and from the lounge and dining room into the garden at the rear of the building. Bedrooms are on two floors, with passenger lifts between floors. The home does not currently have bath facilities, but has 2 level Care Homes for Older People Page 4 of 38 Over 65 24 0 Brief description of the care home access shower rooms. The weekly fees at the time of this inspection ranged from £391-715, depending on the room and the level of care needed. These fees include outings arranged by the home. Additional costs are charged for staff escorts, chiropody, hairdressing, continence pads if not provided by local health services, toiletries and newspapers for personal use. Our most recent inspection reports are available in the homes entrance hall, and also on request from the care home. Our last inspection report is dated 19 August 2009. Care Homes for Older People Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place as part of our usual inspection programme. It included a visit to the home, which took place over two days in the week. Our visit on the first day was unannounced, and was carried out by Vivien Stephens and Rachel Fleet, Compliance Inspectors. We arranged to go back to the home for a second day to complete the inspection and give feedback to senior staff. Prior to our visit, we sent surveys to the home for them to give to 15 people living there and to their relatives or other supporter. We received 8 back from people living at the home (4 completed with help from people employed by the home, and 3 completed with the help of relatives), and 8 from peoples relatives. We sent 8 surveys to health and social care professionals who visit the home; 2 were returned, by health professionals, although one felt unable to answer some questions as they had not been to the home often. Comments and feedback received are included in this report. Care Homes for Older People Page 6 of 38 There were 15 people living at the home at the time of our visit, 2 of who did not have nursing needs. We spoke with most of them, observed some care and attention given to them by staff, and spoke with at least 6 members of care and ancillary staff. We also spoke with Sally Moyse, Director of Nursing and registered manager of another nursing home owned by the same company, who is overseeing the home in the absence of a manger. And with Mr John Towers, Responsible Individual for the home. We case-tracked or followed up 4 people living at the home. We looked in more depth at the care and accommodation offered to these people, as a way of helping us to judge the quality of services overall, and as a way of understanding the experiences of people living here. We chose 4 people with different needs, as a way of making a judgement about how well this home meets the diverse needs of the people living there and how well they address equality. We looked at their care records, including medication records. We met with them, spoke with staff about their care and other related matters, and looked at the accommodation in relation to their needs. We also looked at other records that show us how the home is run - such as staff recruitment and training records, quality assurance information, and records relating to health and safety matters. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? What they could do better: The home gets information about prospective residents needs, which could be more detailed to ensure that people who are offered a place and who choose to move in will be offered individualised care. Information about the home for prospective and current service users should be current or up to date. More comprehensive detail in individuals care plans, daily records and reviews, along with more timely action by staff, would help to ensure that that peoples various needs Care Homes for Older People Page 8 of 38 will be met appropriately. People would benefit further if staff received more training and supervision, partly so that their more diverse or changing needs will be met. Various actions must be taken to ensure that peoples medications are managed safely and they receive medications as prescribed for them. More timely action to address any improvements needed in the environment would provide people with a well maintained home. Provision of assisted bathing facilities would give people more choice and opportunity to maintain their usual lifestyle. The home is currently being managed better than at our last inspection. However, an application must be made to the Care Quality Commission to register a manager for this home, to ensure good management and stability that will promote peoples continued welfare in the longterm. 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. Care Homes for Older People Page 9 of 38 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 gets information about prospective residents needs, although this is not always sufficiently detailed to ensure that people who are offered a place and who choose to move in will receive individualised care. Evidence: We looked at the way people were assessed before they moved into the home. We looked at their care plan files to see what information the home has gathered about them, and how they used this information to determine how their needs should be met. The information was gathered using a form drawn up by the home covering personal and health care needs. A record was kept of who had provided the information, and we saw that this had included the individual, their spouse and their previous carers in one case. For one person, some pages were missing and the person in charge was unable to say where the missing pages were. Complete forms were in place for the other people we Care Homes for Older People Page 11 of 38 Evidence: followed up. The information on the forms was fairly brief, but gave a broad outline of the support the person needed. We suggested that the home should gather better details about individuals preferences for support. For example, the home has a shower room, but not bath. Therefore they should gather evidence to show this has been explained, and to find out if the person is happy to have a shower, and if so, how often. They could also gather better information about the persons normal daily routines, including usual time of getting up and