CARE HOMES FOR OLDER PEOPLE
Avalon 14 Pinewood Road Branksome Park Poole Dorset BH13 6JS Lead Inspector
Amanda Porter Unannounced Inspection 19th January 2006 11:00 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 DS0000020425.V279493.R01.S.doc Version 5.1 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. DS0000020425.V279493.R01.S.doc Version 5.1 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 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) The Avalon Nursing Home (Dorset) Limited Janet Chapman Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places DS0000020425.V279493.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th May 2005 Brief Description of the Service: Avalon is registered with the Commission for Social Care Inspection (CSCI) 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 L Bartlett is the Manager, who is not yet registered with CSCI. 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 staff. These include gentle exercise, board games and parties. DS0000020425.V279493.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place during the morning and afternoon of the 19th January 2006 and took five hours. The purpose of the inspection was to review the requirements and recommendations made in the last report and to assess key standards. The inspector was accompanied by Poole Primary Care Trust Nursing Home Co-ordinator, Gill Webb, and monitoring nurse, Fiona Reid. Since the last inspection the registered manager, Janet Chapman, has taken the role of deputy manager and Lin Bartlett has been appointed as manager. She has not submitted an application to be registered with the Commission for Social Care Inspection. They were both on hand throughout to aid the inspection process. Six residents, two visitors and five members of staff were spoken with and asked their views on the services provided at Avalon. Comments included: “Staff are very kind and look after me.” “The food is good.” “I am not happy with the food. There is very little choice.” “We do get bored sometimes.” “It’s not bad really.” Prior to the inspection taking place residents, relatives, visitors and health and social care professionals were invited to complete comment cards about the home. The Commission for Social Care Inspection received fourteen from relatives, four from care managers/placement officers and two from GPs. Comments were generally positive and included: “Have no concerns regarding care provided to residents.” “I removed my client as Avalon were unable to meet his needs.” “The care my relative receives is good and the staff are always cheerful” “ Staff need to do more to interact with residents.” “ My relative has been well cared for since arriving at Avalon. The staff are always friendly and smiling and their caring manner towards the residents is always evident.” Some documentation was reviewed, including care files, personnel and training files. A tour of the premises was undertaken. DS0000020425.V279493.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better:
During this inspection a total of fourteen requirements and three recommendations have been made. The service user guide needs to be updated to include information about the current manager so that prospective residents are given the correct data to enable them to make a decision about possible admission. To ensure that residents have clear information about the terms and conditions of residency they must be issued with a written contract at the point of moving into the home. Work needs to be done to make sure care plans give clear details to staff of how residents’ needs are to be met and staff must follow them. Social activities continue to be limited and consideration should be given to addressing the individual needs of residents who do not wish to participate in group activities. Group activities need to be provided which reflect the assessed needs of the residents. Through thorough assessment of social needs a plan of action should be included in each service users care plan and monitored on a regular basis to see if these needs are met. It is recommended that the chef include more fresh vegetables in his menus.
DS0000020425.V279493.R01.S.doc Version 5.1 Page 7 The home would benefit from having a plan of routine maintenance. There were no useable bathrooms at Avalon at the time of inspection and a requirement has been made to rectify this situation. Some areas of the home are not clean. To make the environment a more pleasant one in which to live and work a thorough cleaning regime should be followed. Recruitment records were seen to be incomplete, resulting in the management not being able to guarantee that staff were being employed appropriately. The home needs to develop its staff training programme to include the common induction training for care staff, which will meet the National Training Organisation workforce targets and to continue NVQ training. This will equip staff with the ability to meet the assessed needs of the service users effectively at all times. An annual development plan must be developed as part of the quality assurance monitoring system so that residents can be assured the home is run in their best interests. So that residents’ financial interests are safeguarded any monies held by the home on behalf of a resident should be accounted for and clear records must be kept. To ensure that the residents’ and staff safety is maintained all staff need to have regular moving and handling training. Cleaning materials must be held securely. 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. DS0000020425.V279493.R01.S.doc Version 5.1 Page 8 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 DS0000020425.V279493.R01.S.doc Version 5.1 Page 9 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): 1, 2 & 3. Standard 6 is not applicable as the home does not provide intermediate care. Prospective residents do not have correct information to make an informed choice about whether to move to Avalon. Residents are not issued with written contracts and therefore they are not always aware of the terms and conditions of residency. Assessments are carried out for prospective service users so that the home can establish their care needs and give assurances to them and their family and friends that these can be met. EVIDENCE: The service user guide made available to residents did not contain information on the home’s new manager and therefore was misleading. A recent audit highlighted the fact that many of the residents had not been issued with a written contract/statement of terms and conditions with the home. Although the home is in the process of rectifying this situation,
