CARE HOMES FOR OLDER PEOPLE
Avalon 14 Pinewood Road Branksome Park Poole Dorset BH13 6JS Lead Inspector
Amanda Porter Key Unannounced Inspection 10:00 31st May 2006 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.V289310.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.V289310.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 Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places DS0000020425.V289310.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th January 2006 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 Ms D Neilson is the newly appointed 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 facilities. There are 4 double rooms 2 of which have en-suite facilities. The home has assisted bathing facilities on each floor and a passenger list for access between floors. 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. These include gentle exercise, board games and parties. Fees range from £475 - £600 per week. DS0000020425.V289310.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 on the 31st May 2006 and took approximately five and a half hours. The purpose of the inspection was to review the requirements and recommendations made in the last report and to assess all the key standards. The deputy manager was on hand throughout to aid the inspection process. The newly appointed manager, Ms Neilson, was present and undertaking induction training. Information gathered for this report came from several sources including: • Reports made to the Commission for Social Care Inspection by the home. • A pre-inspection questionnaire completed by the deputy manager. • Twenty seven comment cards from visitors to the home. • Tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. • Discussion with residents and staff. Six residents and four members of staff were spoken with and asked their views on the service provided at Avalon. Comments received included: “Overall I am very happy.” “My relative is being well cared for.” “The management and staff are helpful and friendly.” “I have never had to complain.” “Very satisfied.” All the staff and residents were welcoming and helpful. What the service does well:
The home carries out thorough assessments prior to residents moving in and assurances are given that individual needs can be met. The arrangements in the home to meet the residents’ medication needs are good and all procedures relating to this are safe. Residents are confident that staff will treat them with dignity and that their right to privacy is upheld. Residents are encouraged to maintain their links with friends and family and all visitors are made welcome. Residents are helped to exercise some choice and control over their lives as far as possible. DS0000020425.V289310.R01.S.doc Version 5.1 Page 6 The complaints procedure reassures residents that their views are important to the home and that any complaints they raise will be properly investigated. The home protects the residents from abuse by ensuring robust policies and procedures are in place, which staff find easy to follow. Adequate numbers of staff are employed and deployed to care for the number and needs of residents accommodated. What has improved since the last inspection?
At the last inspection a total of fourteen requirements and three recommendations were made. Since that time the home has met thirteen requirements and two recommendations of good practise. The service user guide has been revised and now gives sufficient and accurate information to prospective residents and their families so that they can decide whether living at Avalon would suit them. Each resident is given a written contract, which gives clear information about the terms and conditions of residency. The home now employs an activities coordinator who is organising some activities, which are enjoyed by the residents. She had engaged residents and their families in discussion in order to discover their preferred activities with an aim to create a monthly plan of activities, which will interest them. Meals are wholesome and nutritious and planned around the likes and dislikes of residents and now include more fresh fruit and vegetables. The home is well maintained and generally provides a comfortable, homely environment. The bathroom on the first floor has been converted into a wheel in shower, which is suitable for those residents with mobility problems. A thorough recruitment process is followed when employing staff, which ensures that residents are protected from risk. The home is not involved in any financial transactions made on behalf of residents. The health and safety of the residents and staff were protected by the policies and procedures that the staff followed at Avalon at the time of inspection. DS0000020425.V289310.R01.S.doc Version 5.1 Page 7 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. DS0000020425.V289310.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.V289310.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are given the correct information to make an informed choice about whether to move to Avalon. Residents are issued with written contracts and are therefore made aware of the terms and conditions of residency. New residents move into the home having had their needs assessed and been assured that these needs will be met. EVIDENCE: Since the last inspection the service user guide has been updated and it gives an accurate picture of what to expect when living at Avalon. It was readily available to anyone visiting the home. Residents and their families were encouraged to visit the home prior to admission. Thirteen responses to questionnaires sent to residents and relatives who were asked the question