going to bed. The home asks people if they are of a particular religious faith, and we suggested that this should be followed up with information about whether they still practise that faith, in order that relevant support can be agreed. It was positive to see that the home included the topic Thinking ahead and what the person would want or not want to happen in the future. This gave people an opportunity to say what care they wanted should they be seriously or terminally ill, for example, or if they wanted to try to return home eventually. Their ability to make decisions for themselves was also noted. A list of certain choices or preferences gave people the opportunity to say whether they preferred carers of a certain gender, if they minded wearing an apron at meals (to protect their clothing), their rising time and bedtime, for example. We talked to one person to find out if they were happy with the information they had received about the home before they moved in. She said she knew the home well through visiting friends who had lived at Amberwood, and she was certain that the home would suit her also. She confirmed that she was very happy living at Amberwood and felt she had made the right choice. Another person also told us that they had heard about the home before moving there so decided to live there, and confirmed it had matched their expectations. We noted that the homes Statement of purpose, which is information that homes are required to provide, was readily available in the homes entrance hall. However, it stated the recently appointed manager was the registered manager, before they had applied to register, and our details werent up to date. The home does not provide intermediate care. Care Homes for Older People Page 12 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at this home are treated respectfully, benefiting from a more personcentred approach to care. Their health and welfare needs are not always sufficiently well planned for or managed appropriately, which creates a risk that some of their needs may not be met. Evidence: Comments we received in surveys from peoples relatives included Very good personal individual care, Meet the needs of X very well...very satisfied. Records have been updated which are easier to follow. Visit at different times of day and everything is always of same high standard, and Looking after his nursing needs when we asked what the home does well. Relatives surveys also said the service always or usually met the needs of the person at the home (including their more diverse needs), and gave the support expected or agreed. Professionals responded that the homes assessment arrangements usually ensured that accurate information was gathered and the right service planned for people. One said peoples needs were usually monitored properly and met by the Care Homes for Older People Page 13 of 38 Evidence: service, with advice usually sought and acted on to achieve this. We looked at 4 peoples care plan files, to find out how the nursing and care staff provided care to them. The care plans were kept with the person, and went with them wherever they were in the home - for example, in their bedroom or in the lounge. This meant that if the person needed assistance, staff could refer to the care plan if necessary and immediately complete records of care given. Thus, up to date records were maintained and people were more likely to receive consistent care. We asked people if staff had discussed their care plan with them. One person noted it was in their room but said they hadnt read it and staff hadnt discussed it with them either. Another person felt their care hadnt really been discussed with them either. A third person indicated they had chosen not to read their care plan but knew they could if they wished. It appeared that care plans were reviewed regularly, but it was not clear what these reviews were based on because there were no detailed daily records or evaluations of care given in some peoples care notes. Some entries stating Care plan achieved did not show the outcome for the individual of the care they received. Thus staff could not be sure if the care planned had been suitable or not for meeting the persons needs. Care assistants we spoke with explained that a new recording system had been introduced, which they were positive about as it involved them more fully as caregivers. We found that the nurses kept separate records. They told us the care assistants were good at reporting things to them verbally. Sally Moyse agreed that more work was needed to establish consistent and effective record-keeping, so that people could be properly monitored and receive appropriate care even if their needs changed. The care plans covered a range of topics including social activities, personal hygiene, tissue viability, nutrition, mobility, oral hygiene, and continence. They explained the support each person needed in each of these areas. The care plans also contained risk assessments covering nutrition, falls, tissue viability, moving and handling, mental capacity and the deprivation of liberty. Peoples wishes regarding resuscitation had been sought. Where necessary the plans also contained risk assessments for dehydration. Peoples personal choices were often recorded, including details such as where they liked going out to if they had said they liked outings, what particular TV programmes they liked or what they liked to listen to if they liked being read to. This, along with full personal histories which had been obtained, gave staff very good information for Care Homes for Older People Page 14 of 38 Evidence: understanding people as individuals and giving them personalised care. We looked at the information in one care plan on the persons nutritional needs. We talked to the chef about the persons dietary needs and found he had a very good understanding of these, along with their likes and dislikes. The person had been regularly weighed, so the home was able to show that the persons weight had remained stable and there were no concerns. Other people had also been weighed regularly. We noted that, while good daily records were kept by kitchen staff of what most people ate, records for people who needed a pureed diet did not show what meal they had been given. Thus