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Care Home: Magnolia House, Exmouth

  • 40 - 42 Morton Road Exmouth Devon EX8 1BA
  • Tel: 01395264338
  • Fax: 01395275824
  • Planned feature Advertise here!

  • Latitude: 50.617000579834
    Longitude: -3.4189999103546
  • Manager: Mr Thomas Duncan Keough
  • Price p/w: ~
  • UK
  • Total Capacity: 25
  • Type: Care home only
  • Provider: Ashgrove Care Company Limited
  • Ownership: Private
  • Care Home ID: 10156
Residents Needs:
Dementia, Physical disability

Latest Inspection

This is the latest available inspection report for this service, carried out on 30th April 2010. CQC found this care home to be providing an Good 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 Magnolia House, Exmouth.

What the care home does well Staff generally treat people with respect, promote their dignity, and offer them choice in their daily lives. This helps individuals to exercise control of their lives and promotes their sense of worth or wellbeing. What the care home could do better: More timely action must be taken to monitor and address people`s health and social needs, including the seeking of advice from relevant professionals, so that their needs are met appropriately. This includes how people`s needs and care are reviewed, and how identified risks to their well-being (such as from falls or weight-loss) are acted on. Staffing levels must be such that people`s personal and social needs are met appropriately. And staff should have relevant training and timely updating so that people will receive safe and appropriate care and support at all times. This is especially regarding activities and safe working practises. Care staff should also receive formal supervision more regularly, so that their work can be discussed, with any training needs identified and any issues raised addressed properly. A record should be kept of all complaints and subsequent action taken. All staff should be aware of the definitions of `abuse`, the local authority`s procedures for reporting concerns about people`s welfare or abuse to relevant agencies if necessary, etc. This is to ensure people living at the home will be safeguarded from harm. Some people should be given more opportunities for recreational activities suited to their needs, preferences and capacities, so they can enjoy and benefit from positive and meaningful occupation of their time. Redecoration and refurbishment of the home should include good practise guidance on facilities and design features that will assist people with dementia to move around the home as safely and independently as possible. The oversight and overall management of the home needs attention, so that matters are followed up over the longer term and there is positive development of the service provided. This is to ensure that the home is run in the best interests of people who live there. Random inspection report Care homes for older people Name: Address: Magnolia House, Exmouth 40 - 42 Morton Road Exmouth Devon EX8 1BA two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Rachel Fleet Date: 3 0 0 4 2 0 1 0 Information about the care home Name of care home: Address: Magnolia House, Exmouth 40 - 42 Morton Road Exmouth Devon EX8 1BA 01395264338 01395275824 t_keough@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Thomas Duncan Keough Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashgrove Care Company Limited care home 25 Number of places (if applicable): Under 65 Over 65 0 25 dementia physical disability Conditions of registration: Date of last inspection Brief description of the care home 25 0 Magnolia House is registered to provide personal care for up to 25 older people who may also have a dementia type illness and/or a physical disability. It is close to the seafront, and not far from the town centre of Exmouth. The property was formerly three large terraced houses, which have been converted and adapted. Accommodation is arranged over three floors, with a passenger lift between floors. All rooms are for single occupancy only, with 12 having en suite facilities. There are 2 Care Homes for Older People Page 2 of 13 Brief description of the care home lounges, a small sun lounge, and 2 dining rooms on the ground floor. Outside, there is a small sitting area to the front of the home, and a small courtyard area to the rear. Parking is on the roads around the home. At our last key inspection, weekly fees were £391 - 480. Services not included in this fee are hairdressing, chiropody, newspapers and magazines. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk Our previous inspection reports are available on request from the home, with the summary of our latest report being given to people thinking of moving into the home. Care Homes for Older People Page 3 of 13 What we found: We carried out this unannounced Random Inspection after receiving information which suggested that some people at the home might not be receiving care they required or were not being given appropriate support. Although only one inspector undertook this inspection, throughout the report there will be reference to what we found and what we were told. This is because the report is written on behalf of the Care Quality Commission (CQC). We were at the home for 8.5 hours, after arriving at 8.30am. Mrs Andrea Luxton-Keough - the person with responsibility for the day-to-day running of the home, and who has