DS0000020425.V289310.R01.S.doc Version 5.1 Page 10 “Did you receive enough information about this home before you moved in so you could decide if it was the right place for you?” Ten answered “yes” and three answered “no”. Two pre-admission assessments were reviewed and showed that prior to people moving to the home their needs had been fully assessed by the deputy manager. She gave written assurance that needs could be met. DS0000020425.V289310.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, 9 & 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans were in place to identify needs and to inform staff how those needs were to be met but some work was necessary to improve the presentation of this documentation so that staff were able to use them effectively. Health needs were not always identified or met efficiently, which delays the start of any effective treatment. The systems for the administration of medication are good with clear and comprehensive arrangements being in place to ensure that residents’ medication needs are met. The staff treat people with dignity to ensure their basic individual rights are respected. DS0000020425.V289310.R01.S.doc Version 5.1 Page 12 EVIDENCE: The care documentation for three residents was reviewed. Each file contained assessments for: • Moving and handling. • Nutrition. • Continence. • The risk of developing pressure sores. These assessments were held with the care plans and this format was rather confusing to follow. Assessments identified health problems such as glaucoma, renal failure, infection and pressure sores but they were not routinely followed up or referred to the GP or appropriate health care professionals. This meant there could be a delay before treatment started. Care plans have improved since the last inspection and now accurately reflect the care needed to be given to the individual residents. There was evidence that residents and/or their chosen representatives were involved in the development and review of the care plans. The home has a well-written and informative medicines policy and procedure including reference to self-administration and associated risk assessment and arrangements for ordering, administration and disposal. Medicines were stored securely. Records were kept of the receipt, administration and disposal of medicines. Examination of records indicated that medicines are properly administered in accordance with the prescriber’s instructions. Residents said that they were well looked after and received the care they needed. Comments received included: “If I want help I receive help. I have never been refused.” “I have never been other than impressed with the warmth and care which is displayed at all levels.” “My relative is being well cared for at Avalon. The staff are brilliant. They present themselves in a professional manner and are always polite and friendly. They create a warm and happy atmosphere within the home.” Twelve people responded to the question “Do you receive the care and support you need?” Six said “always”; five said “usually” and one said “sometimes”. DS0000020425.V289310.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): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are offered opportunities to enjoy social and recreational activities although a monthly plan of events is not yet available. Residents are helped to exercise choice and control in their daily lives within their capabilities and desire to do so. The dietary needs of residents are well catered for with a balanced and varied selection of food available that meets their tastes and choices. EVIDENCE: Since the last inspection the provider has employed an activities coordinator to work at Avalon and Ormonde, another home owned by the same provider. The organised activities take place between 10am – 2pm Monday to Friday. Effectively each home has activities for two hours in the morning one day and one hour in the afternoon the following day. The activities coordinator was in the process of auditing the activities within the home. She had involved the residents and their families in this and was
DS0000020425.V289310.R01.S.doc Version 5.1 Page 14 gaining a much clearer picture of the social needs of each individual. From this information she intends to produce a monthly programme of events, which will be given to each resident. This will be reviewed again at the next inspection. Activities at the time of inspection included: • • • Bingo. Hand massage. Soft ball games. One resident spoken with said “It is nice to have something to do.” Residents confirmed that they could meet privately with their visitors if they wanted to and generally they were free to make decisions about what they did each day. Members of the local clergy were made welcome and visited regularly. Most residents were not able to, or chose not to, deal with their own financial affairs. In most instances family members dealt with this. Residents were able to bring personal possessions in with them to personalise their rooms. All meals for Avalon and Ormonde are prepared in the kitchen at Avalon. The menu, which offered choice, was displayed in the dining room. There was a supply of fresh fruit at all times which residents were encouraged to eat during the day. Eleven people responded to the question “Do you like the meals at the home?” Four people said “always”; five people said “usually” and two people said “sometimes”. DS0000020425.V289310.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 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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: The home has a clear complaints procedure available to everyone. No complaints have been received by the home or the Commission for Social Care Inspection since the last inspection. Twelve people responded to the question “Do you know who to speak to if you are not happy?” Eight people said “always”; three said “usually” and one said “never”. Avalon has a robust policy and procedure to respond to suspicion or evidence of abuse or neglect. Since the last inspection many of the staff had received training on abuse. Through discussion the management and staff demonstrated knowledge of the Department of Health guidance “No Secrets” and local protection of vulnerable adults procedures. DS0000020425.V289310.