Random inspection report
Care homes for older people
Name: Address: Avala Park Mile Road Widdrington Morpeth Northumberland NE61 5QW two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Anne UrwinBrown Date: 1 6 0 9 2 0 0 9 Information about the care home
Name of care home: Address: Avala Park Mile Road Widdrington Morpeth Northumberland NE61 5QW 01670-790019 01670791203 avalapark@highfield-care.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross Care Homes Limited care home 35 Number of places (if applicable): Under 65 Over 65 0 24 dementia old age, not falling within any other category Conditions of registration: 11 0 The maximum number of service users who can be accommodated is: 35 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 24 Dementia - Code DE, maximum number of places: 11 Date of last inspection Brief description of the care home 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
Care Homes for Older People Page 2 of 13 Brief description of the care home 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 £419.08 to £463.58 per week. The statement of purpose, service user guide and copy of the most recent inspection report are available at the home. Care Homes for Older People Page 3 of 13 What we found:
This inspection lasted four and a half hours looking areas identified in the last inspection, care planning, staffing, staff training and some areas of management. In addition the pharmacy inspector reviewed current medication policies and procedures. Individual plans have been further developed since the last inspection. Good information is now available about peoples individual needs and the records showed that any changes are updated. The new manager has been involved in reviewing care planning and recording systems to ensure that records are regularly updated and changes made to reflect peoples changing needs. The quality of recording has improved. Evidence was available to show peoples records are regularly audited and assessments were up to date. Risk assessments were in place and provided good information about how risks were minimised. Morning medicine administration was observed and was well managed with support and encouragement offered to people taking medicines. Gloves were worn to prevent direct handling of medication and these were changed regularly during the administration round. However, the carer did not routinely check the medicines selected to be administered against the medicine administration record (MAR) charts before giving the medicines. This means that the carer may not be aware of any recent change in medication which may have been added to a MAR chart. The current MAR charts were looked at. There were very few gaps on the administration record but it was noted that one service user had gone out on visit with a relative a week earlier, morning medicines had not been recorded as given, and the medication was still in the monitored dose package. The same situation arose on the day of the inspection and the senior carer informed us that the medication would be administered when the person returned to the home. This means that some medicines are not being given at the time they are prescribed and may lead to a reduced interval between doses. A number of people were prescribed alendronate which must be given one and a half hours before food or other medication but in fact was being administered at 10am along with the other morning medicines. No additional administration guidance had been printed on the MAR chart at the time of dispensing. Handwritten entries on MAR charts were usually fully completed along with a witness signature to confirm their accuracy. Because of a current difficultly in obtaining blank printed MAR sheets from the dispensing practice an in house MAR chart was sometimes used. These are poorly designed and do not provide sufficient space or labeled boxes to encourage recording of all the appropriate information. On one MAR chart the record for tamsolusin had been marked to indicate that the course had been completed on the morning of the inspection. However, we found a further supply of tamsolusin in the medicines trolley. The senior carer told us she had not seen this supply and assumed that as none was left treatment had stopped. A second person had not checked and signed this entry on the MAR chart to confirm that the treatment had in fact been discontinued and the senior carer herself had not investigated the matter further before assuming treatment was to be stopped. There were no significant discrepancies between the quantities of medication supplied, the number of doses recorded on the MAR charts and
Care Homes for Older People Page 4 of 13 the quantities of medication left in stock. This suggests that medicines are being given as prescribed. Medicines are stored securely within a spacious treatment room but this is also used as an office area by the carers and a photocopier and weighing chair were located there. The medicines fridge did not incorporate a lock and the temperature records show that the temperature is frequently at the top of the accepted range for the storage of refrigerated medicines. One service user was prescribed haloperidol to be taken as required. We were informed that this was to be given when the person was agitated but there was no guidance with the MAR chart or in the care plan to assist the carer in deciding when to administer the medicine. Medicines are supplied by a dispensing practice and the prescriptions are not received by the home before dispensing and no copy is subsequently obtained. This means that the home cannot check the medicines received against the original prescription and may not spot medication errors or omissions promptly. Although no controlled drugs were in use at the time of the inspection the controlled drug cupboard appears to meet safe custody regulations. The home was clean and tidy during the inspection. Most areas are comfortably furnished. Moving and handling equipment was available to help staff do their job. Since the last inspection some work has been done to improve the water supply, however Room 15 had no hot water at all. This room is not currently occupied, but the manager said that this matter would be attended to without delay. The bathroom on the ground floor has been refitted, redecorated and new flooring fitted, which has made a significant improvement. There continues to be a problem with bedside cabinets fitting in next to beds, but this is because of the layout in some rooms. Issues identified in this inspection: Some pull cords for lights and the alarm system in toilets and bathrooms are marked and are not always of suitable length to ensure that people can easily summon assistance or put on the light. The sealant around the taps and cistern top in the toilet at the end of the first floor corridor is badly applied and could be a harbour for germs. In another toilet a hand wash basin for two taps is being used with one tap. The decor and flooring in the ground floor toilet opposite the laundry is poor. There are no sluice facilities in place and commodes are being used in the home, which means that there are no proper facilities for cleaning these. This increases the risk of cross infection. Some furnishings in bedrooms are worn and damaged and a programme of replacement is not in place to identify priorities. The fire extinguisher is not fixed to the wall on the first floor corridor and could present a