staff could not be certain that these people were getting a varied and balanced diet, or if their dietary preferences were being met. We discussed this with Sally Moyse. The mobility assessment for one person provided clear information about how the person should be assisted to move. Someone who had to moved through the use of a hoist felt that staff did this well. Staff had noted someone was getting more rigid, with regard to the persons mobility care plan, but didnt seem to have sought medical advice in case it was due to the medical condition they had that causes rigidity. The care plans contained recording tools to show that care tasks had been completed by the staff, with a form to be completed when the person had a bowel movement. There were some unexplained gaps in the records that either suggested that individuals had become seriously constipated and staff had taken no action, or that staff had failed to complete the forms. It was unclear why the tool was being used when the care plan did not show that someone was prone to constipation. If it is determined that someone is at risk of constipation, care plans should explain how long the person should be left before medical advice should be sought, or what further treatment is needed. We saw from care records that staff had been vigilant regarding some other peoples health needs, and although they may not have seen a doctor very recently, staff had sought advice regularly and acted on the advice obtained. People we case-tracked had been assessed for the possibility of them developing pressure sores. They had pressure-relieving mattresses and cushions in place, and care plans explained the actions staff should take to prevent skin problems. Some were able to confirm that they did not have any sores. However, someone who was more frail had a turn chart, without indication of how often they should be moved. A nurse told us this information should be in the persons care plan and that care staff would have reported if turns were not being done at least 4-hourly. Staff gave us Care Homes for Older People Page 15 of 38 Evidence: different answers when we asked them how often the person should be turned (- from 2-3 hourly to 4-6hourly). Charts indicated the person was sometimes not moved for 6 hours. We saw one person was fed by a senior staff member as indicated in their care plan, because of their swallowing difficulties. We were told that all staff who assisted people with swallowing difficulties had first had training on assisting people with such needs. Staff were using teaspoons when giving these people their meals, which is good practise. However, we saw some staff giving people drinks from spouted beakers, which can cause some people to choke. Other staff were aware of this, saying they removed the spouted top which was meant to be a cover for the drink, and helped people to drink from the cup itself, as is appropriate. There was a care plan for someone who was at risk of choking. The person sounded chesty when we were met them and we noted a similar observation in their care records some days previous to our visit, without indication that this was being followed up. The care plan indicated that this was something staff should monitor for, as the person was at risk of chest infections because of their choking problem. The person felt staff did notice if their health changed, and told us that although they had not seen a GP recently, staff had rung for advice in the past. There was relatively little in one persons care plan regarding their diabetes, and a care assistant we asked was not sure if anyone at the home was diabetic. A nurse we spoke with thought there should have been a specific care plan for this health need, but could not find it. There was a sheet for recording the persons blood glucose, which indicated this was to be checked monthly. The nurse did not know what their expected glucose range was, but said that if the result was above 6-7mmols certain action would be taken. Although the record showed a higher result, there was no evidence that the extra action had been taken. We were concerned about the care of one person who was very frail. Care records showed good attention to management of their pain, their social needs were well addressed, and the person hadnt developed any sores despite their frailty. However, it appeared action was not being taken in a timely way with regard to their poor dietary intake and very marked weight loss. Sally Moyse said palliative care for this person had been discussed with the previous manager and the persons GP but it had not been recorded anywhere. It was not reflected in their current care plan. When we returned for our second day, having discussed our concerns about 2 people at the home on the first day, we found the home had requested GP visits for both Care Homes for Older People Page 16 of 38 Evidence: people, to re-assess them and discuss their care with staff. These visits took place while we were at the home. The individuals care plans had also been re-written to update them in view of the issues we had noted. Care records showed some people were visited by Community Psychiatric Nurses, a dentist, and Speech and Language Therapists, as well as GPs. People we asked were satisfied with how staff manged their medication for them, happy with that arrangement and not wishing they could self-medicate. We looked at the way medicines were administered and handled. The home used a dosage system, supplied by a local pharmacy. There were secure storage facilities for all medications, including those that needed to be kept in a refrigerator and any controlled drugs. At our last inspection, we found incorrect stock levels of some medications as compared with records kept, thus it was not clear that people were getting medication they were prescribed. Senior staff told us that the home has changed its systems, with all unused medicines now returned to the pharmacy or destroyed monthly, when they receive new stocks for the coming month. It should be easier, therefore, to monitor stock levels and thus ensure that people are getting their medication as prescribed. However, when we checked medication for people we case-tracked, we found stocks held still did not tally with records kept. We talked to Sally