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Inspection on 03/12/09 for Avalon Care Home

Also see our care home review for Avalon Care Home for more information

This is the latest available inspection report for this service, carried out on 3rd December 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service always ensures they plan the care that people need before they are admitted to the home to make sure they have the facilities and services to support people safely. Each person has their own care plan which contains assessments of health risks to inform staff how to reduce or stop any unnecessary risks to their health and wellbeing. The home is properly maintained and equipment is regularly serviced. The staff receive training in new ways of working and overall training targets exceed the minimum standard for National Vocational training.

What has improved since the last inspection?

The new acting manager is improving the way care is planned by ensuring a more person centred approach within the care plans and care delivery.

What the care home could do better:

The acting manager must ensure that the medical equipment in use is properly cleaned and serviced to protect people from infection. It is recommended that information is consistently obtained about each residents diverse needs at the point of admission to enable a more person centred approach to care delivery. Care plans should be developed through consultation with the resident and or their representative and wherever possible the records should be signed and dated when consultation takes place. There should be clear guidance to staff on a residents resuscitation status and this should be reviewed regularly. Progress needs to be made with recording end of life care pathways and information about decision making to ensure people`s rights and choices are protected. Liquid medicines should be dated once opened to provide a suitable audit trail. Care plans should record what monitoring is taking place for people receiving treatment for Depression to ensure that it is effective and reviewed regularly. Records of investigations into complaints and safeguarding should be held at the home. Trained nurses should have a record of competency in first aid procedures. Consider staffing arrangements at peak times of activity. Provide feedback for the annual quality surveys to show how this process informs the quality of the service.

