CARE HOMES FOR OLDER PEOPLE
Avalon Care Home 24 Duke Street Southport Merseyside PR8 1LW Lead Inspector
Paul Kenyon Unannounced 15th June 2005 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 Care Home Inspection report OP.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Avalon Care Home Address 24 Duke Street Southport Merseyside PR8 1LW 01704 541203 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) Avalon Residential Homes Ltd Ann Louise Wilson PC - Care Home Only 18 Category(ies) of OP - Old Age - 18 registration, with number of places Avalon Care Home Inspection report OP.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service should at all times, employ a suitable qualified and experienced manager that is registered with the CSCI. 2. Eighteen (18) places are to be registered in the category of OP. Date of last inspection 22nd February 2005 Brief Description of the Service: Avalon Residential Care Homes Ltd purchased Avalon care home in July 2004. Avalon is a Residential Care Home, which provides personal care and support for up to 18 elderly residents. 18 service users were resident at the time of the inspection. Ann Wilson, who lives on site, now manages the home. The home is a large detached converted house, set in a residential area, within walking distance of all the amenities of the town of Southport. Access to the town can be made via the local transport services where necessary. A lift provides access to all floors of the home. There is a large dining/ lounge area, a smoking room and gardens to front and rear, which can be accessed via the basement. Avalon Care Home Inspection report OP.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection lasted four hours and took place during the afternoon and early evening. The first part of the inspection included the opportunity to attend a staff meeting that had been pre-arranged. The opportunity arose for issues surrounding the inspection process to be outlined to the staff team. The next part of the inspection included individual discussions with residents. In total six residents provided comments on a range of experiences they had had within the home. The inspection included a tour of the premises. It was noted that some residents were unable to offer a view about the support they received. In these cases it was left to observation to assess the standard of care that was received. Staff were noted to deal with these individuals in a patient and dignified manner with particular attention to their safety and wellbeing. What the service does well:
The service prepares for the admission of residents thoroughly. It obtains the information needed before the individual comes into the home to ensure that their needs can be met. Included in this preparation is the anticipation of any other issues. An example of this is the introduction of advocacy services if they are needed before the person comes in. The home provides a clear complaints procedure for both residents and staff. The procedure is clear and anyone wishing to make a complaint has the information accessible to them. The home is steadily starting to provide an environment that is pleasant and comfortable and it is clear from the comments earlier in this report that residents appreciate this. Many bedrooms have been redecorated, an assisted bathroom has been totally refitted, a new laundry is in place and many devices that aim to look after people’ welfare (such as radiator covers and temperature controlling devices on hot water taps) have been put into place. Many resident’s comments throughout the inspection indicate that for these individuals, they are satisfied with the standard of care they receive. Such comments covered a number of aspects of living at Avalon and included: ‘I am telling you they look after us here’ ‘The main thing is that I am safe’ ‘We have good food and a good time’ ‘We have a minibus now and we get out a lot now to all sorts of places’
Avalon Care Home Inspection report OP.doc Version 1.30 Page 6 ‘Oh aye I am happy’ ‘I enjoy the company’ ‘They look after us’ ‘I am alright’ ‘On the whole things are good’ ‘I do feel safe here and I am well at the moment’ What has improved since the last inspection? What they could do better:
The home needs to better evidence that its staff sign the procedure for dealing with abuse allegations. At present, not all staff have signed this leading to a conclusion that any allegations may be dealt with in an inconsistent manner. The home needs to look carefully at their recruitment practices, which are failing to safeguard residents, as the past experience of new staff members and references from past employers who operate care homes, are not sought. The Manager needs to tighten the system for receiving monies for residents from their families to make sure that staff know that any ‘deposits’ are witnessed by two members of staff and that families are made aware of this system. Currently the system for the safe keeping of resident’s monies or valuables is open to abuse with not enough accountability at the point of monies being received. This system must be reviewed urgently. The Manager also needs to evidence that the electrical wiring of the building is safe and that a certificate is obtained to confirm this. Staff also need to receive