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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment at Avalon is well maintained generally but at inspection did not appear to be clean, which some residents may find uncomfortable. Not all staff follow the home’s infection control policy, which exposes the residents to the risk of cross infection. There are sufficient lavatories and bathing facilities for residents, which are in good working order. EVIDENCE: Avalon has an ongoing programme of refurbishment and maintenance. Since the last inspection the general bathroom upstairs has been updated and the bath removed and replaced with a wheel in shower. DS0000020425.V289310.R01.S.doc Version 5.1 Page 17 The deputy manager confirmed in the completed pre-inspection questionnaire that a variety of outside agencies have attended the home to undertake the routine maintenance of: • Fire safety equipment. • Gas installation. • Check for compliance with Legionella. • Lift. • Hoists. The layout of the home ensures that all communal areas are accessible. The gardens are tidy and safe. The house is free from any unpleasant odours but touring the premises it was evident that not all areas were being thoroughly cleaned. One en-suite toilet was inaccessible to the occupant because incontinence pads were being stored there. Several areas were dusty and some bathroom floors were urine stained. The laundry, which services both Avalon and Ormonde, is situated in an outbuilding between both homes. There is a designated member of staff to undertake the laundry duties. At this inspection and at the previous one it was noted that the hand washing facilities in the laundry were not being used. This lack of effective hand washing does put residents and the staff member at risk of cross infection/contamination. DS0000020425.V289310.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): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient staff are employed and deployed to ensure that the needs of the residents can be met. The recruitment procedures in place are sufficiently robust and ensure that residents are protected. There are still some shortfalls in training, which may result in some staff not having the necessary skills and confidence to provide care in a competent way. EVIDENCE: Staff rosters demonstrated that there were sufficient staff on duty at all times. Since the last inspection the home’s training programme has been reviewed. 33 of care staff hold the NVQ level 2 award in care, which is below the 50 recommended. Four • • • • staff recruitment files were seen and they contained: Completed application forms. Two written references. Enhanced CRB and POVA first checks. Terms and conditions of employment.
DS0000020425.V289310.R01.S.doc Version 5.1 Page 19 • • • Documentary evidence of any relevant qualifications. Proof of identity. Work permits where necessary. The home has identified gaps in mandatory training and has produced a training programme to overcome this. The effectiveness of this programme will be assessed at the next inspection. DS0000020425.V289310.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the views of residents and visitors has been sought the information gained has not yet been used to formulate an annual development plan. The home no longer deals with residents’ personal finances. Generally the health and safety of the service users and staff are protected by the policies and procedures followed at Avalon. EVIDENCE: At the time of inspection the new manager had only been in post for two days. Standard 31, relating to the management of the home will be fully assessed at the next inspection.
DS0000020425.V289310.R01.S.doc Version 5.1 Page 21 The Deputy Manager confirmed that she had sent out satisfaction questionnaires to relatives but as yet had not used the information gained through them to formulate an annual development plan for Avalon, nor were regular audits of the service provided undertaken. Most residents choose not to deal with their own finances but they all had someone to act on their behalf. The home does not hold any money on behalf of residents. Avalon currently meets the requirements of the Dorset Fire and Rescue Service and the environmental health standards. Records relating to the maintenance and servicing of equipment, including fire safety equipment were seen to be up to date. Staff had received training in manual handling and fire safety. Generally staff follow sound procedures to reduce the risk of cross infection and there is a plentiful supply of gloves and aprons. Accident records were seen. They are recorded promptly and reviewed by the manager on a regular basis and action taken appropriately. DS0000020425.V289310.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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X X X 1 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 3 DS0000020425.V289310.R01.S.doc Version 5.1 Page 23 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 OP8 Regulation 12(1) & 13(1) Requirement The home must ensure that where any health issues are identified for a resident they are followed up and referred to the appropriate health care professionals. The home must be clean. Hand washing facilities must be used in the laundry. The registered person must ensure that all staff receive mandatory training which includes health and safety, food hygiene and infection control. Timescale for action 30/08/06 2. 3. 4. OP26 OP26 OP30 23(2)(d) 13(3) & 16(2)(j) 18(1) 30/08/06 30/08/06 30/08/06 5. OP33 24 The home must have an effective 30/08/06 quality assurance and monitoring system. (This requirement was first made on 19/01/06) DS0000020425.V289310.R01.S.doc Version 5.1 Page 24 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. Refer to Standard OP7 Good Practice Recommendations The format for holding care documentation should be reviewed so that staff can easily find the information they need to give appropriate care. A programme of activities should be circulated to all residents. A minimum ratio of 50 of care staff should be trained to the NVQ level 2 or equivalent. 2. 3. OP12 OP28 DS0000020425.V289310.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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