Moyse and to a person who had carried out medication audits recently. We were told there had been lack of clarity as to whether staff should discard the other half of tablets that had to be broken in half, or keep it for future use. The Destroyed/Returns book for medication had no record that staff had discarded this medication. Senior staff suggested that staff may have been disposing of the tablets down a sink - which is an incorrect procedure. We also found that excess stock was not being accounted for or returned each month, as we found a box of tablets as well as medication in a blister pack for the current month, with the boxed tablets not reflected in the total shown on medication records. We found items supplied in November 2009 and April 2010 (thus that had not been returned at the month end), with no total carried forward onto current medication records in one case. Only 1 signature had been recorded against directions handwritten by staff on 2 peoples medication administration records, so it was not clear that the accuracy of what was written had been checked. One person was prescribed a mouthwash twice a day, but it was only signed for in the mornings, with no frequency indicated in the persons care plan. A medication with a specific shelf-life once in use had not been Care Homes for Older People Page 17 of 38 Evidence: dated on opening, so staff would not know when it should be discarded. We were told the nurses do all medication administration, so have 2 updates a year. It was not clear that there was a system for observing their actual practise, although medication audits had been commenced since our last inspection. We watched as the lunch time medicines were being administered. The nurse checked the records carefully before administering the medicines, and then returned immediately to the medicines trolley to complete the records. This demonstrated good practise. However, she also completed records for skin creams that had been administered to someone earlier in the day by care staff. We were concerned that the records had not been completed by the person who had administered the creams, and that the records were completed several hours later. We also found that the care plan for this person did not explain the use of this cream. We talked to Sally Moyse about this. She said that they were aware of the problem, and had been introducing creams charts in each persons room to be completed by care staff. This had been suggested by the homes supplying pharmacy, when they carried out a recent inspection at the home. We also suggested that the home should write a policy on the administration of creams, and ensure that all staff were following the policy, therefore working in the same way. When we arrived, Sally Moyse was assisting someone with their breakfast. She indicated she wished to continue helping the person and would join us when the person had had their breakfast. She was thus a good role model for other staff, in treating the person respectfully. Staff were discreet in conversations, especially when talking in front of other people. They knocked on peoples bedrooms doors or called out as they entered. Bedrooms were kept tidy by staff. We didnt see any incontinence pads visible in the rooms of people who required them. Some people were having nail care, and manicures if they wished, during our visit. These actions all help to promote peoples privacy, confidentiality of personal information, their dignity and self-esteem. People we asked felt they were treated as an individual and not just as one of a number. Care Homes for Older People Page 18 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are benefiting from improvements in the daily life of the home which are aimed at meeting their individual interests, choices and wishes. They can keep in touch with their family and friends. They are offered an appetising, balanced diet that meets their various needs and preferences. Evidence: Surveys from people living at the home said the home always or usually arranged activities they could take part in if they wanted, and they always or usually liked the meals. They indicated that staff always or usually listened to them and acted on what they said, and always or usually supported people to live the life they chose. Asked what the home does well, a relative commented Keeping and respecting Xs dress code...Ensuring Xs meals are always on time, giving choice. When asked what the home could do better, a relative suggested occasional events for people and their families to share - such as Bingo. The person added They do hold a lovely summer garden party each year which includes everyone - family, friends, etc. The home employs a staff member specifically to organise recreational activities for people as groups and as individuals. An album was by the visitors signing in book, with photos showing activities or events that people at the home had attended. During Care Homes for Older People Page 19 of 38 Evidence: our visit, a professional musician visited the home in the afternoon to provide entertainment. Some people we spoke with were expecting him and looking forward to the occasion. One person we talked to said she prefers to spend much of the day in her own room. She receives a number of visitors and therefore she never feels lonely. The home had respected her wishes, although they always invited her to join in with planned activities. She said that she enjoyed some of the group activities, including visits from the donkey sanctuary and Pets as Therapy. When we asked another person if they minded being in their room, they said they were able to watch their TV whenever they wanted, which they enjoyed. We noted that more suitable activities had been planned for someone who had become more frail in recent weeks. The new activities were still based on the persons preferred ways of spending their time, but were now more in line with their current ability to be actively involved. Most people we asked said they had enough to do with their time, although one person said they got bored. When we asked what they used to enjoy doing they said they liked sport, and confirmed they would like to go and watch a match when we asked if that was something they might like to do (as the weather was currently