Inspection on 13/11/06 for Avala Park

This inspection was carried out on 13th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

Other inspections for this house

Avala Park 16/09/09

Avala Park 12/06/08

Avala Park 13/06/07

Avala Park 10/01/06

Avala Park 15/08/05

Avala Park 20/10/04

Avala Park 21/06/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Avala Park Mile Road Widdrington Morpeth Northumberland NE61 5QW Lead Inspector Anne Urwin Brown Key Unannounced Inspection 13th November 2006 08:45 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 Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 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. Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avala Park Address Mile Road Widdrington Morpeth Northumberland NE61 5QW 01670-790019 01670 791203 avalapark@highfield-care.com 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) Southern Cross Care Homes Limited Mrs Alison Martin Care Home 35 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (24) of places Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th January 2006 Brief Description of the Service: Avala Park is a purpose built two-storey home located in the rural village of Widdrington. The home is set back from the road in its own large gardens and it has ample car parking space. Local amenities and public transport are limited but include a small supermarket, public house, community centre and GP surgery. The home is registered to provide accommodation and personal care to 35 older people, 10 of whom have a dementia. Southern Cross Care Homes Limited owns the home. Fees range from £389 to £394 per week. The statement of purpose, service user guide and copy of the most recent inspection report are available for the residents. Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was carried out over seven hours. Before the visit the Inspector used information from the pre-inspection questionnaire to assist in planning the inspection. The inspection involved talking to the Manager, eight residents and seven staff, a tour of the building and inspection of records. Case tracking was used as part of the inspection process. Two residents, and four health and social care professionals completed questionnaires. Residents and care managers made very positive comments on the quality of service. What the service does well: What has improved since the last inspection? Medication records are signed and countersigned. The ground floor bathroom has been redecorated and new lighting fitted. The shower pole has been replaced in the downstairs shower room. Shower chairs are clean and paper towel dispensers are available. Plastic pull cords are fitted in bathrooms and toilets. Some work has been done to improve residents’ social care plans, but further information is needed in plans about individuals’ interests and preferences. Residents’ preferences about bathing, dressing and communication are recorded appropriately. Assessments are recorded of residents’ ability to handle their personal money. Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 6 Residents’ views are included in the Service Users Guide. 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. The summary of this inspection report can be made available in other formats on request. Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 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 Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 6 were inspected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are able to get the information they need to make an informed choice about where they live. No resident moves into the home without having his/her needs assessed and been assured that these will be met. Intermediate care is not provided. EVIDENCE: The Statement of Purpose has been reviewed since the last inspection and now gives enough information for people thinking about coming to live at Avala Park. Residents’ records inspected contained a full assessment of need. The assessment covers the areas identified in this standard. Care management assessments were also available that identified residents’ needs. Residents Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 9 said that when they came to live at Avala Park staff knew what their needs were. Records showed that Intermediate care is not provided at Avala Park. Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, and 10 were inspected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are identified within a care plan, but more information is needed about residents’ social care needs. Residents’ health care needs are appropriately met. The home’s policies and procedures for dealing with medicines protect the residents. Residents are treated with dignity and respect and their right to privacy is upheld. EVIDENCE: Care plans based on residents’ assessed needs are in place. Information about individuals’ social care needs is limited. Limited information is available about individual preferences and how staff meet these. Records show that plans are updated to take account of residents’ changing needs. Assessments for falls, pressure areas, nutrition and moving and handling are available for each resident. Plans and assessments are reviewed monthly. Residents said that they were satisfied that staff knew what they needed help with and Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 11 provided them with appropriate support. One resident said that staff were always helpful and cheerful. Residents’ health care needs and any specific treatments are clearly recorded and all contact with the doctor, district nurse and other health care professionals is available in individual records. Risks are regularly assessed for falls prevention, nutritional needs and skin care. Residents said that the staff are aware of their health needs. They said they get support to attend appointments. Two residents said they were satisfied that they can access the health services that they need. Guidance is in place for staff about handling medicines. Medication records are kept in good order. Appropriate arrangements are in place for the storage of medicines. All senior staff have completed appropriate training and the manager said that most other staff have also had training in case they needed to give out medicines. Residents said that they felt that staff respect them and treat them well. Staff were seen knocking on residents’ doors before entering rooms by the inspector. There was a relaxed atmosphere evident in the home and staff spoke respectfully to residents during the inspection. Staff induction training includes reference to privacy and dignity. Staff guidance is available about privacy and dignity. People are asked what they prefer to be called by staff and this is recorded in care plans. Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, and 15 were inspected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The lifestyle in the home suits residents preferences and expectations. Their care plans need to provide more information about their social needs and how these are met. Residents keep in contact with family, friends and the local community. Residents have control over their lives. The dietary needs of residents are well catered for with a balanced and varied selection of food. EVIDENCE: Residents said that they are able to make choices about their daily routines, like when they get up and go to bed. Individual routines are identified within care plans, but more information about residents’ wishes about daily activities is needed. Notices about activities provided were available in the front hall and these showed that arranged events are available each day. A quiz was organised on the afternoon of this visit that residents were evidently enjoying. One resident said she felt happy spending time in her room, while others said they enjoyed the company of other residents and the activities staff arranged. The manager is trying to recruit an activity organiser for ten hours per week at the time of this inspection. Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 13 Residents said that they have regular visitors and the inspector saw this during the inspection. Residents said that they could see visitors in their own rooms or in the public areas of the home. Information is available for relatives about visiting and this is made available before a resident is admitted. A relative said that she had information before her mother was admitted. Residents are encouraged to continue to manage their finances for as long as they are able and records confirm this. Residents’ rooms are well furnished with their own possessions and they said that they were encouraged to bring items from their previous home. One resident said that she thought she could look at her records, but was not sure that she wanted to. Menus show a variety of healthy food is available and residents said there was an alternative at each mealtime. They said they enjoyed the food and that there was plenty of it and they could ask for something else if they did not like what was provided. The meal served during the inspection was well cooked and presented. Staff were aware of residents’ likes and dislikes. Visitors are able to have meals. The cook has had Food Hygiene training. Residents said they are asked about what they would like for meals. Meals are served in the dining rooms or in residents’ rooms if they prefer. The cook keeps records of residents’ likes and dislikes. She provides home baking for residents and is aware of the dietary needs of older people. Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were inspected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are confident that their complaints will be listened to and acted upon. Residents are protected from abuse, however some staff need updating training to ensure they know the procedures to be followed. EVIDENCE: Guidance is available for dealing with complaints. Residents said that they knew how to make a complaint and that they felt able to speak to staff if they have any concerns. No complaints have been made in the past year. Appropriate systems are in place for recording and dealing with complaints. Appropriate guidance is in place for dealing with allegations of abuse. Not all staff were clear about the procedures to be followed if an allegation is made. Staff training has been provided, but the manager intends to provide regular updates to ensure staff are clear about the process for dealing with allegations. Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 24 and 26 were inspected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well-maintained environment, however repairs were outstanding for the shaft lift and the water boiler in the kitchen. There are comfortable and safe indoor and outdoor communal facilities. There are sufficient lavatories and washing facilities that are equipped to suit residents’ needs. Residents have safe, comfortable bedrooms with their own belongings around them. The home is clean, pleasant and hygienic apart from one bedroom where an odour was evident. EVIDENCE: The home is purpose built on two floors with a shaft lift fitted. The lift doors did not shut properly on the inside during the inspection. The manager said that parts have been ordered and residents are supervised when using the lift. Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 16 The home is generally well maintained and staff said that repairs are carried out promptly. The front of the water boiler in the kitchen is taped over and a new part is on order. The cook said it is expected that this will be fitted in the next few days. The safety of this arrangement needs review. The gardens and exterior of the home are tidy and safe for residents. Bedroom doors are being repainted and fitted with door knockers. The residents said that they were very satisfied with the accommodation at Astor Court and particularly with their own rooms. One lady said she was “very comfortable and well looked after.” There is spacious sitting and dining areas that are comfortably furnished to suit residents’ needs. One sitting area is available for smokers. Lighting is appropriate for reading and other activities. Bathrooms are well equipped and aids are fitted that suit residents’ needs. One bathroom has been redecorated and lighting renewed since the last inspection. Plastic covers have been fitted on all pull