Key inspection report Care homes for older people Name: Address: Avalon Care Home 116 Clipstone Road West Forest Town Nottinghamshire NG19 0HL     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: Mary OLoughlin     Date: 0 3 1 2 2 0 0 9 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 28 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Avalon Care Home 116 Clipstone Road West Forest Town Nottinghamshire NG19 0HL 01623644195 01623429977 avalon@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Ltd care home 40 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: One named sevice user as applied for in application dated 16/10/05 may be within category PD Service users shall be within category OP Date of last inspection Brief description of the care home Avalon Care Centre is a purpose built two-storey, forty bedded care home for older people situated on the outskirts of Mansfield, close to the former mining village of Clipstone. It is situated on a main road, which has a public bus service, and is approximately two miles from Mansfield town centre to the North East. All bedrooms are single occupancy, with half having en-suite facilities. Avalon is close to local shops, and a pub. There is ramped access to the home and a passenger lift is installed. The range of fees are £350.00 and £550.00. No information was supplied as to extra Care Homes for Older People Page 4 of 28 Over 65 40 0 2 0 0 2 2 0 0 9 Brief description of the care home charges. Copies of the last inspection report and the homes statement of purpose are available to people in the home. Care Homes for Older People Page 5 of 28 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: The focus of inspections undertaken by the Care Quality Commission(CQC) is upon outcomes for the people using the service and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of the service that need further development. Prior to our visit an analysis of all the information we have received about the home since our last inspection was undertaken. We looked at what the acting manager had told us in the Annual Quality Assurance document(AQAA) and the responses we received from our Have Your Say surveys which we sent to residents and staff at the home. Care Homes for Older People Page 6 of 28 The main method of inspection used was called case tracking, which involves looking at the quality of care received by a number of people living at the home.We use evidence from our observations, from speaking to people about their experience of living at the home, talk to staff about their understanding of peoples needs and the training they receive to support them in their role. Nottinghamshire County Council sent us their Quality Audit report following their visit to the home on 23/06/09 and we used this information to inform our inspection. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: The acting manager must ensure that the medical equipment in use is properly cleaned and serviced to protect people from infection. It is recommended that information is consistently obtained about each residents diverse needs at the point of admission to enable a more person centred approach to care delivery. Care plans should be developed through consultation with the resident and or their representative and wherever possible the records should be signed and dated when consultation takes place. There should be clear guidance to staff on a residents resuscitation status and this should be reviewed regularly. Progress needs to be made with recording end of life care pathways and information about decision making to ensure peoples rights and choices are protected. Liquid medicines should be dated once opened to provide a suitable audit trail. Care plans should record what monitoring is taking place for people receiving treatment for Depression to ensure that it is effective and reviewed regularly. Records of investigations into complaints and safeguarding should be held at the home. Trained nurses should have a record of competency in first aid procedures. Consider staffing arrangements at peak times of activity. Provide feedback for the annual quality surveys to show how this process informs the quality of the service. Care Homes for Older People Page 8 of 28 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 28 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 28 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 process of admission ensures that people are properly assessed and their care is planned before they are admitted. The home does not provide intermediate care. Evidence: The manager told us in the AQAA that they give people the opportunity to visit the home and read about its facilities and services to help them decide if its the right place for them. The records we looked at showed that all new residents receive an assessment before they come to stay to ensure that the staff can prepare for meeting their needs from the start of their stay. The professional survey we received told us that the homes assessment Care Homes for Older People Page 11 of 28 Evidence: arrangements usually ensured that accurate information was gathered and the right service planned for people. It said that they usually respond to peoples diverse needs and the managers and staff usually have the right skills and experience to support peoples social and health needs. The 5 staff surveys we received told us they always or usually had been given up to date information about the needs of the people they support and they usually or always felt they had enough experience and knowledge to support people. We spoke to a person who had recently come to stay at the home and they said they had settled in well with the help of staff and were very happy with the care provided. Care Homes for Older People Page 12 of 28 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 have their health needs monitored but there is a lack of attention to recording consultation and changes in need. Staff understand the need for the safe administration of medicines but systems do not always follow good practice. Evidence: The service user responding to our survey told us they always received the support they needed and always got the medical care they needed. The carers are wonderful, kind and patient The professional survey told us that peoples health care was usually monitored properly and reviewed and met by the service. That they usually seek advice and act on it to meet and improve peoples needs and wellbeing. One person commented, Good communication with community nursing services and provide good care standards. The 5 staff survey comments included, The staff team are very dedicated We care deeply about our role. Care Homes for Older People Page 13 of 28 Evidence: We looked at the records for three people and found that each one had a full assessment of their needs before coming to the home. Staff had assessed their health risks including the risk of falls. Each day the staff record how the person is and what they have done to support their needs. People told us that they were aware of their care plans but the plans did not reflect whether people had been consulted to make sure they agreed to the care or if anything needed to change. There was limited information available about peoples wishes with end of life care and care pathways, resuscitation, and peoples ability to make decisions. We identified that some risks were not recorded, in one persons plan there was no mobility assessment and although changes in the support had been made the care plan had not been amended to reflect this which means that anyone not familiar with the person would not know how to support them safely. When one person had received treatment by external health professionals the care plans were not updated to describe what support they would receive to monitor or improve their mobility. Staff were able to give a verbal update on the actions being taken to ensure effective management of their condition. The trained nurses administer medicines and we saw how they record medicines each time they are administered to provide a suitable audit trail. The acting manager told us that medicine audits are completed, however liquid medicines and eye drops were found to not be dated when they are opened which does not provide a suitable audit trail. We found that one person who had been prescribed anti depressants had no record of depression within their care plans and no guidance to staff on how to support them. People receiving services tell us they are happy with the way their care is delivered and their dignity respected. The manager demonstrates to us that she is working towards improvement with the appointment of a dignity champion. Care Homes for Older People Page 14 of 28 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 have suitable opportunities for social activities and receive suitable hydration and nutrition. Evidence: The acting manager tells us in the AQAA that she has been focusing on ensuring people have more opportunities for social and recreational activities. She has produced a calender