Avalon Care Home F53 F03 Avalon Care Home S61380 V233831 15.06.05 Stage 4.doc Version 1.30 Page 7 updates in many aspects of compulsory training such as manual handling, first aid and infection control. At present residents are being supported by staff that have not had recent training in these areas. Those who administer medication need to sign medication sheets more consistently. On occasions, there are no signatures for regular and prescribed medication and as a result it cannot be evidenced that this medication has ever been given. 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. Avalon Care Home F53 F03 Avalon Care Home S61380 V233831 15.06.05 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Avalon Care Home F53 F03 Avalon Care Home S61380 V233831 15.06.05 Stage 4.doc Version 1.30 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 standard(s) 3 Prospective residents have their care needs identified before they come into the home so that an indication can be made whether these needs can be met. This is done in a thorough and systematic manner. EVIDENCE: One resident had been admitted since the last inspection in February 2005. The Local Authority had conducted an assessment and this had been made available before the person they arrived at Avalon. This assessment was available and contained all the information available so that the manager and staff team could identify whether this person’ s needs could be met. On the day of the visit, one individual was due to arrive at the home to receive respite care. Again information about this person’s needs had been obtained long before the person came to stay at the home and contained detailed information about the person’s needs. Avalon Care Home F53 F03 Avalon Care Home S61380 V233831 15.06.05 Stage 4.doc Version 1.30 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 All residents have their needs outlined in a care plan that is clear and informative with reference to regular review. All residents should benefit from the new system of care plan format that is being developed by the home and it is considered good practice that a deadline for the implementation of this new format is identified. Residents are not fully protected by the home’s policies and procedures for dealing with medication. EVIDENCE: A new format for care planning has been introduced and half of the residents now have these care plans in place. These provide staff with the information they need to support individuals. The process is ongoing and it is recommended as good practice that a deadline for the transfer of other care plans to the new system is identified. Medication is secured in a trolley which itself is tethered to a wall when not in use. Controlled medications have been prescribed for one resident and these have also been locked away. In addition to this a stock book is available
Avalon Care Home F53 F03 Avalon Care Home S61380 V233831 15.06.05 Stage 4.doc Version 1.30 Page 11 identifying how much of this controlled medication has been administered compared to the amount in stock. Risk assessments are in place for those residents who wish to self-administer their medication. Medication records sheets showed in the main, staff sign after each time their administer medication. In some cases, records had not been signed consistently and as a result no evidence was available to suggest that medication had been given. It is required that staff indicate reasons for nonadministration of medication on all occasions. Avalon Care Home F53 F03 Avalon Care Home S61380 V233831 15.06.05 Stage 4.doc Version 1.30 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) No standards from this section were looked at during this inspection. EVIDENCE: Avalon Care Home F53 F03 Avalon Care Home S61380 V233831 15.06.05 Stage 4.doc Version 1.30 Page 13 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 Residents and their families have access to a clear, accurate and transparent complaint’s procedure, and complaints are handled fairly and promptly. Not all staff however, has signed the abuse procedures, which could compromise resident’s safety. The home has not made arrangements to fully protect residents from harm as a result and despite the perceptions of residents. EVIDENCE: The complaints procedure is included within the service users guide that has been provided to all residents. In addition to this, the complaints procedure is on display in the hallway of the home as well as a complaints sheet that can be readily used by families if needed. No complaints have been received by the home or the Commission for Social Care Inspection since the last inspection in February 2005. A ‘Whistle-blowing’ procedure is on prominent display in staff room area and outlines the action that can be taken by staff in the event of any concerns about care practice they may have. In addition to this, there is a detailed policy on what constitutes abuse and the action that should be taken if an allegation of abuse is made. Not all staff have signed this with the possible result that inconsistent action may be taken in the event of an allegation, which does not benefit residents or may compromise any investigation. Avalon Care Home F53 F03 Avalon Care Home S61380 V233831 15.06.05 Stage 4.doc Version 1.30 Page 14 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) 19,26 The premises are comfortable, homely and well maintained, with ongoing refurbishment to areas of the home continuing, which