Care Homes for Older People Page 5 of 13 hazard to people living in the home. The fan in the toilet off the first floor atrium is not working properly. Some seating used in sitting rooms is not appropriate for the needs of the people using the chairs. Three people looked very uncomfortable, although they did not complain about the seating. The manager said that plans to improve the facilities and provide a separate dementia unit are being considered by the senior management. As part of the plans the first floor atrium area will be floored and a large sitting area will be created on the first floor. In addition it is planned to improve some bedrooms providing more en-suite accommodation. At the time of this inspection there were sufficient care staff and other staff on duty to cater for the needs of the people living in the home. The rota showed that this level of staffing is maintained. Two people living in the home said that there are enough staff and that they respond quickly when they ask for help. One person said the staff are lovely, we couldnt have better. I really like living here. Staff training is arranged as part of a planned programme and records were available to show that individual staff have completed appropriate training. Since the new manager came into post staff meetings have been arranged at regular intervals and minutes were available to show that these are used for consultation, for imparting information and for training. All staff have the opportunity to attend meetings and to take an active part in them putting forward their views about the operation of the service. Staff supervision is happening now at regular intervals and staff said that they feel well supported by the manager. The manager has been in post for about six months. She previously worked in another of the groups homes and is undertaking managers induction training after which she will be working towards further qualifications in care and management. She has a good knowledge of Southern Crosss management and administration systems. She is aware of the need to implement good person centred planning systems and is working with staff to further develop the current plans. Auditing systems are now in place to ensure that the systems for operating the service are well managed. The manager is anxious to involve people living in the home and their relatives in the decision making process. Records show that people are consulted and have regular opportunities to attend residents meetings and that social events are planned monthly to involve and consult with relatives. Good health and safety policies and systems are in place and staff training in these areas is now updated on a regular basis. What the care home does well:
Good individual plans are in place to ensure that people get the care and support they need. Staff are well informed about peoples needs and plans are regularly updated to
Care Homes for Older People Page 6 of 13 reflect any changes. Good risk assessments are in place to keep people safe. The administration of medicines is well managed and flexible to meet the needs and preferences of service users.Medication records are generally well maintained. There are enough staff to support people living in the home and meet their needs. Staff have the training they need to ensure that they can do their job effectively. Good communication systems are in place to ensure that staff have the information they need to provide appropriate care to the people living in the home. The home is clean and no odours were evident. The bathroom on the ground floor has been refitted and provides good facilities for people living in the home. Peoples rooms are personalised and show evidence of their interests and taste. Health and safety policies and practice help to keep people safe. There are systems in place to consult people living in the home and their relatives or representatives about the operation of the service. What they could do better:
Managing medication for service users who leave the home on day visits could be improved. Care plans do not contain sufficient guidance to help staff when administering as required medication. The medication audit trail could be improved by receiving and copying prescriptions before they are dispensed by the dispensing practice. The water system should be checked to ensure that appropriate services are available in each room. An audit is needed to ensure that pull cords for lights and the alarm system in bathrooms, toilets and en-suites are clean and of suitable length to ensure that people can easily summon assistance or put on the light. The sealant around the taps and cistern top in the toilet at the end of the first floor corridor is badly applied and could be a harbour for germs. In another toilet the sink for two taps is being used with one tap. The decor and flooring in the ground floor toilet opposite the laundry is poor. There are no sluice facilities in place and commodes are being used in the home. This increases the risk of cross infection. Some furnishings in bedrooms are worn and damaged and a programme of replacement is not in place to identify priorities. Care Homes for Older People Page 7 of 13 The fire extinguisher is not fixed to the wall on the first floor corridor and could present a hazard to people living in the home. The fan in the toilet off the first floor atrium is not working properly A review of the seating available is needed to ensure that people have appropriate chairs that suit their individual needs. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 13 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 13 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 9 13 Best practice guidance and 16/11/2009 the providers policy must be followed when storing, giving and recording medicines. To safeguard the health and welfare of people livivng in the home 2 9 13 Medication must be given as prescribed and a record made at the time that it is given. To safeguard the health and welfare of people living in the home 16/11/2009 3 21 23 The provision of sluice facilities must be be made a priority to ensure that commodes are effectively cleaned. To safeguard people from increased risk of cross infection. 31/12/2009 4 21 23 The water system should be checked to ensure that appropriate services are 16/11/2009 Care Homes for Older People Page 10 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action available in each room. To ensure that people have the facilities they need. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 9 Arrangements should be put in place to ensure that service users going out on visits receive all their medication as prescribed Prescriptions should be received into the home for checking prior to being dispensed and photocopies maintained. Additional guidance should be prepared, in addition to the current medication policy, to describe local arrangements for the handling of medicines within the home. Care plans for people who are prescribed as required medication should incorporate additional guidance for staff on how to determine when medication should be offered. The dispensing practice should be requested to include full details on dispensing labels for medicines that have specific administration requirements The treatment room should be used exclusively for the storage of medicines and entry should be controlled. A replacement medicines fridge fitted with a lock should be obtained. The fire extinguisher is not fixed to the wall on the first floor corridor and could present a hazard to people living in the home. A review of the seating available is needed to ensure that people have appropriate chairs that suit their individual needs. The facilities provided in all bathrooms are toilets should be
Page 11 of 13 2 3 9 9 4 9 5 9 6 7 8 9 9 19 9 20 10 21 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations reviewed to ensure that good quality fittings and flooring is in place. Pull cords for lights and the alarm systems should be checked to ensure that these are clean and of suitable length. This will ensure that people have the facilities they need. 11 24 A review of furnishings in bedrooms is needed to ensure that worn and damaged items are replaced as part of a planned programme of refurbishment. Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 13 of 13 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
