Exmouth House

We found the following examples of good practice.

The management and staff team had worked very hard to ensure people maintained positive wellbeing and contact with their loved ones throughout the COVID-19 pandemic and beyond. People told us how wonderful the staff team were and praised them for creating a sense of community saying that even during isolation periods they had never felt alone. The registered manager had recently left the service but they had spent time handing over to the new manager to ensure continuity for people.

An online secure ‘relative’s gateway’ had been set up enabling messages and photographs to be shared from around the world and we saw how people had been supported to be part of family celebrations, share what they were doing and stay connected. Staff printed out chosen photographs for display. There were also portal devices around the home that could be used to access the internet. For example, one person loved to watch a fish tank and enjoyed moving online images. People also were enjoying a new penpal scheme.

The whole staff team were involved in activities with people. During our inspection most of the home were enjoying a bingo game. Another person had an easel set up in the light conservatory. There were themed meals such as Chinese New Year with decorations. The chef dressed up as Cupid for Valentines Day. A trolley served various purposes such as a market shop, fish bar, ice cream parlour and coffee stand to try different coffees. Residents’ meeting enabled people to discuss their anxieties on the pandemic. A ‘Rising Vibe’ scale was used to monitor people’s feelings so staff could further target mental wellbeing and support. The new manager said they tried to do something fun each month for people as well as staff. That evening there was to be a pizza night to celebrate staff awards. The home Facebook page showed what people were doing and praised staff. Comments from families were all positive and showed appreciation for the communication.

Staff were very well supported by the management team and the provider. The new manager had attended Mental Health First Aid training and a counsellor had visited the home to support staff in person. There had been regular praise and treats and awards for the staff team to show appreciation of their good work.

There was an infection control and prevention champion. They had devised a bespoke induction training pack to easily inform staff about infection control and prevention in simple terms and to monitor staff competency. Staff received ongoing training in infection control and staff had received training regularly from various sources to ensure they were up to date.

The service ensured people could continue to receive visitors in line with government guidance. There was a clear process, including a health questionnaire and testing regime in place for visitors, with personal protective equipment (PPE) provided. A dedicated visiting pod had been purchased accessed from outside. Families were able to become essential care givers as part of the staff team if they wished, book visits and safely visit people in their rooms. Throughout the pandemic people at the end of their lives had been able to spend time with their loved ones.

Staff were seen to wear PPE throughout the inspection. They frequently used hand sanitiser, available throughout the home. The large group of people in the lounge during the inspection told us how safe they felt and how amazing staff had been.

There was an extensive cleaning schedule, with regular spot checks and audits. This ensured cleaning was completed to a high standard.

Exmouth House is a care home providing personal care for up to 31 older people. At the time of the inspection there were 30 people living at the home.

People's experience of using this service and what we found

Exmouth House had a strong and visible person-centred culture which ensured that staff in all roles were highly motivated and offered care and support that was exceptionally compassionate and kind. The ethos of the home made care and compassion every staff member's business. Everyone, without exception, spoke of the commendable kindness, compassion and understanding shown by staff. The provider and management team put people at the centre of everything they did. People were valued and respected as individuals allowing them to be partners in their care. There was an exceptionally strong ethos within the service of treating people with dignity and respect. People were at the forefront of the service delivery and the provider was committed to and passionate about providing a high-quality service.

We received exceptionally positive feedback from all people and relatives. The feedback reflected staff were very kind, caring and committed. People complimented the continuity of care provided by regular staff which contributed to the building of meaningful relationships. Staff exceeded in recognising what was important to people and ensured individually tailored approach that met people's personal needs, wishes and preferences was delivered. There was evidence the staff often went 'the extra mile' to meet people's needs. People, relatives and professionals, without exception said they had and would definitely recommend Exmouth House to families and friends.

Staff used innovative and individual ways of involving people and others in their care. The care and support plans were reviewed and changed as people's needs changed. This included reasonable adjustments which were used to encourage independence.

The service ensured arrangements for social activities met people's individual needs and followed best practice guidance, so people could live as full a life as possible. The service had found out what people had done in the past and evaluated whether it could accommodate activities and made them happen.

