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Inspection on 20/02/09 for Avalon Care Home

Also see our care home review for Avalon Care Home for more information

This inspection was carried out on 20th February 2009.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Avalon Care Home 116 Clipstone Road West Forest Town Nottinghamshire NG19 0HL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mary OLoughlin     Date: 2 0 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Avalon Care Home 116 Clipstone Road West Forest Town Nottinghamshire NG19 0HL 01623644195 01623429977 avalon@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross Care Homes No 2 Ltd care home 40 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: One named sevice user as applied for in application dated 16/10/05 may be within category PD Service users shall be within category OP Date of last inspection Brief description of the care home Avalon Care Centre is a purpose built two-storey, forty bedded care home for older people situated on the outskirts of Mansfield, close to the former mining village of Clipstone. It is situated on a main road, which has a public bus service, and is approximately two miles from Mansfield town centre to the North East. All bedrooms are single occupancy, with half having en-suite facilities. Avalon is close to local shops, and a pub. There is ramped access to the home and a passenger lift is installed. 1 4 0 1 2 0 0 9 0 Over 65 40 Care Homes for Older People Page 4 of 24 Brief description of the care home The range of fees were not detailed in the Service User Guide, however information supplied on the day of the inspection by the temporary manager detailed fees ranged between £350.00 and £550.00. No information was supplied as to extra charges. Copies of the last inspection report and the homes statement of purpose are available to people in the home. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Commission for Social Care Inspection is about the outcome of the care provided to people using the service. This process considers the providers capacity to meet regulatory requirements and focuses on aspects of service provision that need further development. The last key inspection of the service was undertaken on 03/10/08 and found that there were serious shortfalls in the care provided to people using the service. A random inspection of the homes medicine practices was also undertaken in January 2009 by the commissions pharmacist inspector. This key inspection focused on the issues that we felt needed addressing from our last key and random inspections, and the improvements and compliance with the Care Homes for Older People Page 6 of 24 requirements we set. The main method of inspection used was called case tracking. This involves selecting the care records and looking at the quality of the care people receive by talking to them, examining their care files and discussing how support is offered to them by staff members. Some of the people who live at this home have a very limited ability to understand and communicate. Therefore many judgements in this report are from observation and reading records and documents. People living at the home, members of staff and the acting manager were spoken with as part of this inspection, documents were read and medication inspected to form an opinion about the quality of the care provided. We looked at what the provider told us they were doing in their Annual Quality Assurance document (AQAA) that they sent to us. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed before they are admitted to the home to ensure that there are suitable facilities, services and skills available to deliver the care they need. Evidence: We did not focus on how people were admitted to the home as the service has not admitted anyone recently and our judgment from the inspection in October 2008 was that people were assessed before they were admitted. We had examined the way 4 people had been admitted to the home and found that in all cases they had received a full assessment by a trained person from the home. The assessments provided the staff with a picture of what the persons health and personal needs were. From information we received within the AQAA it was clear that the acting manager was aware of and working to robust procedures before people were admitted. Care Homes for Older People Page 10 of 24 Evidence: Care Homes for Older People Page 11 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are improved systems in place to monitor peoples needs and administer medicines safely ensuring the health and wellbeing of people using the service. Evidence: At the last key inspection in October 2008 we found that people did not always receive the support they needed through suitable care planning, referral to NHS specialists and personal care. At this inspection we focused on 2 people who needed special support with their diets and full assistance with personal care. Both people had an up to date care plan in place that reflected fully how they needed to be supported to maintain their health and wellbeing. There was evidence that staff have now made sure that people receive a suitable diet and are referred to speech and language therapy if this is required. The staff told us they have more time to provide personal care since the review of Care Homes for Older People Page 12 of 24 Evidence: staffing levels. Relatives we spoke to said that they were happy with the care that is now provided. People using the service were seen being supported appropriately with skill and sensitivity. Information we have received from Nottingham County Council following a review of all people at the home tells us that care practices are improved and people are happy with the care provided. The acting manager told us in the improvement plan they sent to us that they had started to complete daily communication sheets for staff each day to make sure that any issues arising in peoples health would be referred promptly. We saw that food diaries are now completed to inform staff of the actual dietary intake of the person and a fluid balance sheet records how much fluid is taken over 24hrs, this is good practice and alerts staff to any possibility of dehydration. However the fluid balance sheets were not being calculated after each day and it was not clear where or how this information was translated into care plans or through staff communication