better for outings). Their pre-admission records stated that they liked outings, but we noted from care records they hadnt been out for 2 months prior to our visit. Sally Moyse said she would look into this. A representative from the Catholic church visited the home while we were there. She told us she was always made welcome when she visited and she had no concerns about the way people were cared for. People living at the home also said their visitors were made to feel welcome, and could visit freely. Surveys from peoples relatives said they were always or usually kept up to date with important issues affecting the person living at the home. Asked what the home does well, a relative commented Provide a friendly atmosphere...Staff are caring not just to their clients but also to their relatives, which was echoed by others. The care plans we looked at provided good information to care staff about the things each person was interested in doing, including information about their past. There was classical music playing in the room of one person who was in bed, which was their preference according to their care plan. One person we spoke with used to be a gardener. They said they didnt want to do gardening now, but did sit out in the homes garden. The Recreation staff had spoken with them about what they would like and acted on this, liaising with their family, to have pot-plants (with their preferred plants in them) outside their window where they could see them, as they didnt have a Care Homes for Older People Page 20 of 38 Evidence: close view of the garden from their bedroom where they spent much of their time. When we met this person they were watching TV, which they told us they enjoyed, and this was included in their care plan. Peoples rooms had been personalised with their possessions, reflecting their interests and their lives to date. Everyone we met in their rooms had a call bell and television remote control (for those who wanted to watch television) within reach. People we asked were happy with the time they got up, including those who were in bed when we arrived. One person explained they didnt sleep very well at night so wanted to sleep in a bit in the mornings. We noted however that people were not always offered a choice of drink, nor did staff check that the person was happy with what they had been brought, although those we asked were not unhappy with the drink they were given. Music was playing in the lounge and we asked one person who chose what was played. They said the activities lady did, in consultation with the people sitting in the lounge. People we asked liked the food provided at the home. Fresh vegetables were cooked for lunch on the day of our visit, and the cook clearly took pride in providing good quality food that was in line with peoples preferences. People were given eating aids such as plate-guards, which helped them to eat independently. However, we noted the desserts were given to people at the same time as their first course, which is not good practise for various reasons. During the morning, we heard the chef discussing what people wanted for lunch, after telling them what was on the planned menu, and the intended choices for that day. We saw a record of peoples meal choices for the day, with lists of those with certain dietary needs. The chef showed us a photo book of meals, which he said he used to help people make choices, especially if they had gone off their food, observing their body language if they had difficulty expressing a choice verbally. He also had information on peoples preferences, food intolerances and requirements, and said he got feedback from staff as to how people had responded to different meals. Menus were to be reviewed with the new manager, and we were assured people who lived at the home would be involved in this. Care Homes for Older People Page 21 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples concerns and complaints are listened to and acted upon, to uphold the rights of those living at the home, with action taken to safeguard them from harm. Evidence: In the surveys we received, 2 of 8 people living at the home did not know how to make formal complaint. Relatives indicated that 1 of 8 of them did not know how to make a complaint. Asked if the home responded appropriately if they or the person at the home raised any concerns, 1 relative said Sometimes whilst 7 relatives and 2 professionals said Always,Usually or Not necessary. No-one chose through their survey to speak to us. In response to matters raised at our last inspection about peoples concerns or complaints not being listened to, there is now a communication sheet at the front of everyones care plan. As these were kept in peoples rooms, relatives, etc. could write messages here for staff if they wished to. We noted a visitor had raised a concern a month before our visit that their relative did not have a call-bell to hand. Everyone we met in their rooms during our visit had a call-bell within reach, and they told us staff came sufficiently quickly if they used their bell. We were told in an action plan from the home that a comments/complaints book would be situated in the entrance hall. This was not evident on the 2 days we visited the home, but was found in a hallway drawer when we asked about it. Care staff were Care Homes for Older People Page 22 of 38 Evidence: aware of it, and also told us about the communication form in peoples care plans when we asked about enabling peoples complaints to be heard. Senior staff said they would ensure it was kept available. Records made by the home of complaints it had received included the action taken to address the complaint. Mr Towers told us that he asks on his visits if there are any other issues other than those recorded in the complaints log, and he goes to speak with anyone who has made a complaint to see if they are satisfied with the outcome. Some people whom we asked about the homes response to complaints told us they had not had to complain, so couldnt comment. One added there was a friendly atmosphere. Other people said they felt able to complain if it became necessary, and they felt their complaint would be dealt with. Sally Moyse had a clear understanding of safeguarding processes to be followed if concerns were raised