CARE HOMES FOR OLDER PEOPLE
Avalon 14 Pinewood Road Branksome Park Poole BH13 6JS Lead Inspector
Amanda Porter Unannounced 16 May 2005 10:00 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 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. Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Avalon Address 14 Pinewood Road Branksome Park Poole Dorset BH13 6JS 01202 761119 01202 761119 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Avalon Nursing Home (Dorset) Ltd Janet Chapman CRH N - Care Home with Nursing 22 Category(ies) of OP - Old Age (22) registration, with number of places Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 03 February 2005 Brief Description of the Service: Avalon is registered with the Commission for Social Care Inspection to accommodate a maximum of 22 frail elderly service users with nursing needs. The home is owned by the Avalon Nursing HOme (Dorset) Ltd, Mr A H Jaffer is the Responsible Individual and Mrs J Chapman is the Registered Manager. The home is situated in a residential area of Branksome Park. Accommodation is provided on the ground and first floor with two rooms on a mezzanine floor between. There are 8 single bedrooms with en-suite facilities and a further 6 singles without en-suite. There are 4 double rooms 2 of which have en-suite. home has assisted bathing facilities on each floor and a passenger list. On the ground floor a large conservatory has extended the communal space of lounge-dining room. There is a small and well-maintained garden surrounding the home, which is accessible to wheelchair users by ramps at the front door and the conservatory. Some recreational activities are organised by a member of staff designated to do so. These include some trips out, gentle exercise, board games and parties. Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place during the morning of the 16th May 2005 and took 2.5 hours. The purpose of the inspection was to review the requirements and recommendations made in the last report and to assess key standards. The registered manager, Mrs Chapman, was on hand throughout to aid the inspection process. Eight service users and four members of staff were spoken with and asked their views on the services provided at Avalon. Service users said that staff were very kind and caring. Staff spoken with said that they enjoyed their work and spending time with the service users. Some documentation was reviewed, including care files, policies and procedures. A tour of the premises was undertaken. What the service does well: What has improved since the last inspection?
In the last report a total of two requirements and eight recommendations were made. At this inspection it was found that two of the recommendations had been met. Firstly the staff are now recording the date of opening medicines with a limited life, such as eye drops, after opening so that they are not used beyond the recommended life. Secondly the complaints procedure has been revised and now indicates that a complainant may refer their complaint to the Commission for Social Care Inspection at any stage, should they wish to do so. Service users spoken with say that they feel comfortable talking to the manager and her staff should they have any concerns and that what they had to say would be taken seriously. Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 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 standard(s) 1 and 3. Standard 6 is not applicable as the home does not provide intermediate care. Prospective residents do not have sufficient or correct information to make an informed choice about whether to move to Avalon. The assessment process is insufficient and does not enable the home to thoroughly assess a persons needs or establish whether those needs can be met. EVIDENCE: It was identified at the last inspection that the service user guide did not provide the reader with up to date information about the registered manager and provider. The manager confirmed at this inspection that no progress on the document had been made. The care files for three service users were reviewed and each contained information on pre-admission assessment in various forms none of which showed a thorough and complete assessment. One assessment had been undertaken with the manager of the care home the service user was being
Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 Page 9 transferred from and did not include talking with and gaining information from the service user. One file contained a transfer letter from another care home manager and a copy of an old community care plan. This gave out of date information on the needs of the service user. The third pre-admission assessment contained inaccurate information and some areas were not assessed, such as social needs and foot care. Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 9 & 10. The information written in the care plans are not always followed which results in service users receiving inappropriate care. The systems for the administration of medication are poor and potentially place service users at risk. Residents are respected and their right to privacy is supported. EVIDENCE: Of the four care files seen all contained plans of care that were reviewed on a monthly basis. Service users said that they did not get involved in these files, which were held in their rooms. There was no evidence that either the service user or chosen representative were asked to contribute to the drawing up or review of care plans. One care plan seen concerning the mobility needs of a service user was not being followed by staff, who were seen to be using inappropriate handling procedures during the inspection. This was brought to the manager’s attention at the time of inspection, who immediately required to review manual handling practises.
Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 Page 11 Service users said that they were treated with respect and kindness and their right to privacy was upheld. Staff were seen giving care in an unrushed and sensitive manner. Nursing staff were not following the written policy and procedure for the administration of medications. The nurse on night duty had taken all the morning medication for each service user and put them in named pots but did not then administer them. Some were given out by the nurse on day duty, who had not signed the medication administration record (MAR). One service user was self-medicating but no risk assessment of the safety of this practise had been undertaken. This service user’s MAR chart did not include the medication that was being self-medicated. Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12. The social and recreational needs of the service users are not wholly satisfied, which results in some service users being bored and under stimulated. EVIDENCE: One senior healthcare assistant is allocated two afternoons per week to undertake group activities with service users in the lounge. This is a total of four hours. Activities include: • Extend exercise class every fortnight • Quizzes and games • Music • Trips out. Service users said they were very appreciative of the efforts of this member of staff although the time allotted to her was short. They said at other times they were bored. For those service users who did not wish to take part in the organised activities no plan was evident for how their social needs were to be met. Generally care plans did not contain information on how individual social needs were to be met. Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 Page 13 Standard 15 was not assessed on this occasion however the manager confirmed that the recommendation made in the last report that a copy of the menu should be made available to all service users had not been addressed. Therefore this recommendation is carried over to this report. Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18. A written complaints procedure leaves residents in no doubt that steps will be taken to deal with any complaint or concern they may have. Procedures for responding to suspicions of abuse are not held in accordance with Department of Health guidance therefore any allegations of abuse cannot be managed effectively and protection of service users cannot be guaranteed. EVIDENCE: Since the last inspection the home’s complaints policy has been revised and it now indicates that the complainant may refer their complaint to the Commission for Social Care Inspection at any stage, should they wish to do so. Residents spoken with said that they “could not think of anything to complain about” and that they would talk to the matron or staff about any concerns that they had. Avalon has a policy available to staff which deals with the action required in responding to suspicion or evidence of abuse. This policy did not make clear that in the event of any allegation being made staff must consult with the local Dorset Social Care and Health agency and refer to the “No Secrets” guidance provided by that agency. Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed during this inspection. EVIDENCE: Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 The shortfalls in training, results in care staff not being fully competent to do their jobs properly. EVIDENCE: Through discussion with the manager and staff it was evident that staff had received induction, which met the National Training Organisation workforce training targets. The manager confirmed that no progress had been made with foundation training to these standards. This resulted in some care staff being insufficiently trained to do their jobs competently. Standard 28 was not fully assessed on this occasion but the manager confirmed that the NVQ training was progressing slowly and no further candidates had achieved the level 2 award since the last inspection. At that time 13 of care staff employed had this award, which falls short of the 50 recommended to ensure that service users are in staff hands at all times. Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Some manual handling practises do not promote and safeguard the health and safety of residents, leaving them potentially at risk of harm. EVIDENCE: During the inspection poor manual handling practices were seen when transferring a resident from wheelchair to armchair. Further evidence is referred to under Standard 7. Staff confirmed that they had training in infection control and health and safety and fire safety training. Touring the premises all areas were clean. The Control of Substances Hazardous to Health guidance was adhered to and all cleaning products were stored securely. Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 x 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 x x x x x x x 1 Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 Page 19 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 OP1 Regulation 5(1) Requirement The registered manager must produce and make available to service users and up to date service users guide. The registered manager must only admit a service user into the home after carrying out a thorough assessments of his/her needs and given assurance that these needs will be met. The registered manager must ensure that each plan of care is drawn up with the involvement of the service user and/or their chosen representative. The registered manager must ensure that staff adhere to the policy and procedures for the recording of medicines. All medicines must be recorded on a medication administration record. The registered manager must ensure that for those service users wishing to self medicate a risk assessment is carried out. All nurses giving medication must follow the Nursing Midwifery Council guidance on administering medication and the home’s medication policy. Timescale for action 16/08/05 2. OP3 14(1) 16/08/05 3. OP7 15(1) 16/08/05 4. OP9 13(2) 16/08/05 5. OP9 13(2) 16/08/05 6. OP9 13(2) 13/06/05 Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 Page 20 7. OP18 12(1) 8. OP30 18(1) 9. OP38 13(5) The homes policy relating to 16/08/05 adult protection must inform the reader to consult with an officer of the local Dorset Social Cae and Health agency in the event of an allegation of abuse and must refer him/her to the No Secrets guidance provided by that agency.(Timescale of 03.05.05 not met) all staff must receive foundation 16/08/05 training to NTO soecification within the first six months of appointment. (Timescales of 21.07.04 and 03.05.05 not met.) All manual handling care plans 13/06/05 Must be reviewed and all care staff must be made aware of them and follow the plans in place. 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 OP12 OP15 OP28 Good Practice Recommendations The social interests of service users should be recorded in their care plans and provision made for meeting any needs identified. A copy of the menu should be made available to all service users. A minimum ratio of 50 of care staff should have the NVQ level 2 award in care (or equivalent). Avalon D55 S20425 Avalon V220978 160505 Stage 4.doc Version 1.20 Page 21 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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