The service worked closely with healthcare professionals and provided excellent end of life care. People experienced a comfortable, dignified and pain-free death. We saw feedback from relatives following end of life care was commendable. Staff had the specific skills to understand and meet the needs of people and their families in relation to emotional support and the practical assistance they needed at the end of the person's life. Records showed staff had attended end of life care training. Staff told us they were supported by the management team with empathy and understanding.

The provider's vision and values put people at the heart of the service. These were centred around people having a sense of purpose and of belonging, to live well, and to find enjoyment. This was supported by ensuring people had choice on how they wanted to spend their time and with whom. They were developed with people and staff in meaningful and creative ways and were owned by everyone. The registered manager provided supportive leadership and had developed a dedicated staff team who were committed to the vision and values of the service. The provider had effective quality assurance systems in place which were used to drive improvement.

People living at Exmouth House told us they received safe care from skilled and knowledgeable staff. Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place. Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. Medicines were managed safely, and people received their medicines as prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were supported to maintain good health and to meet their nutritional needs.

Rating at last inspection and update

The last rating for this service was Good (published 28 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Some of the people who lived in the home had limited communication therefore we spent time observing the care and support they received.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection, the service was rated Good overall. At this inspection we found the service remained Good in all areas.

Why the service is rated good.

People said; “Oh yes the staff are very caring. Always help me when I want them to.” Another person said; “Everything is very nice here” and a relative said; “I’m very satisfied with the care Dad gets.”

People remained safe at Exmouth House as they received their medicines safely. People able to, visitors, relatives and staff told us there were sufficient staff to meet people’s needs. Risk assessments were completed to enable people to retain as much independence as possible. People received care with minimum risk to themselves or others.

People continued to receive care and support from staff who were well trained and competent. Staff had the skills and knowledge required to effectively support people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's healthcare needs were monitored and people were able to access a wide range of healthcare professionals according to their individual needs.

People, relatives and visitors all agreed that staff were kind and very caring. One relative said; “Staff are very caring.” There was a busy and friendly atmosphere in the service. People's privacy was respected. People where possible, or their representatives where appropriate, were involved in decisions about the care and support people received.

The service remained responsive to people's individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. Complaints were fully investigated and responded to. A relative said; “Never had to raise any concerns- never. If I had any concerns I know they will help me.”

People were assisted to take part in a wide range of activities according to their individual interests. Entertainers visited the service and trips out were also planned for people.

The service continued to be well led. People, relatives, visitors and staff told us the registered manager and management team were very approachable. The registered manager and provider sought people's views to make sure people were at the heart of any changes within the home. The registered manager and provider had monitoring systems which enabled them to identify good practices and areas of improvement.

Further information is in the detailed findings below.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

The inspection was unannounced and took place over eight hours. We spoke with nine people living at the home and five visitors. We also spoke with the registered manager and twelve staff members about their roles and responsibilities

On the day of our inspection there were 30 people living at Exmouth House.

Is the service safe?

We found the service was safe because the registered manager ensured there were staff on duty with the appropriate qualifications, skills and experience required to ensure people’s needs were met. People who used the service told us that staff were not rushed and had time to meet their needs. Comments included “There are enough staff here; they look after me very well.

The registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty safeguards (DoLs). For example they told us they had applied to the local DoLS team to restrict the liberties of one person living at the home in line with Deprivation of Liberty Safeguards legislation.

The home had suitable arrangements in place to reduce the risks of people receiving inadequate nutrition or becoming dehydrated. We saw there was a choice of suitable and nutritious food and drink available in sufficient quantities.

The homes medication management was robust and protected people from medication errors.

The home was clean and had processes in place to maintain a hygienic environment. We found the home to be clean and free from offensive odours.

Is the service effective?

This service was found to be effective because people told us the service supported them in a way that suited their personal needs and maintained their quality of life. All of the people we spoke with were very happy with the care and support provided. They told us, “Everything is good here, I can’t think of anything bad” and “Staff are excellent here, wouldn’t change a thing” and “I love coming to the home, I feel part of the family” and “I am very happy here”.