DS0000020425.V279493.R01.S.doc Version 5.1 Page 10 management are still awaiting a returned, signed copy of the contract from fourteen residents and/or their chosen representative. In two of the three care files seen there was evidence that pre-admission assessments had occurred and that sufficient information had been gathered on which a care planned could be based. DS0000020425.V279493.R01.S.doc Version 5.1 Page 11 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 & 8. There is no clear or consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet resident’s needs. However the health needs of residents are well met with evidence of good support from community professionals such as GPs, occupational therapists, opticians and dentists. EVIDENCE: Three care files were reviewed and each contained assessments for moving and handling, nutrition, continence and the risk of developing pressure sores. Each file also contained care plans and these were of varying quality. Although it was apparent that residents were receiving adequate care, evidence of this was not clearly given in the care documentation. Instructions in some of the care plans were not specific. One plan stated, “Use barrier cream if required.” It did not say which cream to use. Another said, “Ensure toilet facilities have been offered regularly.” Again it was not clear how this should happen or when. Another plan stated the resident should have three supplementary drinks per day but the fluid chart did not record this was happening. DS0000020425.V279493.R01.S.doc Version 5.1 Page 12 Residents said that they were well looked after and received the care they needed. There were general notices, which invited relatives to be part of the care planning process. Care documentation recorded visits from health care professionals. Records showed that each service user was assessed for the risk of developing pressure sores. Where the risk was high action was taken and the equipment necessary for the promotion of tissue viability and prevention or treatment of pressure sores was provided. Standard 9 was not fully reviewed at this inspection. However the registered provider has confirmed that the home’s medication policy has been reviewed. A full review will take place at the next inspection. DS0000020425.V279493.R01.S.doc Version 5.1 Page 13 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): The social and recreational needs of the service users are not wholly satisfied, which results in some service users being bored and under stimulated. The residents are supported in maintaining contact with their friends, family and the narrow community and in making decisions about their lives in the home. A varied diet is provided offering a choice of menu for those residents able to express their views. EVIDENCE: At the time of inspection there was no programme of activities for the residents. The manager stated that between 2pm and 3pm staff undertook some activities in small groups or on a one to one basis with residents. These were not necessarily based on the assessed needs of the residents. Time undertaking these activities would mean that staff had less time to meet the physical needs of a group of highly dependant residents, many of whom were nursed in bed during the course of the afternoon. Some residents said they were bored. Others appeared to be content. DS0000020425.V279493.R01.S.doc Version 5.1 Page 14 Residents and visitors confirmed that their visitors were made very welcome in the home and they could receive their visitors in private if they so wish. Residents spoken with said that they were free to make decisions about how they spent their days. Most preferred to allow family members to handle financial affairs. They were able to bring personal possessions in with them to make their rooms more homely. The menus showed that residents were offered choice at mealtimes. However the home was reliant on using a large amount of frozen vegetables with very little fresh vegetable used. There was fresh fruit available in the lounge to the residents who used this room. Residents’ comments about the food included: “The food is good.” “There is no choice.” “I am not happy with the food.” Comment is made under standard 26 about the cleanliness of the food storage areas. DS0000020425.V279493.R01.S.doc Version 5.1 Page 15 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. A written complaints procedure leaves residents in no doubt that steps will be taken to deal with any complaint or concern they may have. Staff’s knowledge and understanding of Adult Protection issues provides a safe environment to protect service users from abuse. EVIDENCE: Since the last inspection there has been one complaint made directly to the Commission for Social Care Inspection and five directly to the home all of which have been upheld. This demonstrates that complaints are taken seriously, listened to and acted upon. The home had a robust policy and procedure to respond to suspicion or evidence of abuse or neglect. Through discussion staff demonstrated knowledge of the Department of Health guidance “No Secrets” and local protection of vulnerable adults procedures. DS0000020425.V279493.R01.S.doc Version 5.1 Page 16 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): 19, 21 & 26 The standard of décor within Avalon is satisfactory but there is little evidence of routine maintenance or future planning. There are no usable baths within the home. Some areas of the home are not clean. Avalon does not, therefore, present as a homely and comfortable environment for all the residents. EVIDENCE: A tour of the premises showed that both bathrooms were out of action and had been so for several months. Staff confirmed this. This meant that none of the residents had been able to have a bath recently. There were insufficient chairs and tables in the lounge area to accommodate all the residents who wanted to use it. One resident said that she had to sit at the dining table away from other residents because there was no space for her in the lounge.