the title of Care Manager - was not on duty but came to the home to assist us. The Registered manager, Mr T Keough, and Mrs Keough - who have both been involved in the running of the home for many years - were also present at times during our visit. We wanted to look at whether peoples health and welfare needs were being met. We thus looked at how their health and social needs were being met, including aspects of the environment as well as consideration of whether people were given choice in their daily lives, and how they were being safeguarded. We also looked at staffing arrangements and the overall management of the home. We briefly looked around the home, visiting the communal day rooms at various times. We spoke with Mrs Luxton-Keough as well as Mr & Mrs Keough. They and their staff were very helpful and assisted us fully. Some of the information we received related to people in one part of the home, so we spent time in that area. We spoke with the 10 people who had bedrooms in that area and with the staff caring for them. We observed how support and attention was provided there through the morning. We case-tracked 3 people, following up their care, daily life, etc. in more detail. When we arrived at 8.45am, all but one of the 10 people were still in their bedrooms, with breakfasts being served. Throughout our visit, staff assisted people as necessary with their meals, drinks and personal care without rushing them. However, some people were not assisted to wash and dress until after 11am. Staff said this was usual, and that sometimes it was noon before people were dressed. Several people were on pressure-relieving cushions or mattresses and had profiling beds, to promote their wellbeing and comfort. We brought to the attention of senior staff that one mattress was at a much higher setting than indicated for the persons weight. One person had a wound due to pressure, which had not developed at the home. Staff told us they had recently consulted district nurses when concerned about someones skin condition. Peoples care records included assessment of their risk of developing pressure sores, carried out by senior care staff. However, where a high risk was identified, the timescale for a review was 3 months - the same as where a lesser risk had been identified for another person, suggesting care plans were not always used meaningfully or to promote Care Homes for Older People Page 4 of 13 individualised care. The National Minimum Standards for Older People recommend that care plans are reviewed monthly. We saw that staff followed guidance in care plans to safely assist people to move, using equipment or 2 staff when indicated. We heard them talking to people to involve them and get their co-operation at such times. Staff felt they had sufficient moving and handling equipment. People told us that staff were gentle when helping them to move. They also said that exercise classes were held at the home, which would help maintain peoples mobility. Staff identified 1 person who was particularly prone to falling, so we asked if there were any problems with the environment that might cause people to fall. They confirmed lighting was sufficient, but rightly commented that the homes patterned carpets might cause difficulties for people with dementia, as they may mistake the pattern for an object to be picked up, for example. We also noted that there were fewer handrails, raised toilet seats, etc. on the top floor of the home than in other areas of the home. There was little signage or other design features to assist people who have dementia to orientate themselves or move around more independently. The Keoughs and Care Manager said they were aware that the environment needed attention, and intend to address this in coming months. Staff were consistent, when we spoke with them, about what people could do independently for themselves and when they needed support. We heard staff speak with people as they helped them. They listened to their responses, explaining what they were doing, etc. The people we case-tracked had dementia, and staff appropriately used diversion and reassurance when assisting them through the morning. This enabled them to meet individuals physical care needs and promote their wellbeing. However, we found that one person spent long periods in their bedroom with the door shut and with little variety of stimulation because of an aspect of their behaviour. The person had been seen by relevant mental health professionals about the behaviour some months ago but had not been reviewed recently. When asked about professional visitors to the home, staff spoke about GPs, District nurses, chiropodists, Physiotherapists and Occupational therapists; they said that Community Psychiatric Nurses visited less often. There was a calm atmosphere at the home throughout our visit. We asked if there were incidents between people due to individuals mental health needs, and staff indicated these were not common. Mr Keough and the Care Manager spoke about managing aggression when we raised the matter of behaviours due to peoples mental health needs. We discussed that there were other forms of behaviour that staff might need to manage or monitor besides aggression. Staff told us that they would record incidents in individuals daily care notes, and we saw some evidence of this. If an injury was sustained, they said they would complete an accident form, and