with her, including which agencies should be contacted. She told us that she and the new manager were booked on the local authoritys managers safeguarding courses later in the year. We saw training was to take place at the home in coming weeks for other staff. The local authoritys Safeguarding pathway was displayed outside the nurses office. Some staff we spoke with couldnt describe the process to follow if they suspected or witnessed abuse, but they knew this information was available and referred to it to answer our questions. One member of staff said they would refer to the safeguarding policy for guidance on who to report concerns to outside the home. We pointed out to senior staff that the safeguarding policy said that concerns were to be reported in accordance with the Department of Health guidance, which did not help staff have easy access to relevant information. Peoples care records included assessments of their capacity to make decisions for themselves, with systems in place with regard to possible deprivation of liberty issues. Care Homes for Older People Page 23 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy pleasant, homely and clean accommodation, although they would benefit from more timely action to address any improvements needed in their environment. Evidence: Surveys from people living at the home said it was always or usually fresh and clean. In a tour of the home, we found the overall impression was that the environment was clean, bright, attractive and homely. People we asked also felt it was kept sufficiently clean, including shared areas such as toilets and bathrooms. One persons room was very warm, and they said that was how they liked it. Asked in a survey what the home could do better, someone commented Improve maintenance of the (bed)room. The house had generally been well maintained, although some areas showed signs of damaged paintwork, curtain hooks needed attention, we noted a wardrobe door was ill-fitting, and some chairs in the lounge were showing signs of wear (with a torn cover that might affect hygiene standards, in one case). Some toilets and bathrooms had a damp smell. While carpets looked clean, a few areas showed signs of stains that had not been resolved by shampooing. The garden also looked in need of some attention. Staff told us the lounge had recently been re-painted and bedrooms were being repainted over time. The handyman was painting bathrooms during our visit. Staff Care Homes for Older People Page 24 of 38 Evidence: said they either used a repairs book to alert the handyman to repairs needed, or told the senior staff on duty. Mr Towers, Responsible Individual, told us that he carries out an environmental inspection every calendar month. It thus seemed that staff need to report more promptly any issues arising between his checks, and he was going to ask them to do so in view of our findings. During our visit, the lawns were mowed and the edges neatened, making the garden appear attractive. Staff explained the gardener employed since our last visit had been absent due to illness, so attention to the garden to date had not been as much as hoped. We were told that they have had some fund-raising events to raise money for a new patio area and they hoped work on this would be carried out later in the year. A survey from a relative included a comment that they were very pleased that the person at the home had been given an electric bed. We were told that 4 profiling beds had been purchased since our last inspection. We talked to staff about the equipment available in the home to help people move around safely, and were told this had improved in the last year. At the time of this inspection there were 3 hoists and 1 Standaid. Staff told us they felt this equipment was sufficient, in working order, and there was always a hoist available if they needed one. The bedrooms we looked in were clean, tidy, and well furnished. People had been encouraged to bring items of furniture and personal effects to make their bedrooms feel homely. One toilet on the first floor was not available for use during our visit, as there was a ladder in it to the loft. We were told that work being carried out would be completed the second day. The bathroom on this floor was not in use, and was instead used as a storage area. We saw two shower rooms that had been tiled and appeared bright and modern. Staff confirmed there were no bath facilities, and that some people had to go to a different floor from their bedroom to use the showers. We noted some toilets had a handrail one side but not the other, which might disadvantage some people if the rail was not the same side as the arm they preferred to use. The laundry was in good working order. There were good systems in place to make sure peoples clothing was returned to them correctly. A laundry person was employed and she told us that she made sure clothing was correctly labelled. She said clothing went missing very rarely. We saw evidence of good infection control measures in place. Soiled laundry was transported using red bags. Linen skips, disposable gloves and aprons were seen Care Homes for Older People Page 25 of 38 Evidence: around the home, easily available for staff. Paper towels and liquid soap dispensers were used. Staff wore different aprons for serving food, and plated meals were covered as they were carried to people around the home. Care Homes for Older People Page 26 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are cared for by suitable individuals who, as a team, provide a safe level of care. They would benefit further if staff received more training and supervision related, so that peoples current, more diverse or changing needs will be met. Evidence: People surveyed felt staff had the right skills and experience. When asked what the home does well, a relative commented Sensitive staff, caring and dedicated workers offer myself, family & my parent all the support we need...I am always impressed with my parents carers - their kindness, gentleness & friendliness. We looked at the employment files of two staff who have been recruited in the last year. We found that good procedures had been followed before the staff had started work in the home, including receipt of at least two satisfactory references and a