of activities which is organised by a full time activities worker. Care staff ask people about their interests and document these within a social care plan. The acting manager is planning to provide more training for the activities worker to provide her with more insight into different approaches to increase peoples quality of life. People we spoke with told us they have lots of people coming to the home to provide entertainment and the staff have organised family events on bonfire night and Halloween. Each person is regularly weighed and have their nutritional needs assessed and we saw how problems are referred to external professionals if required. Care Homes for Older People Page 15 of 28 Evidence: Where people have hydration problems the staff complete a record of fluid taken each day and the acting manager told us that these are calculated daily to ensure appropriate hydration is maintained. There are choices available at each mealtime and people living at the home told us that the catering staff go out of their way to provide for individual preferences. Care Homes for Older People Page 16 of 28 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. There are suitable complaints procedures followed in practice and robust safeguarding practices to ensure that people are listened to and protected from abuse. Evidence: The home has a robust complaints procedure and our inspection found that this is displayed for people to see. The acting manager has informed us that the procedure is being reviewed to ensure the new address of the commission is included. We have not received any complaints about the service since our last inspection but we were informed of two safeguarding alerts that were made by the home manager. The outcome of these investigations is not yet complete but suitable safeguards are in place to ensure that residents are protected. The acting manager tells us in the AQAA that they have addressed 12 complaints during the last year and each was resolved within the stated 28 day timescale. The service user survey told us that they knew how to make a complaint and always felt listened to and taken seriously. The professional survey told us that the service always responds appropriately if they have concerns. Staff training records we viewed show that 93 of the staff team have received training in how to safeguard adults from abuse. Care Homes for Older People Page 17 of 28 Evidence: The 5 staff surveys told us they always know what to do if someone has concerns. Care Homes for Older People Page 18 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The infection control practices require review to ensure people are fully protected from infection. Evidence: The home was found to be clean and warm. All areas appeared well maintained and the AQAA tells us that appropriate servicing of equipment takes place to ensure the health and safety of the residents. People told us both within our surveys and when we spoke with them that the home is always fresh and clean. The AQAA told us that 97 of the staff team are trained in infection control practices and the acting manager tells us that they are acting on recent recommendations from the local authority to provide the infection control policy and protocols within the laundry room to ensure that staff are aware of their responsibilities. We found that there were no cleaning schedules for medical equipment which could place people at risk of cross infection. The acting manager took immediate action to rectify the shortfalls in cleanliness within the treatment area and told us she would implement a record of cleaning for all equipment in use. Care Homes for Older People Page 19 of 28 Evidence: We case tracked three people all of whom had access to the equipment needed to support their needs, these included pressure cushions and mattresses, raised seating, call bells and moving and handling devices. Care Homes for Older People Page 20 of 28 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 are supported by appropriately trained staff in sufficient numbers to meet their needs. Evidence: From information we received in the AQAA and from examining the recruitment records of two staff we know the acting manager ensures that people are properly checked before they start work at the home. The home holds reference numbers for all police and criminal record checks they have completed on staff employed to make sure they are suitable to work with vulnerable people. New staff receive an appropriate induction to their role and there is clear evidence of ongoing training that provides staff with the skills they need to care for people who live at the home. The AQAA tells us that the number of staff who are trained to level 2 National Vocational Training exceeds 50 . One external professional told us that the staff usually have the right skills to provide appropriate support to people. People living at the home told us they felt that their needs were being met by the staff Care Homes for Older People Page 21 of 28 Evidence: and there was always someone available when they needed help. They told us that staff always answered their call bells during the day and in the night, supported them in the way they preferred. We did identify that there are no extra staff provided at peak times of activity such as early morning and evenings but there was no evidence to suggest that people were not being supported properly. Care Homes for Older People Page 22 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The acting manager is aware of and working towards the required improvements in the service to ensure continuous and sustained improvement in the services provided at the home. Evidence: Since July 2009 there has been an acting manager in post who is in the process of registering with the commission. She told us that she is a trained nurse and that she has a management training award. She sent us the AQAA on time and the information was clear and described continuous improvement of the service. The acting manager has focused on improving the planning and delivery of care to ensure it is more person centred, supporting people in the way they prefer. The care records we saw supported the delivery of more person centred approaches. The staff surveys told us that they are all regularly supervised by the manager.They usually felt that communication was good between the manager and staff. Care Homes for Older People Page 23 of 28 Evidence: The acting manager ensures that a comprehensive quality assurance system is in place such as satisfaction surveys which were last completed in 2009. The survey establishes the views of service users, relatives and visiting professionals. The results of the satisfaction surveys were not available and we could not identify how those participating were given information about the results of the surveys. There are suitable policies in place to protect people who leave personal finances with the manager, a recent local authority audit told us that there are robust procedures that protect peoples financial interests. The records of training show that the staff team receive training in health and safety practices, this includes First Aid, Moving and Handling and Fire safety. Care Homes for Older People Page 24 of 28 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 25 of 28 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 26 13 You must make suitable arrangements to clean and maintain all medical equipment that is not single use. To ensure that adequate arrangements are in place to control the spread of infection. 30/12/2009 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 3 3 7 8 Make sure that information about race, religion and sexuality are consistently recorded at admission. Wherever possible record the involvement of the resident when care planning takes place. Care plans should include details of the persons capacity to make decisions, their wishes regarding end of life, resuscitation and the care pathway. Ensure care plans are updated as conditions change. Hand written medicines should be signed and witnessed and all bottles dated on opening. Care plans should reflect Page 26 of 28 4 5 8 9 Care Homes for Older People 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 the treatment in use for depression and how it is being monitored. 6 12 Ensure that the care plans recording the spiritual needs for people record how and when they have access to ministers and church services. Ensure copies of all complaints and safeguarding investigations are held at the home and available for inspection. Consider the staffing numbers at peak times of activity to ensure that as the number of people accommodated in the home increases, that needs continue to be met safely and in a timely fashion. Trained nurses should have suitable records of competency in First aid and resuscitation. Provide feedback on the results of quality assurance questionnaires. 7 18 8 29 9 10 30 33 Care Homes for Older People Page 27 of 28 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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