again we saw evidence of this. Whilst accidents were audited, incidents were not monitored in the same way, however. Accident audits showed a rise in the 2 months prior to our visit. Action had been proposed to try to reduce the number of falls occurring, but that action had not yet been taken. Peoples weight was monitored, and their care records included nutritional assessments Care Homes for Older People Page 5 of 13 carried out by senior care staff. We noted, however, that one persons care plan had not been revised when it was found that they had lost weight, and there was no greater monitoring of their weight subsequently. There was little information about peoples dietary preferences or requirements in the care plans we read, and some staff told us that they would like more information about this. One person was sitting in the dayrooms when we arrived, and they said they were happy to be there at that time of day. Other people we spoke with later couldnt clearly express their preferences due to their mental frailty. We asked staff how they knew when to assist people to get up or go to bed. They said some people could tell them. Those less able to say were assisted to get up in the morning if they were awake, or if people looked sleepy in the evening, staff would offer to take them to bed. Daily care notes evidenced this sort of support although care plans suggested a different approach - instead stating approximate times when people preferred to get up or go to bed. We saw that staff were observant of peoples non-verbal communication when offering them choices. For example, one carer recognised that an individual didnt want any of the drinks offered to them initially, and offered them something else that they said was the persons usual preference - which the person then showed agreement with. Although staff had a kindly manner when with individuals, we saw that often there was little interaction other than when physical care tasks were being carried out. Two people we spoke with said they could occupy themselves and were content with that; another said although the home provided certain activities, they got bored and would like different activities. One person spent a lot of time in their bedroom because of how their mental health condition was affecting them. Recent activity records for them showed watching TV as the only recreational activity they had undertaken for a week, with one earlier entry indicating a carer had spent time with them in their bedroom. Staff told us that they took people out locally, on foot or using wheelchairs, but the weather had not been very suitable lately. We were also told that the home has a minibus but it is rarely used. The Care Manager explained that the person who drove the bus had not been available due to other commitments, but that this has been addressed in very recent days. We saw that visitors to the home were made welcome, and that people were enabled to go out with their family or friends. Since our last inspection, the home has employed someone to help provide recreational activities for 11 hours a week (over 2 days). We were told this included one-to-one time with people, both at the home and taking them out locally. Mrs Luxton-Keough explained the home doesnt have a structured activities plan, preferring to remain flexible around peoples inclinations, wishes, etc. However, there was little detailed care planning to meet peoples needs, with little evidence or evaluation of what had been offered, enjoyed or declined, etc. We noted there was a complaint form included in the Service User Guide given to people living at the home. Mrs Luxton-Keough told us the home has not received any complaints since our last inspection, but that one person had raised an issue which they then did not wish to pursue further. There was no record of this, or of other matters raised by staff. Some staff we spoke with did not know local procedures for reporting safeguarding concerns to agencies outside the home if necessary. And in relation to definitions of Care Homes for Older People Page 6 of 13 abuse, there was some lack of recognition that certain ways of speaking to people could be deemed verbal or psychological abuse. Training records showed that few staff had had a recent update on safeguarding people, although Mrs Luxton-Keough said she had undertaken the local authoritys on-line training. When we arrived, there were 5 care staff on duty to look after 24 people, with a cook, a cleaner, a maintenance man and a laundry person supporting them. In the afternoon, there were 4 care staff on duty until the night staff came on duty at 8pm. The cook left mid-afternoon, having prepared the teas for the care staff to serve and clear. Care staff also told us they had some kitchen duties earlier in the day. Some care staff felt staffing levels were sufficient, whilst others did not. One pointed out that most people in one area of the home need 2 staff to assist them, as we also observed, so demands on staff working there were very challenging. We found issues relating to timely assistance with personal care and meeting of social needs. Mrs Keough told us there were usually 6 care staff in the mornings, but one was covering vacancies on night shifts while the home was recruiting more staff. Rosters showed that 3 staff had worked 60 hours or more a week in the current month, mainly on night duty. Four new staff had just