DS0000020425.V279493.R01.S.doc Version 5.1 Page 17 A laundry trolley was stored in a corridor on the ground floor. Staff had used it to put their coats and handbags on rather than putting them in the staff room. Both sluice rooms were dirty and untidy. The one on the ground floor had a stack of commode pots resting in the hand washbasin. Therefore staff were unable to wash their hands in this area. The dry food store was situated in an outside shed, which was damp and had mould on the ceiling. The laundry room is situated in an outbuilding and deals with the laundry for Avalon and Ormonde, the home next door. There is no facility for staff to wash their hands in this area. DS0000020425.V279493.R01.S.doc Version 5.1 Page 18 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): Sufficient staff are employed and deployed to ensure that the needs of the residents should be met. Shortfalls in the recruitment procedure do not protect residents from risk. The shortfalls in training, results in care staff not being fully competent to do their jobs properly. This means that residents cannot be assured they are in safe hands at all times. EVIDENCE: Staff rosters demonstrated that there are sufficient staff on duty at all times. The home has an ongoing training programme, which includes NVQ level 2 in care. At the time of inspection 20 of care staff held this award, which is below the 50 recommended. Five • • • • • • • staff recruitment files were seen and they contained: Completed application forms Two written references Enhanced CRB checks Terms and conditions of employments Documentary evidence of any relevant qualifications Proof of identity A record of the interview
DS0000020425.V279493.R01.S.doc Version 5.1 Page 19 However two files lacked the relevant work permits needed. Training files did not demonstrate that healthcare assistants were receiving the common induction training, which meets National Training Organisation workforce training targets. Some care staff and ancillary staff had not received manual handling training within the last year. DS0000020425.V279493.R01.S.doc Version 5.1 Page 20 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): 33, 35 & 38. Some management practices do not promote and safeguard the welfare of residents. The manager does not have a clear development plan and vision for the home, which has been communicated to residents, relatives and staff. The systems for resident consultation in this home are poor with little evidence that residents’ views are sought or acted upon. The lack of staff training for manual handling and fire safety do not promote and safeguard the health and safety of residents, leaving them potentially at risk of harm. EVIDENCE: The manager confirmed that there had been little progress made yet with regard to quality assurance processes within the home. One audit for medication had taken place but an action plan had not been produced as a result. There was no annual development plan for the home, based on a
DS0000020425.V279493.R01.S.doc Version 5.1 Page 21 systematic cycle of planning – action – review, reflecting aims and outcomes for residents. The home holds “pocket money” for some of the residents. However there were no written records of any transactions made on behalf of the resident concerned. Through reviewing training records and talking with staff it was evident that some staff had not had manual handling training in the last year. Cleaning materials and other substances hazardous to health were not stored securely. A record of accidents to residents and staff were held appropriately. DS0000020425.V279493.R01.S.doc Version 5.1 Page 22 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 1 1 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 1 X X X X 1 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 1 X X 1 DS0000020425.V279493.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Yes 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. Standard Regulation Requirement The registered person must produce and make available to residents an up to date service user’s guide. (Original date for compliance was 16/08/05.) Each resident must be provided with a statement of terms and conditions. The registered person must ensure that care plans set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the residents are met. Residents must be consulted about a programme of activities and the home must provide facilities for recreation. Both general bathrooms must be in good repair and usable by residents. Hand washing facilities must be made available in the laundry. The sluices must be clean and hygienic. The dry food store must be clean and hygienic and food within must be held securely.
DS0000020425.V279493.R01.S.doc Timescale for action 19/04/06 1. OP1 5(1) 2. OP2 5(1)(b) & (c) 19/04/06 3. OP7 15(1) 19/04/06 4. OP12 16(2)(n) 19/04/06 5. 6. 7. 8. OP21 OP26 OP26 OP26 23(2)(j) 13(3) & 16(2)(j) 13(3) 16(2) 19/04/06 19/04/06 19/04/06 19/04/06 Version 5.1 Page 24 9. OP29 19 & Schedule 2 10. OP30 18(1) 11. OP33 24 12. OP35 17 & Schedule 4 13. 14. OP38 OP38 13(5) 13(3) The registered person must ensure that the relevant work permits are obtained for staff. The registered person must ensure that care staff receive common induction training to National Training Organisation specification.(Original date of compliance of 21/07/04, 03/05/05 and 16/08/05 have not been met.) The home must have an effective quality assurance and monitoring system. A clear record must be maintained of all money held on behalf of a resident. This must included a record of any transactions made on their behalf. All care staff must undertake manual handling training every year. Cleaning materials must be stored securely when not in use. 19/04/06 19/04/06 19/04/06 19/04/06 19/04/06 19/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP15 OP19 OP28 Good Practice Recommendations The home should include more fresh vegetables in the menu. The home should have a planned maintenance programme. A minimum ratio of 50 of care staff should be trained to the NVQ level 2 or equivalent. DS0000020425.V279493.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Poole Office 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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