Staff told us the provider arranged relevant training and support to help them meet the needs of the people they supported.

People’s health and care needs were assessed and their care plans and assessments were reviewed monthly. Specialist dietary, mobility and equipment needs had been identified in care plans where required. This showed that people were having care delivered effectively or in accordance with their assessed needs.

It was clear from our observations and from speaking with people and staff that they had a good understanding of people’s care and support needs and that they knew them well.

Is the service caring?

We found the service was caring. People were supported by staff who were understanding and sensitive to their needs. We saw that staff showed patience and gave reassurance and encouragement when supporting people. We saw when staff used equipment to support people with their mobility; they appeared competent and clearly explained what they were going to do. They kept the person informed of what was happening and reassured them through the process.

There were good communication systems in place to ensure staff were updated on people’s changing needs.

We saw people’s social needs were met as there were opportunities for people to be engaged in activities.

Is the service responsive?

We found the service was responsive because the service had appropriate systems in place for gathering, recording and evaluating information about the quality and safety of the overall service. Systems were in place to make sure the registered manager and the provider learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

People told us they knew how to make a complaint if they were unhappy. We saw two complaints which had been acted upon promptly and in line with the homes complaints policy and procedure. People can therefore be assured that the home acted upon complaints, which were investigated and action was taken as necessary.

Is the service well-led?

We found the service was well led. The registered manager had been in post for a couple of years and was registered with the Care Quality Commission (CQC). We saw there was good team work at the home. Staff and visitors told us they had confidence in the registered manager and were able to approach her if they had any concerns. Comments included “We are well supported by the manager” and “The ethos of the home is on clients and staff wellbeing”.

The provider’s area manager undertook a monthly compliance visit and supported the registered manager. This showed that they worked with the registered manager and the staff to ensure the standards that people expected at the home were maintained.

At this inspection on 19 April 2013 the home had made significant improvements. People were treated with respect. Staff acknowledged people and made time for them. Staff sat with people, talked with them and went through reminiscence.

People were offered choices of food and drink and asked if they liked the food and drink that they were given. Staff were empathetic towards people and took time to listen and determine how people felt based on their body language.

Staff regularly walked around the home and asked each person how they were. People told us that they felt safe. The staff described types of abuse to us and what they would do if abuse occurred. All staff had received training in safeguarding. The home had a current safeguarding policy in place.

The home had comprehensive quality assurance systems which included regular visits and support from a regional manager. Regular staff meetings and management meetings had been held. Service quality was discussed and plans to improve quality reviewed. The homes records were in the process of being developed and improved.

Observation was used to assess the interaction and engagement between staff and people living at the home. We talked with three people that lived at the home and four staff. We looked at four care records.

People living at the home told us that they were happy living there and staff were very kind and friendly. We observed positive interactions between staff and people living at Exmouth House and saw that people were involved in their care.

We found that the home had communicated with GPs to obtain mental capacity assessments for significant decisions including end of life care. We observed staff respected the rights and dignity of people with advanced dementia.

We found that all of the staff had received additional training in safeguarding, dementia care and use of the Mental Capacity Act (2005). Staff were able to describe when and how they obtained consent from people living at the home.

We found that the service still needed to make some improvements with their paperwork in relation to consent to care and treatment. This was because mental capacity assessments had not been regularly reviewed. Apart from the initial involvement of relatives, continued involvement was not evident from the care plans, care reviews or care records. The manager and provider agreed with this.

People living at the home told us that they are happy living there and staff were very kind and friendly. Relatives said they were very happy with the home and pleased with the care provided to their family members. We observed some good interaction between staff and people living at Exmouth House and saw that some people were offered choices.

Some people who use the service were not fully involved in decisions made about their care and treatment. We found that mental capacity assessments had not been completed for some significant decisions and some day to day decisions including personal care. We observed poor manual handling techniques. We observed staff not respecting the rights and dignity of people with advanced dementia.

During the inspection we had to intervene because we observed that one person with advanced dementia was left without having any drinks for three hours forty five minutes. We observed that two people were not engaged in any activities during this time and sat unattended.