cords since the last inspection. The ground floor bathroom has been redecorated. There are five rooms with en-suite accommodation and the other rooms have a wash hand basin. Bedrooms are well furnished and equipped. Residents have brought in items from their previous homes and rooms are homely. Each resident is provided with a lockable space to keep valuables. In one room there was a slight odour. Records showed that a continence programme is in place, but action needs to be taken to address this problem. The home was clean and hygienic at the time of the inspection and no odours were evident apart from that mentioned earlier. Space is limited in the laundry, but appropriate equipment is available for cleaning soiled linen. The laundry is well organised. Hand washing facilities are available where necessary throughout the home. Infection control procedures are in place and staff are aware of them. The kitchen was clean and tidy. Records show that cleaning routines are in place. All foodstuffs are appropriately stored. Kitchen staff have completed Food Hygiene training. Records show that infection control training is provided. Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, and 30 were inspected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff numbers are appropriate to the assessed needs of the residents, size, layout and purpose of the home. Staff have the skills to meet residents’ needs. Residents are supported and protected by the home’s staff recruitment procedures. Staff are trained and competent to do their jobs. EVIDENCE: There are generally four staff on duty during the day and the rota showed that this level of staffing is maintained. One person was off sick on the day of the inspection and four staff were on duty including the manager. Two waking staff are on duty at night. This level of staffing is in accordance with previous agreements with the local authority and it is adequate for the number of residents, the layout of the home and the needs of the residents. Residents said that they felt there are enough staff on duty in the home and that staff respond promptly to their needs. Staff said there were enough staff to meet the needs of the residents living at the home. Ten staff have completed national qualifications in care and a further twelve staff are working towards gaining qualifications. Staff have achieved a level of Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 18 over fifty per cent of qualified staff. Staff are committed to training and recognise the importance of gaining qualifications. Recruitment procedures are in place and records show these are followed. Appropriate reference and Criminal Records Bureau checks are carried out before staff start work at Avala Park. The manager said that telephone checks are made with referees, however records of these calls are not kept. Evidence of identity checks was available. Training provided in the past year included Protection of Vulnerable Adults, Dementia, Yesterday, Today and Tomorrow and National Vocational Qualifications at Level 2 and 3. A staff training plan is in place. Individual training records are kept. Staff said that new staff receive appropriate induction training and records confirmed this. Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 were inspected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is run and managed by a person who is appropriately qualified and experienced in caring for older people. The home is run in the best interests of residents, but an annual development plan was not available. Residents’ financial interests are safeguarded. Systems are in place to protect residents and staff from health and safety hazards. EVIDENCE: The manager has worked at the home for a long time and is experienced and qualified in caring for older people. She has opportunities for training and is to undertake further management training. A job description is in place for the Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 20 manager. She has regular supervision with her line manager and feels well supported. Questionnaires for residents and audits of records are used as part of the quality assurance system for the home. Responses to the questionnaires are sent to the company’s head office and results were not available in the home. An annual development plan based on a cycle of planning, action and review is not yet provided and the manager said this is being prepared. Guidance is in place for staff about handling residents’ money. Records are kept of any money held and all individual transactions are recorded. Appropriate arrangements are in place for the storage of money held. Training in moving and handling, first aid, fire safety, food hygiene and infection control is provided at regular intervals. Records showed this and staff said that they receive this training. Records showed that regular checks are made of electrical equipment and the central heating system. Risk assessments are in place for safe working practices. Staff said that they receive appropriate induction training and records are in place to confirm this. Records of fire alarm tests, servicing of fire equipment and the alarm, fire training and emergency lighting are kept in an appropriate manner. Full details of accidents are kept. Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 21 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 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 X X 3 X 2 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 15 Requirement Residents’ care plans must to be further developed to include more information about their social care needs and how these are met. Staff training in dealing with allegations of abuse must be updated to ensure staff are clear about procedures. Appropriate steps must be taken to deal any odours in residents’ rooms. Repairs must be completed on: • the lift to ensure inside doors close properly and • the water boiler casing. Timescale for action 31/12/06 2 OP18 13 31/12/06 3 4 OP26 OP19 23 23 31/12/06 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Avala Park DS0000000553.V304383.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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