systems. At the key inspection in October 2008 and following a safeguarding alert there were concerns about how the service was managing medicines. The commissions pharmacy inspector undertook a random inspection in January 2009 making requirements for the improvement of medicine management. During this inspection we identified that all the required improvements have been made. Medicine storage temperatures are now recorded and administration times have changed to ensure the privacy of people during administration. There are improved policies for medicines and suitable audit trails to make sure there is no misuse. Care Homes for Older People Page 13 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More creative methods are being introduced to make sure that people are supported as they prefer and receive a suitable diet in a calm unhurried way. Evidence: We spoke to a member of staff that has recently been appointed as a dignity champion at the home. He told us that he is receiving training in his role and that his main responsibilities are to talk to people about what they want to do each day. He uses the persons care plan to record individual preferences and the plans are to focus on what is important to the person and how they wish to be supported. People using the service said they were happy and were receiving visitors during our inspection. The care plans now record the social interests of each person and records are in place showing what people have done each day. We saw a lot of improvement around mealtimes, there is now a protected mealtime where all staff are available to support people as they require, and we saw them doing this with sensitivity. Care Homes for Older People Page 14 of 24 Evidence: The improvement plan tells us that the activities worker is now part of a networking group within Southern Cross where they can share ideas and implement good practice issues. Care Homes for Older People Page 15 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are improvements in the responses to complaints and staff are suitably trained to respond to any suspicion of abuse. Evidence: At our last key inspection we saw that the home provides people with a suitable complaint procedure but did not always respond to people who complained. At this inspection we saw that the acting manager has made improvements to the way complaints are addressed. We saw that 5 complaints, all minor issues were recorded and people were responded to in a timely way. We identified that there is improved consultation with people using the service through care planning and review to make sure their views are taken seriously about how they wish to be supported. Since our last inspection there has been 1 safeguarding alert made through the local safeguarding adults procedures, the outcomes of this investigation has prompted improved medicine ordering and collection. The manager did not have an up to date copy of the local safeguarding adults procedures but staff could access the homes own procedure in the event of any allegations of abuse. Care Homes for Older People Page 16 of 24 Evidence: Care Homes for Older People Page 17 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and well maintained. Evidence: The home is well maintained and there are suitable cleaning systems in place to safeguard people from infection. Staff are trained to control infection and the manager audits the infection control practices to make sure people are safe. People case tracked all had suitable equipment in place to manage their needs appropriately. Care Homes for Older People Page 18 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are in safe hands at all times. Evidence: The last inspection identified that there is a suitable recruitment procedure that is followed in practice, ensuring that people are properly checked to make sure they are safe to work with vulnerable adults. We also know that staff receive suitable training and induction to their role with regular updates on practices such as moving and handling people safely. There have been improvements in the number of people on duty since our last inspection and staff told us that they feel there is more staff now and have time to undertake more suitable support for people. We saw that there is improved care planning and communication between staff. The home was calm and staff supported people sensitively in an unhurried way. The manager told us that any staff reported through safeguarding procedures have been suitably investigated and disciplined to ensure that people are not at risk from anyone that is unsuitable to work with them. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been improvements to the way the home is managed and the outcomes for people living at the home have improved. Evidence: The acting manager has now submitted her application to register with the commission. She has worked hard since her appointment to improve the services provided at the home. In response to our last inspection in October 2008 she sent us an improvement plan addressing the areas of compliance that were needed to improve the lives of people at the home. Both the manager and the operations manager have attended meetings with social services and worked with all agencies to investigate any concerns or allegations and put in place suitable measures to sustain improvements at the home. The management of medicines has improved and there is better auditing taking place of the homes management of medicines to make sure people receive prescribed Care Homes for Older People Page 20 of 24 Evidence: medicines quickly and appropriately. The numbers of staff have increased and there is improved support provided to people at peak times of activity such as mealtimes. The systems in place to ensure that all issues are communicated and acted upon have improved through a daily report sheet. Our last inspection identified suitable safeguards are in place for the management of peoples personal finances and for the management of health and safety issues. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 Make sure that fluid balance records are calculated each day and the information used each day to alert staff to any problems and obtain appropriate response and referral to external health care specialists. Obtain the local safeguarding adults procedures. 2 18 Care Homes for Older People Page 23 of 24 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!