been recruited, and there was occasional use of agency staff. We were shown staff training records. These showed that some staff training or updating was overdue or had been undertaken by only a small proportion of the staff. The Care Manager said that staff who attended formal training shared their learning with other staff. And that they learnt from any advice given by the district nurses. She also told us there is always a qualified first aider on duty, with the roster written so as to ensure this. All staff had undertaken an accredited long distance course on dementia, which those we spoke with said they had found helpful or useful. The Care Manager acknowledged, however, that training was an area that had been neglected. Staff told us they have formal supervision or an appraisal every 6-12 months. The National Minimum Standards recommends formal supervision 6 times a year for care staff. The Keoughs told us they or the Care Manager had discussed issues with individual staff about their practise in recent months, but confirmed no records had been kept of these conversations. We were told that the last staff meeting was in October 2009, for day staff, and that no-one had attended a more recently-arranged night staff meeting. We noted that Mrs Luxton- Keough was rostered for only 16 hours each week, and that the Registered Manager was not shown on rosters at all. Some staff we spoke with felt there was no one person overseeing the home, to ensure matters were followed up as necessary and the home was managed well. We identified staff training, supervision and attention to peoples care plans had not been carried out in a timely way, and it was also acknowledged that the environment needed attention. Mr & Mrs Keough told us that they had been occupied with other matters in recent months, and thus had been less involved in the running of Magnolia House. What the care home does well: Staff generally treat people with respect, promote their dignity, and offer them choice in their daily lives. This helps individuals to exercise control of their lives and promotes their sense of worth or wellbeing. Care Homes for Older People Page 7 of 13 What they could do better: 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 set out on page 2. Care Homes for Older People Page 8 of 13 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 13 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, 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 15 You must revise peoples 14/06/2010 care plans where reviews of their care plan indicate that their health, personal or social needs have changed or are not being met. This includes reviews of risk assessments and other monitoring records, which should be used as part of care planning. So that there is clear guidance as to how the service is to promote peoples welfare and meet their current needs. 2 8 12 You must make proper 14/06/2010 provision for the health & welfare of people who live at the home. This includes taking action in a timely way to address risks to their wellbeing, such as from falling, and seeking advice from relevant health or social care professionals in a timely way. Care Homes for Older People Page 10 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 To protect & promote individuals health and welfare. 3 18 13 You must make arrangements, through staff training & other means, to protect people from harm or abuse To safeguard people who live at the home and uphold their rights. 4 30 18 You must ensure staff receive training for the work they are to perform. This includes timely updating on safe working practises, and training for particular roles such as provision of activities for people with dementia or physical disabilities. So that people living at the home receive appropriate and safe care and support. 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 14/07/2010 14/08/2010 1 12 You should record each individuals interests and give them more opportunities for recreation or leisure which are suited to their needs, preferences and capacities, so that their quality of life is improved through meaningful and positive occupation of their time. Care Homes for Older People Page 11 of 13 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 2 3 16 19 It is recommended that you keep a record of all complaints made, with details of action consequently taken. The home should be refurbished and developed with reference to relevant good practise guidance on design, furnishings, signage, etc. that will assist people with dementia to move around the home safely and as independently as possible. Staffing levels should be maintained at a level appropriate for the identified health, personal & social needs of the people living at the home, as well as the layout and the purpose of the home. The oversight and management of the home should be such as to ensure a quality service is offered and that the home is run in the best interests of the people who live there. It is recommended that care staff should receive formal supervision 6 times a year, and that supervision covers all aspects of practise. 4 27 5 33 6 36 Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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 noncommercial 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 13 of 13 - 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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