will serve to benefit residents further. The home is clean and hygienic although it is considered good practice for the manager and staff team to monitor those areas that may have some slight odours present. Resident’s now have their clothes laundered in an upgraded and organised laundry area, improving the care of their personal clothing. EVIDENCE: A tour of the premises noted that a number of bedrooms had been refurbished as well as other general areas such as hallways and an assisted bathroom. One lounge area has also been redecorated. Residents stated that ‘oh there is a difference’, ‘it is a lot better now’ and ‘it looks very nice’. The home has a new laundry area as well as a sluice that is separated separately to residents’ toilets and bathrooms. A tour of the building noted that the home was clean and hygienic. Residents stated ‘it is very clean and comfortable’. In some areas there was a slight odour. It is considered to be
Avalon Care Home F53 F03 Avalon Care Home S61380 V233831 15.06.05 Stage 4.doc Version 1.30 Page 15 good practice for the staff team to monitor this and to adjust the cleaning schedule (that is in place) accordingly. Avalon Care Home F53 F03 Avalon Care Home S61380 V233831 15.06.05 Stage 4.doc Version 1.30 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) 29 The service is failing to fully safeguard the residents in the home by incomplete recruitment practices. EVIDENCE: Four personnel files were viewed. Two relate to staff who are being shadowed at the moment pending a satisfactory police clearance check. Another two files were examined. One was in order, the other had two references yet it was noted that no references related to the member of staff’s recent experience of working in another care home. It is required that a reference from this home is obtained so that a better picture of the person’s experience can be gained. Avalon Care Home F53 F03 Avalon Care Home S61380 V233831 15.06.05 Stage 4.doc Version 1.30 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) 35,38 The service fails to fully protect the financial interests of residents because of practices and procedures open to abuse. Residents do not benefit from a fully trained staff team, which can compromise their care, and the safety of electrical wiring in the home cannot be confirmed. EVIDENCE: The majority of residents rely on families to deal with their finances and a system is in place for the receipt, recording and storage of monies/other valuables as they arrive in the home. All monies are locked in a safe and any monies received are receipted with transactions recorded. However, the procedure for receiving monies is open to abuse. When money is received, only one member of staff deals with the funds and there is no other witness to the transaction apart from the family member. It is required that any monies handed over to the home is witnessed by two members of staff, that key
Avalon Care Home F53 F03 Avalon Care Home S61380 V233831 15.06.05 Stage 4.doc Version 1.30 Page 18 holders for the safe are clearly identified, and it is also required that this amended procedure is made known to families and friends. Training records suggested that some staff required updates to their compulsory training such as manual handling and first aid. As a result it is required that they are fully trained in these areas. In addition to this, a requirement at the last inspection noted that the home must have a certificate to evidence that the safety of the electrical wiring in the building had been checked. This has been done for portable electrical appliances but not yet for wiring. This is raised once more as a requirement. Avalon Care Home F53 F03 Avalon Care Home S61380 V233831 15.06.05 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x 2 x x 2 Avalon Care Home F53 F03 Avalon Care Home S61380 V233831 15.06.05 Stage 4.doc Version 1.30 Page 20 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 9 Regulation 13 Requirement Medication records must e signed after administration or reasons for non-administration entered All staff must sign the protection of vulnerable adults procedure A reference from the last employer of one staff member must be obtained The receipt of residents monies from relatives must be witnessed by two members of staff, recorded and the new system must be reinforced to all staff and made known to all relatives The safety of the electrical wiring in the home must be confirmed by an electrician qulaified to carry out such checks and a certificate produced All staff must receive updates in mandatory training Timescale for action 30 June 2005 31 July 2005 31 July 2005 30 June 2005 2. 3. 4. 18 29 35 13 19 13 5. 38 23 30 June 2005 6. 38 13 September 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Avalon Care Home F53 F03 Avalon Care Home S61380 V233831 15.06.05 Stage 4.doc Version 1.30 Page 21 No. 1. 2. Refer to Standard 7 26 Good Practice Recommendations A deadline for the transfer of information to new care plan formats should be identified Attention should be paid to idenifying the causes of slight odours in some bedrooms Avalon Care Home F53 F03 Avalon Care Home S61380 V233831 15.06.05 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Burlington House, 2nd Floor, South Wing Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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