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Inspection on 17/03/09 for Avandale Lodge Nursing Home

Also see our care home review for Avandale Lodge Nursing Home for more information

This is the latest available inspection report for this service, carried out on 17th March 2009.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Not yet rated. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Key inspection report CARE HOMES FOR OLDER PEOPLE Avandale Lodge Nursing Home Manchester Road Lostock Gralam Northwich Cheshire CW9 7QA Lead Inspector Anthony Cliffe Unannounced Inspection 17th March 2009 08:30 DS0000018754.V375093.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 2 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 Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avandale Lodge Nursing Home Address Manchester Road Lostock Gralam Northwich Cheshire CW9 7QA 01606 48978 01606 48997 avandalelodge@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care Home 48 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (48), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (13) Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 48 service users to include: * Up to 48 service users in the category of DE(E) over the age of 65) * Up to 13 service users in the category of MD(E) (Mental disorder excluding learning disability or dementia, over the age of 65) * 2 named service users in the category of DE(Dementia) Date of last inspection Brief Description of the Service: Avandale Lodge is a two-storey, detached purpose built care home providing both nursing and personal care for adults with memory problems and dementia. The home has its own grounds. Bedroom accommodation is all single with en-suite facilities. There are lounge and dining facilities on both floors, with access to both floors via the staircase or passenger lift. The home is in a residential area close to Northwich and is on a local bus route. Fees range from £446 to £809 per week. These do not include hairdressing or chiropody. Information about Avandale Lodge can be obtained directly from the home or the providers’ web site on the internet. Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is a two star. This means that the people who use the service experience good quality outcomes. References to we, our or us represent the Care Quality Commission This unannounced visit took place on the 17th March 2009 and lasted over eight hours. One inspector carried out the visit. This visit was just one part of the inspection. Other information received was also looked at. Some weeks before the visit the manager was asked to complete a questionnaire called an Annual Quality Assurance Assessment (AQAA) telling us what they thought they did well, what they needed to do better and what they had improved upon since the last visit, to provide up to date information about the service provided. This helps us to determine if the management of the home see the service they provide in the same way we do and if our judgements are consistent with homeowners or managers. We provided questionnaires for people that use services, staff employed at the home and social and healthcare professionals involved in their care to find out their views about the service the home provides. During the visit various records and the premises were looked at. A person that uses services was spoken with and gave their views about the service. We also received questionnaires from staff that said the home had good recruitment procedures and staff received support and training. In March 2008 we did an annual service review of the home, which told us standards at the home were not as good as they were at the time of our last visit and we may decide to bring our main inspection forward. An annual service review is a summary of our knowledge about how a service that has not had a visit in the last year. It is also how we decide if a service is still as good as we thought it was since the last visit or annual service review. What the service does well: Avandale Lodge provides a welcoming homelike atmosphere and is well maintained both internally and externally so people living there have a comfortable home in which to live. A person living at the home said about living at Avandale Lodge, “Everyone are friends together, we never have a dull day”. Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 6 The manager is experienced in managing a care home and this was reflected in how policies, procedures and training had been introduced since she was appointed so improvements in how the home was managed could be seen. Before people that use services decide if they want to live in the home their needs are discussed with them, their families and people involved in their care by a representative of the home so important information is gathered about their needs. The home demonstrated a positive commitment to staff training with a varied staff training programme taking place so staff were provided with training and support to do their jobs. The home provides information to people that may choose to live there and people that use services so they had information on the facilities, services and costs of their care. Staff were seen to be friendly, approachable, courteous and polite to people that use services and relatives. Relatives seemed comfortable in approaching staff for information or help. Care is of a good standard and people that use services looked well cared for and comments from people living there and visitors support this. The recruitment and training of staff is of a good standard so people that use services were protected by the employment systems in place. The manager and staff communicate well with people that use services, relatives and visitors. Visitors said they are kept informed about their relatives, were made to feel welcome and requests or concerns were responded to positively so had confidence in how the home was managed. A variety of social activities were provided for people that use services. People that use services were encouraged and helped to exercise choice and control over their lives so their rights to have everyday choices were promoted. What has improved since the last inspection? The appointment of an experienced manager who has worked for Southern Cross Health Care for several years has improved the management of the staff team and the home so we and people that use services will be confident that standards in the home will be improved. Training on protecting vulnerable adults for staff to support them to recognise and respond/report their concerns or worries, about vulnerable adults being abused or neglected, has improved so staff report their concerns and protect people that use services. Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 7 The facilities in the building have improved with a lot of money spent on redecoration of the building, replacement of carpets and flooring and purchase of new furniture, so people that live at the home have more comfortable surroundings. The home has improved how it supports people with memory problems and dementia to recognise their bedrooms, toilets and bathing facilities so they can recognise and find these facilities more easily and lessen their confusion as to where they are. What they could do better: If you want to know what action the person responsible for this care home is Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 8 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. Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 People using the 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 their needs assessed before they move into Avandale so they know their needs can be met. EVIDENCE: Information about the home is provided to people that may wish to use the service. Information was available for them at the home with the previous inspection report and information on the facilities and services available. This was called the ‘service users’ guide’ and provided information on all the facilities and services available to people wishing to live at Avandale. This provided information on moving into the home, what people could take with them and what the arrangements were for arranging their care so people that may wish to live at the home had relevant information to help them make a decision about living there. Information on the care home can be made available on request in different Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 11 formats such as large print, audio and DVD so people that choose to live at the home are provided with information in a style they can understand. We examined the files of two people that had moved into Avandale since the last visit. The home had gathered information on their needs. Information gathered about people covered details on maintaining their safety, managing finances, health, social and psychological care and the support that people that use services needed. Gathering information about people that use services involved their families, advocates and health and social care professionals involved in their care. People that may want to use the service can visit the home before decisions are made about choosing Avandale so they see what facilities the home has to offer them. Information was obtained about their life histories so staff had information about their lives before they moved into the home. Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the 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 to live a lifestyle of their choice but information held about them does not support that they are directly included in the decision making process so are not always involved in everyday decisions or decisions about their care. EVIDENCE: Before the visit took place the manager provided us with information that said the home works in person centred way and all care plans were completed by staff at the home gathering information on people that use services, which included gahering information from their families, friends, advocates and professionals involved in their care so the home had a variety of information about people that use services. The information said people that use services were included in planning their care. We examined the care plans of two people that use services. From looking at care plans and having conversations with them, relatives and staff we could see that the health and personal needs Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 13 of people living at the home were consistently met and their privacy and dignity respected. We saw that staff treated people that use services with courtesy, dignity and respect and sought their views about how they wanted to be supported and saw staff help them make decisions. We did not see information about how people that use services made decisions or where they lacked capacity, experience or judgement to make decisions so could not confirm why, when, where and how staff supported people that use services to make decisions or what decisions they made for them or supported people that use services to make. We could see that the home had gathered a lot of information on people that use services. The information included copies from the NHS Primary Care Trust We saw that a lot of information was gathered about the needs of people that use services so staff had information to provide support and care. The home did not use person centred planning to provide care and support to people living at the home so their care is based around their needs. Person centred planning is a really good way for people that use services to take control of their lives. Person centred thinking helps staff that care and support people that use services to listen to them and then to get what they want. A person centred plan contains information on what is positive about people that use services for example what people like and admire about them and their gifts and talents. Information should be included about what and who is important to people that use services from their viewpoint, as well as what people want for their future. A person centred plan should have information about how people that use services want to be supported, so stay healthy, safe and well. This is called a support plan but may be called a care plan. This should be detailed enough to provide a living description of how people that use services want to be supported, how they make decisions and says who will do what by when. We saw the home used very detailed documents to gather information on people that use services which included details on their life history, health and keeping them safe. Information about how staff could support people that use services to care for themselves and what skills they had in caring for or could be supported to care for themselves were not recorded in detail so staff would not know how people that use services would choose when they wanted their support and care to be provided. Some people that use services had behaviours that meant their safety and the safety of others was at risk. Their care plans advised staff how to respond rather than prevent this so staff supported people to take risks without reducing their choices. Mobility information and guidance on how to manage medical conditions such diabetes, monitor what people were eating, and preventing the breakdown of skin were included so staff had information on what to do if people that use services needed medical attention. Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 14 Surveys returned by professionals said that staff was good at asking for advice and acting upon it. Two doctors wrote that staff were ‘very caring’ and ‘always had time to sit and talk to the people they were caring for’. One doctor wrote that the home was ‘more organised and supervision and training had improved’ since the new manager had been appointed. Surveys were returned by people that use services and they said there health care needs were always met. One commented, ‘They always help me if I have trouble’. Medication policies were detailed so staff had guidance on how to receive, store, administer, record and dispose of medicines safely. Both floors in the building had similar arrangements for the storage of medicines. Each storage area contained the policies and procedures for medicine administration with specimen signatures for the staff responsible for the management and administration of medicines so staff were aware of their responsibility and accountability for managing and administering medicines. Storage included controlled drugs storage and theses were looked at and found to be safe. Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the 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 that use services are supported to maintain relationships and make choices about lifestyle and leisure activities but could be supported further to have control over their lives based on their personal choices. EVIDENCE: The home employs a full time activities co-ordinator so people that use services had support to do activities arranged for them Surveys returned by people that use services said that activities were usually arranged for them and they liked to join in them. Activities were arranged flexibly and included both individual and group activities so people that lived there had some choice in the type of activities they were involved in. At the time of the visit the home had arranged a St. Patrick’s Day celebration for people living there and their families. This involved singing songs and enjoying a drink. The celebration was held on both floors so everyone had a chance to join in the event. Other activities arranged around the time of the visit included a Mother’s Day afternoon, coffee morning, and Easter bonnet competition in early April. Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 16 The home had regular weekly events planned in the home so people that use services had contact with the community. This included visits form the hairdresser, chiropodist and local school. The home also holds a weekly luncheon club for relatives of people living at the home. Activities also included people that use services talking about important events in their lives and remembering what different foods tasted like and common smells they would have encountered. Activities also included relaxation, playing dominoes, talking about and tasting favourite foods form their childhood, painting and planned visits for people that use services to see family members so they maintained contacts with them. Despite the level of activities arranged we saw people were not always engaged in doing everyday things and were sleeping for periods. The home had a meeting for people that use services and comments received from this were that activities needed to improve during the day and evening. People that use services wanted more entertainers in the home and trips out so they had more variety in the things they did. Visitors to the home said they were always welcomed and offered a drink. One visitor said the welcome they had received when they were looking for a care home for their relative helped them to choose Avandale and described staff as “Really friendly, fantastic from day one. It’s been great we have just had a six week review and mum has really improved, she’s like her old self. She is talking more and looks well. She is really well cared for. For the first time in 12 months I’m not worried and am sleeping and can get on with my life. The entire family visit and all say they are welcomed and get a cup of tea. They said this is mums home and we are to treat it as such and visit when you like”. Another visitor said, “Staff show interest in him and encourage him to socialise and staff have time to talk to him. I see he gets good care which is what matters most”. The home had a varied menu which offered a variety of choices including a cooked breakfast. People that use services could choose where they ate their meals. We saw meals being served during breakfast, lunch and tea time. People that use services that could assist themselves to eat had the opportunity to sit in the dining room so they could choose their meals and assist themselves with their meals. Staff were seen to take the choices of main course plated up over to people that use services so they could choose what they wanted, otherwise people chose their meals when asked by staff what they preferred. People that use services that could not use words were shown the choices of main course to make a choice where possible but a number of meals were seen to be served onto the plate by staff and then taken over to the person to be helped to eat so were not always offered a choice. The nurse in charge said staff knew what people preferred to eat but this was not supported by decision making agreements in care plans which would detail Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 17 how decisions for people that lacked capacity to make decisions about choices would have them made on their behalf. Another example of this was that at meal times on one of the areas people that used services had blue plastic aprons put on them without staff asking them if they wanted to wear one. We could see this was an attempt to protect their clothing and promote dignity but people were not given a choice by staff so their dignity was not always upheld. A visitor said she had told staff she did not want an apron putting on her relative as “He would not have done this at home”. We saw medicines being administered during meal times which seemed to add to this busy time of the day. The manager agreed to look into this so that people that use services did not have medicines during their meals unless necessary so they had time to concentrate on their meals and were not disturbed by staff administering medicines. Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the 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 that use services are protected by the safeguarding adults’ procedure in place so people that use services will be confident they are protected. EVIDENCE: The complaints procedure was contained in the information given to people that use services when they moved in and displayed throughout the home so people that use services could use it. The home did not make the complaints procedure available in a way that people with memory problems could read and understand easily. Before the visit people that use services sent us surveys and said they knew who to speak to if they were unhappy or had concerns but did not know how to use the complaints procedure. Comments received were that people that use services would ask the care staff or nurses for help if they wanted to make a complaint. Policies and procedures were in place to protect vulnerable adults called the safeguarding adults procedures. The safeguarding adults’ procedure is how we, the local council, police and other agencies respond to and manage allegations or suspicions of abuse against vulnerable adults. We met with the operations manager from Southern Cross Health Care in May 2008 to discuss a number of concerns about the management of the home and the number of safeguarding adults’ referrals that were being made by the Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 19 home. We did an Annual Service Review of Avandale in March 2008 and said we would bring the key inspection due in March 2009 forward. Since the appointment of the manager in October 2008 we had seen an improvement in how the home is managed and how safeguarding referrals have been made. Improvements were supported by the local council and Primary Health Care Trust providing reassessment of the mental health of people that lived at the home and finding more suitable places for them to live so the home reduced the amount of people living there whose mental health needs interfered with the lives of others. Staff were provided with guidance on the best practice when writing care plans from staff at the Primary Health Care Trust so focused more on improving their care of the mental health needs of people that use services. As a result of investigations between the local council, Primary Health Care Trust and Southern Cross. Southern Cross Health Care used the disciplinary procedure and dismissed staff. Some staff have been referred to the independent safeguarding authority the organisation which decides if people should be placed on the protection of vulnerable adults register. Staff at Avandale had received safeguarding training which helped them to respond to suspicions or allegations of abuse or neglect to make sure vulnerable adults were protected. Staff spoken with said they received safeguarding adults training during their induction. Staff spoken with during the visit were knowledgeable about the safeguarding adults’ procedure and how to report their concerns so could protect vulnerable people. Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the 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 that use services live in a comfortable well maintained home which is suitably equipped so their needs can be met. EVIDENCE: Since the last visit the provider had spent a lot of money on improving the decoration and furnishing in the home. Corridor carpets had bee replaced in all main lounges and corridors and the dining rooms fitted with laminated flooring so the environment was clean and well maintained. Many bedrooms have been decorated and had items of personal furniture, photographs and electrical items so people that use services could make their bedrooms more recognisable to them. Dining rooms and corridors have been redecorated and doors to bedrooms, bathrooms and toilets painted in different colours so people with memory Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 21 problems could tell the difference from bedrooom doors. This was helped by the use of large signs on toilets and bathrooms to help people that were partially sighted or could not recognise words to know where these failities were so they could use them. The home had also introduced memory boxes which are boxes that contain photographs, or pictures of hobbies or interests that people that use services had so they could recognise their bedrooms. One of the bathrooms was out of use as the bath hoist was broken. This was not the same bathroom which had a broken hoist at the last visit. The manager said the replacement parts for the hoist to be repaired had been ordered but took some time to arrive due to the age and manufacture of the equipment so had been out of use for some weeks. The home did not have have many walk in shower facilities which would benefit people that use services that are disabled or use wheelchairs so they could have the use of shower facilities. The minutes of a meeting with people that use services in Janaury 2009 recorded that people living at the home wanted a shower bath installed. The number of hi-low beds and profile beds have increased so people that use services had beds which suited their personal needs. One of the lounge areas has been themed around activities and staff had decorated this with soft furnishings and pictures of film stars from the twentieth century so people that use services had an area in which they could meet and relax. Cleaning schedules had been altered so a domestic assistant was available during the late afternoon so the home was kept clean and hygieneic. The main foyer area had been redecorated and furnished and new furniture had been purchased for people to sit on as well as dining furniture. Externally the building was well maintained with large gardens. The manager said the home wanted to create a sensory garden area as well as raised flower and vegetable areas so people that use services could be involved in gardening and enjoy the garden area. Access to the large rear garden area is limited and improved access would benefit people that use services that are disabled or use wheelchairs so they could have easier access to the garden. The minutes of a meeting with people that use services in Janaury 2009 recorded that people living at the home wanted better access to the garden area. Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good employment policies, procedures and training is in place so staff understand the needs of people that use services and they receive appropriate care. EVIDENCE: Two staff surveys returned before the site visit all said that recruitment was thorough; induction was very well done or mostly covered what staff needed to know. Supervision and appraisal were referred to and staff said the manager regularly or often met with them to offer support and guidance so they had opportunities to discuss how they did their jobs and how they could develop. Staff said they were confident that they had the right skills to provide care for people that use services. Staff said they had the opportunity to complete and NVQ level 2 and NVQ level 3 which is a nationally recognised qualification in social care. The information returned to us before the visit by the manager said 25 care staff were employed three of theses had an NVQ level 3 qualification and eleven had an NVQ level 2 or above qualification so had a commitment to developing the staff team. We examined the recruitment records of three staff employed at the home. Recruitment procedures were robust and included staff having to complete an application form, full employment history and two references sought about Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 23 their suitability for employment. The recruitment of staff also included a Criminal Records Bureau (CRB) disclosure which is a check of staff to see they are suitable people to provide personal care and support to vulnerable adults. Staff were also isused with the General Social Care Council code of practice a guide for social care staff on the standards expected of them so they were aware of their responsibilities and practice when providing care to people that use social care services. Staff had attended training in induction, moving and handling, safeguarding adults, fire, food hygiene, customer care, medicine administration, first aid and Yesterday, Today and Tomorrow training from the Alzheimer’s Society a nationally recognised programme of training to increase staffs knowledge and awareness of dementia so they were able to provide appropriate care. The home has access to the organisations training staff as well as having its own trainer who was qualified to provide training in safer moving so staff had a variety of training to be able to do their jobs competently. Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 21, 33, 35, 36 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality assurance identifies areas for improvement so the welfare of people that use services is promoted. EVIDENCE: Surveys returned to us before the visit said that the manager often met with staff to provide support. The manager had been the manager of the adjacent Southern Cross Health Care home for several years and since her appointment in October 2008 improvements had been made. The manager has many years experience as a nurse and as a manager so we and people that use services can be confident that further improvements will be made. The manager was not working as part of the staff rota and worked in addition to this so was able to provide supervision and support to the staff team. Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 25 The manager completed quality assurance audits as part of the quality assurance system. These were checked externally during visits by the operations manager so the provider was aware of any matters in the home which needed to be improved. Quality assurance also included meetings with people that use services. The last meeting was held in January 2009 and 12 people attended this. The meetings have an agenda so important things that people living at the home want to be discussed were raised. This included the menu, quality of food, activities, staff, redecoration of the building and fundraising. People that use services said the food was good and wanted more home made items, more outside activities with trips out and access to the garden and improvement in activities during the day and evening as people living at the home felt this was limited. Staff were discussed and people that use services said they were happy with the staff team and described them as polite, helpful and cheerful. The home also needed more comfortable chairs. The home manager also holds monthly meetings where relatives have an opportunity to discuss the management of the home as well as meeting are private with relatives. The home does not act as appointees for any people that use the service or manage finances on their behalf. All people using the service have an account opened for them to deposit money for personal use but they or their relatives may not choose to use this facility so manage their finances themselves. Monies held at the home were kept to pay for chiropody, newspapers, toiletries and hairdressing so people using the service could purchase things they wanted. Balances were checked against deposits and debits made to monies held on behalf of people that use services and balances tallied against records kept so financial procedures were safe. Monies held on behalf of people that use services were checked every month as part of the quality assurance system by the person that did the required visits on behalf of the provider so there was an independent check of financial procedures. The AQAA confirmed that all the required maintenance and health and safety checks had been completed as required so people that use services lived in a safe environment. Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP31 Regulation 8(1) Requirement The registered person must ensure that an application for a suitably qualified and experienced manager is submitted to the Care Quality Commission. Timescale for action 01/07/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The home needs to improve how the personalisation of the care of people that use services are reflected in their care plans so staff and others involved in their care understand how important peoples routines and decisions are to them and how these are transferred into how they receive care. A variety of activities should be freely available throughout the day so people that use services have the opportunity to be involved in social and recreational activities so they are provided with support and help to remain fit, independent and well and lessen the impact of dementia upon them. DS0000018754.V375093.R01.S.doc Version 5.2 Page 28 2. OP12 Avandale Lodge Nursing Home 3. OP16 4. 5. OP19 OP19 The information about complaints should be made available in different ways so that people that use services that have memory problems can be supported to understand and use the complaints procedure. The home should provide better access to the garden area so people that use services can spend time there and benefit from activities arranged around the garden area. The home should provide more choice in the bathing facilities available so people that use services have a greater choice in how they keep themselves clean and healthy. Avandale Lodge Nursing Home DS0000018754.V375093.R01.S.doc Version 5.2 Page 29 Care Quality Commission Care Quality Commission Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 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. 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