criminal records check. New staff had followed the homes own initial induction procedure that took place over the first 2 weeks. After that the new staff had completed a more detailed induction training programme following nationally recognised standards. The home is devising an induction pack for new staff to keep, to ensure they have important information easily accessible. Care Homes for Older People Page 27 of 38 Evidence: We asked people about the staff, and they were positive about them. When asked if staff were caring, one person said Very much so. We asked someone if the staff were as nice or caring about people who were less able , and they said they were, adding They know how to talk to them, you know. When we arrived, Sally Moyse (who is a nurse) was assisting people. Another nurse was in charge of the shift, with a third nurse and 3 care assistants also on duty. Two kitchen staff, a housekeeper and Recreational organiser were supporting the care staff for most of that day. Cooks were employed between 7.30am & 7pm, so care staff did not have to prepare food. The roster we were given for the week of our visit showed there was at least 1 nurse on duty at all times, there was a total of 5 care staff rostered to be on duty in the morning and 4 on duty in the afternoon during the week. At the week-end, this was reduced by 1 staff in the morning, to 4 care staff. Staff told us they enjoyed working in the home, and said there was good teamwork and communication. Care assistants felt that the nursing staff listened to them and acted on their observations. They said the atmosphere was happy. They felt staffing levels were good. The number of agency staff used was very low, with agency staff used on the rare occasions when there was more than one staff off and shifts could not be covered by the permanent staff team. Staff felt the home provided good training. They said training was provided at least once a month. Sally Moyse told us there was a reasonable training budget. Nutrition, tissue viability and hydration were taught in house, with external trainers used for multiple sclerosis, oral care, audiology and other topics related to peoples conditions. Training on dementia and challenging behaviour were being planned, with medication and nutrition already planned for nursing staff. The chef said he had had training on infection control and fire safety in the last year, and was booked to attend health and hygiene, manual handling, and a nutrition course in coming months. Information we were given indicated that 9 of the 12 care assistants employed had a care qualification. We noted that since our last inspection, when issues around equality were raised, there had been no further training on this topic. We met people who were at risk of choking when eating or drinking. Of 26 staff, 5 had had training on assisting people with swallowing difficulties to eat. A care assistant who had been at the home for Care Homes for Older People Page 28 of 38 Evidence: several years told us they had not had any first aid training, and didnt know if there was a first aider on duty. They had, however, learnt about assisting people to eat in ways that would reduce risks of them choking, in their care course (NVQ2 in Care). We also met people who had diabetes or Parkinsons disease. Their care plans and conversations with staff suggested that staff would benefit from training about these conditions, which were not topics on the training records we were shown. Care Homes for Older People Page 29 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is run in their best interests. However, the absence of a registered manager creates a risk to the effective and stable management of the home in the longer term. Evidence: The homes manager had recently left, before becoming registered with us, and the previously registered manager retired after a year. A new manager has been appointed and was due to commence employment at the home in the month after our visit. Sally Moise, Registered Manager of another nursing home in Exmouth owned by the same company, has been overseeing the home in the meantime. Mr Towers, Responsible Individual, has also continued to make regular monitoring visits to the home, recording his findings on each occasion in some detail and following up points identified for action. Asked in surveys what the home does well, 2 people who lived at the home commented Most things and Everything. They made no suggestions as to what the Care Homes for Older People Page 30 of 38 Evidence: home could do better. Relatives commented Everything seems to be fine; The overall quality of service is very good; High level of service has been consistent throughout; and They are good at responding to any request. There was no-one living at the home who was subject to a deprivation of liberty authorisation, and we did not find that anyone was having their liberty deprived without an authorisation. We looked at the way the home listens to peoples views and encourages them to have a say in the way the home is run. We heard that the home carries out surveys and audits every year, consulting people living in the home, their families, and professionals involved in their care. The last quality assurance audit was carried out just before the last inspection and they were not due to carry out the next one until August 2010. We asked about meetings for people living at the home and for staff. We were told that residents meetings took place occasionally, and there had been a staff meeting in the last month, which Sally Moyse thought had been minuted but did not have these records. Staff told us that they had not had formal supervision with senior staff recently, but that it was being planned. We felt staff would benefit from regular supervision, especially regarding their accountability and responsibility in relation to the issues we identified during our visit. We looked at the way the home handles money on behalf of people who do not want to hold cash themselves. The home held agreed amounts of cash, but did not hold bank books or cards, and they did not have access to any persons bank accounts. They had kept very clear records for each person, including receipts for any items purchased on the persons behalf. Each month, a copy of the record