CARE HOMES FOR OLDER PEOPLE
Alvony House 25 Linden Road Clevedon North Somerset BS21 7SR Lead Inspector
Patricia Hellier Unannounced Inspection 14:30p 9 January 2006
th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Alvony House Address 25 Linden Road Clevedon North Somerset BS21 7SR 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) 01275 875573 01275 349655 Mr Alec Rendall Mrs Veronica Rendall Mrs Veronica Rendall Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. May accommodate up to 27 persons aged 65 years and over requiring personal care only May accommodate one named person aged 50 years or over. This exemption is specific to one individual and will lapse when that person attains the age of 65 years or leaves the home. May accommodate one additional person for periods of respite; total persons accommodated during periods of respite should not exceed 28. 14th July 2005 Date of last inspection Brief Description of the Service: Alvony House consists of two Victorian properties joined by a linking corridor. The home is registered by the Commission for Social Care Inspection to provide residential care for 27 residents aged 65 years and over, with low dependency needs. At the present time there is a condition of registration covering one named resident under the age of 65 years. Alvony House has a warm friendly and homely atmosphere. Accommodation is provided over three floors with access to all floors provided by a stair lift. It is situated a short walk from the local shops and bus route. Dedicated sitting areas and a patio area in the rear garden allow for good weather activities outside. Garden furniture is provided. Provision is made within the home for a variety of activities and outings, which also enables close links with the local community to be maintained. Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over seven hours on 9 January 2006. The Registered Manager, Veronica Randall, was present for part of the inspection. All residents and members of staff on duty also took part in the inspection. The inspection focussed on the residents’ experience of the home; the care given and the way in which it is provided, to make sure residents are comfortable and care is being given to meet their needs in the best possible way. The inspector checked the medication and fire records, inspected 5 resident care files and 3 recruitment files. She read through the home’s policy and procedure files and risk assessments. Eleven residents, one relative, and three members of staff were spoken with during the inspection. All spoke highly of the home saying, “it is very homely and comfortable”. What the service does well: What has improved since the last inspection?
The complaints policy has been reviewed and now includes timescales so anyone who complains knows when to expect a reply. Staff have received update training in the recognition and handling of abuse, and in infection control practices, to maintain residents’ safety. All communal toilet and bathroom areas now have dispenser soap and paper towels to assist in the prevention of the spread of infection. Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 7 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 Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,5 The home’s assessment process is thorough and ensures that it is able to meet residents’ needs. The home encourages prospective residents and their relatives to visit the home prior to admission EVIDENCE: A full assessment process had been completed for 3 of the care records inspected. A fourth care record showed no assessment of needs prior to admission, or any assessment in the weeks since admission by the home. A Social Services assessment and care plan were present but staff were not fully aware of the contents of it. While the inspector was aware of the urgency of this admission in the first instance, it is however expected that an assessment by the home would have been conducted by the time of the inspection. Four of the residents spoke of coming to visit the home with their relatives to see what it was like. One resident said, “I liked it so much I stayed”. Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,10 Care plans do not contain all relevant information to enable staff to meet residents’ health and social care needs. Risks to residents are not fully assessed and actions to minimise these planned, which potentially places residents at risk. The systems for the receipt, monitoring and administration of medicines, do not provide the necessary safeguards for residents. Residents feel they are treated with respect and dignity. EVIDENCE: Four care records were inspected. One did not have the current details of the GP for the resident. Another did not have contact details for other professionals involved in the care of the resident, and there was no care plan for the resident although she had been at the home a few weeks. Three of the four care records had long term care plans for the residents. Where shortterm care needs had arisen or care needs had changed, no care plan had been completed. Each set of records had a risk assessment form, which did mention falls, but in one case this had not been completed since September 05 and did not reflect the current situation. No actions to minimise, risks or outcome of actions to prevent risk, was noted. This applies with particular reference to falls and pressure areas.
Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 10 On inspection of the medications administration system it was seen that medication for the following mornings breakfast was put into pots on a tray and signed for, 18 hours before it was to be given. This is unacceptable practice, as it does not provide the necessary safeguards for residents. An immediate requirement was issued. The provider informed the inspector that the system had been changed 3 days later. Medication found in the cupboard for one resident that should have been given earlier in the day, had not been given yet had been signed for on the medication sheet. A number of medication records had been hand transcribed and others had written alterations to the pre-printed medication sheets. None of these had been signed, thus not providing the accountability lines for the protection of residents. No record of orders from a qualified practitioner could be found for the change in doses made on the Medication Administration Records (MAR). Medicines to be stored in the fridge are kept in an unlocked area of the kitchen fridge. A more secure system to prevent potential risks should be put in place. The medication practices observed do not comply with the homes policy. This puts staff in a position of working outside the homes policies, and residents at potential risk. The interactions of the care staff observed demonstrated respect for individuals and their right to privacy. Residents spoken to say, “the staff are very thoughtful and kind and treat you very well”. Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14 Residents are happy with their lifestyle at Alvony House and are able to make choices and follow their own interests. Contact with families and the wider community is encouraged. EVIDENCE: Resident told the inspector that they can see their visitors at any time. Relatives were seen popping in during the course of the evening and being welcomed by staff. One relative said, “I feel quite happy coming here and the staff are very good to me and my mum”. There are posters throughout the building advertising forthcoming events. These include local trips, visiting entertainers, bingo sessions and regular church services. These are free of charge. Some residents spoke of going to local clubs. Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Residents are confident that they are listened to and their requests acted upon. Residents are protected from abuse by knowledgeable and competent staff. EVIDENCE: The home has a complaints procedure that is well displayed and all residents have a copy of. Since the last inspection timescales for complainants to measure response against have been included. There have been no complaints and residents stated that if they were not happy about anything they would speak to the manager. Staff and residents spoken to, say the manager is very approachable and understanding. One service user said, “I’ve nothing to complain about, it’s the best home I’ve been in”. The home has a copy of the North Somerset ‘No Secrets’ Guide. A procedure for responding to allegations of abuse is available and staff were fully aware of it. Since the last inspection staff have received update training in recognising and dealing with situations of abuse. They have completed a test to demonstrate knowledge, and these showed staff competency in this area of practice. Staff said they had never seen any signs of abuse in the home. Three residents said, “The staff are very kind and take time”. “I can’t fault them”. Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,26 Residents are provided with safe, comfortable surroundings with adaptations to aid independence. Infection control practices are good and minimise risk to residents’. EVIDENCE: The property is well maintained, with homely and comfortable communal spaces. The accommodation is furnished to a high standard with fixtures and fittings complementing the general relaxed atmosphere of the home. Residents’ rooms are personalised and comfortable. Special attention has been paid to the provision of aids and environmental markings for the visually impaired e.g. white lines at step edges, handrails in the garden painted white. The home is clean and pleasant. Since the last inspection dispenser soap and paper towels have been provided in communal toilet and bathing areas, providing good practice in the prevention of the spread of infection. Staff interviewed said they had received update training in this area and demonstrated knowledge and competence in this area. Staff were observed using gloves and aprons in the right way to prevent the spread of infection.
Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 The numbers and skill mix of competent staff are sufficient to meet residents’ needs. The procedures for the recruitment of staff are robust and provide the necessary safeguards for residents. EVIDENCE: Residents spoken to say that the staff are “kind and caring”. During the visit staff were observed answering call bells quickly. Two residents spoke of the time and care that the manager had taken to assist them with official papers when arriving in the home. The staff rota showed appropriate numbers of staff to cover the different times of the day. The manager’s duties are now recorded on the rota giving an accurate record of staff on duty at any time. A number of the staff team have worked at the home for a long time and provide good continuity for residents. Recruitment practices for new staff employed are satisfactory. Three recent recruitment files were checked. Application forms, references and CRB checks were evident. Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,38 The manager provides clear leadership and guidance to staff to ensure residents receive consistent care in a safe environment. EVIDENCE: The manager gives clear leadership, guidance and direction to staff. Relatives and staff stated that the manager is good at her job, approachable and one relative said she ‘can’t do enough’ and ‘she is always helping’. Residents feel the manager is approachable, available and seeks to ensure all their needs are met. Records inspected indicated regular safety and fire checks are carried out. Staff spoken to confirmed that regular fire instruction and drills had taken place. Some environmental and individual risk assessments had not been completed to ensure the safety of residents at all times. Since the last inspection the Environmental Health Officer has visited and made a number of requirements and recommendations. The manger told the inspector that these were being addressed. Evidence of this was seen.
Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 16 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 X X 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X X X X 2 Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 17 NO 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 OP3 Regulation 15.1 Requirement All residents should have a full needs assessment, by the home, to ensure the home can meet the needs prior to moving into the home To complete individual risk assessments for residents with risks identified through the care plan, actions stated and outcomes evaluated regularly, e.g. falls, pressure sores Changing and short-term care needs to be recorded in the care plan together with actions to meet those needs. The system for administration of medicines to be changed to provide safe practice. An Immediate Requirement was issued Staff to received training in the policies and safe practice of the administration of medicines. To have clear records of all medication received into and leaving the home. Timescale for action 13/03/06 2 OP7 13.4 (c) 13/03/06 3 OP7 15 13/03/06 4 OP9 13.2 12/01/06 5 6 OP9 OP9 13.2 13.2 17/03/06 17/03/06 Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 18 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. 2 3 Refer to Standard OP7 OP38 OP38 Good Practice Recommendations To evaluate and record outcomes thus informing future actions to ensure needs are appropriately met To review the entire upstairs window opening mechanisms to ensure safety when opening. Carried forward as not assessed at this inspection To complete environmental risk assessments for areas within the home that could pose a risk to residents e.g. the propping open of fire doors and window restrictors for windows on upper floors. Carried forward as not assessed at this inspection To monitor and record the hot water outlets in bathrooms to ensure not above 43 degrees Celsius. Carried forward as not assessed at this inspection 4. OP38 Alvony House DS0000008137.V268609.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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