was sent to the persons family or representative to provide evidence of how the money had been handled. All transactions had been signed by two members of staff as witnesses. We checked the balances held for two people and found they tallied with their records. Staff had annual refresher training on safe working practises. We saw training was to take place in coming weeks on manual handling and food safety. Staff we asked could describe safety checks for bed-rails (which we saw on some peoples beds), although written risk assessments showed reviews of the related risk assessments were not carried out as often as for other parts of peoples care plans. A hoist we saw had been serviced within the last 6 months, as is required by legislation. Staff told us that pressure-relieving air mattresses had been checked Care Homes for Older People Page 31 of 38 Evidence: recently. We were shown a recently provided Landlord certificate for servicing of gas appliances, when we asked if this had been done. The Fire service had confirmed the home was compliant regarding fire safety requirements when they visited in December 2009. During our visit, we pointed out that some fire doors werent closing properly, and Sally Moyse told us she had already identified that new batteries were needed in some automatic door holders, and was addressing this that day. Peoples care records included personalised fire evacuation plans. We saw the chef completing records of relevance to safe catering procedures and food hygiene. Although we found that a problem with fridge temperatures identified in May 2010 had not been noted in them, other records showed more recent fridge and freezer temperatures were in recommended ranges. The chef told us a fridge had been replaced when the problem with temperatures was noted. Cleaning schedules were up to date, and the kitchen looked clean. The last Environmental Health report about the homes kitchen, dated 26/8/09, indicated no action was required at the time. Care Homes for Older People Page 32 of 38 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 You must ensure that all 05/08/2010 sections of each persons care plan is sufficiently detailed and up to date, with clear guidance on the care they require from staff, and with care plan reviews based on suitable, recorded evaluations of the care given and its outcome In order that peoples various health and welfare needs are met, in a personcentred, safe and consistent way, and their changing needs identified. A previous timescale of 30/11/09 has not been met, although improvements are noted on this occasion. 2 8 12 People must have their health and welfare needs met. This includes taking prompt action to prevent deterioration or health 05/08/2010 Care Homes for Older People Page 34 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action problems arising from choking/aspiration, malnutrition, constipation, and diabetes among other conditions. This will help to ensure that people remain healthy for as long as possible. Previous timescale of 30/11/09 not met although improvements noted. 3 9 13 You must have effective systems in place for the recording, handling, safe administration & disposal of medication received into the home, especially regarding Provision of written policies (including for monitoring stock levels, dealing with tablets that have to be halved, the administration of prescribed topical preparations, etc.) with action taken to ensure that staff follow these; Maintaining an accurate audit trail of all medication received into the home, including its administration & disposal; Systems for ensuring that 05/08/2010 Care Homes for Older People Page 35 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action directions handwritten by staff are correct (such as checking by an appropriate second person); Systems for ensuring that medication is given according to the prescribers instructions, especially regarding frequency, and where and how topical preparations are to be used; Systems for monitoring the shelf-life of medication; Safe disposal of medication; So that you can be sure people are receiving medication they are prescribed safely & appropriately. 4 31 9 An application to register a 31/08/2010 manager for this home must be made to the Care Quality Commission, in line with Section 11 part 1 of the Care Standards Act To ensure that the home is run & managed by a person who is fit to be in charge, to the benefit of those who live there. Care Homes for Older People Page 36 of 38 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 1 3 You should ensure information in the Statement of Purpose is correct and that it reflects the service currently. It is recommended that you gather better details about individuals preferences for support and usual lifestyle, so that the home can be sure it can meet their very individual or diverse needs if they move into the home. You should ensure that medication audits are effective monitoring systems for ensuring safe, appropriate medication management & administration. You should ensure that the needs and care of anyone considered to require palliative care is clearly identified with appropriate health professionals as well as the individuals advocates (family, etc.), recorded appropriately and fully included in their care plan, so that there is clarity about the support they require. It is recommended that more minor repairs and renewals are addressed in a more timely way. Consideration should be given to provision of assisted bathing facilities, and to the siting of such facilities so that people have them near to their bedroom if possible. It is recommended that staff have training on more topics related to the needs of people currently living at the home (such as equality & diversity, diabetes, Parkinsonism & swallowing difficulties), so that they can meet both individuals needs and the needs of those for whom the service is intended. Care staff should receive formal supervision at least 6 times a year, covering their practise and development needs (including training) among other topics. 3 9 4 10 5 6 19 19 7 30 8 36 Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 38 of 38 - 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!

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