CARE HOMES FOR OLDER PEOPLE
Avalon Care Home 24 Duke Street Southport Merseyside PR8 1LW Lead Inspector
Mr Paul Kenyon Unannounced Inspection 4.15 6 and 20 December 2005
th th 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 Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 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. Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Avalon Care Home Address 24 Duke Street Southport Merseyside PR8 1LW 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) 0151 200 8841 0151 200 8841 Avalon Residential Homes Ltd Ann Louise Wilson Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should employ a suitable qualified and experienced manager that is registered with the CSCI Twenty (20) places are to be registered in the category of OP Date of last inspection 15 June 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 twenty elderly residents. Nineteen service users were resident at the time of the inspection. Ann Wilson 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 DS0000061380.V264216.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection to be held at Avalon this inspection year (April 2005 to March 2006). The inspection was undertaken on two occasions both of which were unannounced with National Minimum Standards for older people being used to measure the quality of care provided by the home. The first part of the inspection took place during the evening and involved a tour of the premises as well as discussion with six residents in total. A number of records were also examined. The second part of the inspection took place during the early morning and involved a further examination of records and tour of the premises as well as indirect observation of routines. In total the inspection took seven hours. What the service does well:
The service is good at ensuring the privacy and dignity of residents and this was borne out by comments by residents during the first part of the inspection. ‘I can wash myself and get myself ready because I am able to’ ‘Staff are very good and give me privacy’ ‘Of course they treat us with dignity’ ‘We are treated with respect’ The service provides activities and this was certainly the case in the lead up to the Christmas period. Information had been provided to residents and their families about forthcoming activities and records of recent events had been recorded. Evidence from residents suggested that their preferred routines are honoured ‘We can get up when we want’ ‘There is no pressure to go to bed or get up in the morning-we go when we want’ The service is good at maintaining the independence of residents in respect of finances. Those who are able to manage their own finances do so and this is included within care plans. No resident uses advocacy services at present although information on local advocacy groups is available. Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 Page 6 The service is good at providing a choice of food and ensuring that preferred meals are selected by residents. Residents stated that ‘The food is very good’ ‘There is nothing wrong with the food’ ‘There are no complaints about the choice of food’ ‘On the whole food is good’ On the two days of the inspection, it was noted that staffing levels are maintained. The service has introduced an induction booklet for new staff and has devised a separate one for senior staff, which reflects their additional responsibilities. The service has obtained the service of an independent body, which assesses the quality of the service on an annual basis, the most recent one being in November 2005. Other comments by residents included: ‘Staff are very good and honest’ ‘I have no complaints’ ‘Staff are smashing’ ‘I am well looked after’ What has improved since the last inspection?
Medication administration records (with the exception of controlled medication records) are now consistently signed after medication is administered. All staff have now signed the vulnerable adults procedure outlining the actions to take in the event of an allegation of abuse. The service has now introduced a system whereby any monies received by the families of residents are now accountable and recorded. The service has now identified the mandatory training needs of staff and has booked courses for the early part of 2006. Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 Page 7 What they could do better:
The service must ensure that care plans are available for all residents. It is recommended that when a resident is admitted into hospital that a summary sheet including important information about that person’s needs is devised. The service must provide consistent evidence that residents are receiving basic personal care such as bathing and that evidence is provided that continence advisors have been contacted for advice enabling the continence needs of one resident to be assessed. It is recommended that residents should given the opportunity to have keys to their own bedrooms unless determined otherwise in their risk assessment. The service must ensure that records maintained in relation to the administration of controlled medication are being consistently countersigned. The service must ensure that a headboard attached to the bed identified at the inspection is replaced given that it is loose and made of metal therefore posing a risk to that resident. The service must ensure that any proposals to alter the bathing facilities within the home is inline with the assessed needs of residents and involves an assessment of bathing facilities by a suitably qualified individual. The service must ensure that the odour in one bedroom is identified and eradicated. The service must ensure that references are consistently obtained before individual staff members start work in the home and that proof of staff members’ identity are consistently obtained. The service must ensure that the electrical wiring of the home is checked for its safety and that a certificate is issued to that effect. It is also required that the cleaning cupboard is provided with a lock so that the area can be secured when not in use. The service also needs to ensure that risk assessments outlining hazards faced by each resident are consistently available. It is recommended that the service should ensure that the uniforms ordered and obtained are issued to staff members. In October 2005, a number of staff left the service at the same time. One resident commented on this and stated that this had had an affect on them. Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 Page 8 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 DS0000061380.V264216.R01.S.doc Version 5.0 Page 9 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 Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 Page 10 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): No standards were measured in this section during this inspection. Standard 3 was examined during the last inspection and was met. Standard 6 does not apply to Avalon at present. EVIDENCE: Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 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 and 10. Residents do not benefit from consistent care planning. Not all the health and personal care needs of residents are evidenced. Residents are not protected by the home’s medication systems. EVIDENCE: Seven care plans were examined as part of this inspection. One care plan had accompanied a resident into hospital following a recent admission and had not been returned to the home. The availability of care plans is raised as a requirement in this report. The health needs of residents are included within care plans. These take the form of an ongoing commentary of appointments that have been maintained. Such appointments included visits to General Practitioners, hospital appointments and visits by District Nurse staff. It was clear through records that one person has needed to be referred to a Continence Advisor. There was no evidence on file that such a referral had been done and even though the progress of this person in relation to their continence needs was discussed during the inspection, it was clear that this needed review. It is required in this report that evidence of ongoing discussion with a Continence Advisor is
Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 Page 12 provided and maintained. A guideline for the preferences of residents in respect of bathing is available although daily records did not consistently indicate whether residents had had baths. Evidencing this is raised as a requirement Medication records were examined as part of this inspection in response to a requirement at the last inspection. These records continue to be signed yet omissions are still being made with no reasons provided as to whether medication has been administered or reasons for non-administration. A controlled medication register is maintained given that some residents have been prescribed controlled medication. In the main staff have countersigned these records yet on some occasions only one signature is present. It is required that two signatures are obtained in all cases. Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 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 and 15 Activities are made available to residents who also benefit from flexible routines. Residents are enabled to take control over their financial affairs and receive a good standard of food. EVIDENCE: Details of activities are recorded although there was evidence through discussions with some residents that they preferred to maintain their own activities within the local community. Comments on the routines of the home included: ‘We can get up when we want’ ‘There is no pressure to go to bed or get up in the morning-we go when we want’ Records suggested that a number of activities had taken place in the lead up to the Christmas holidays The first part of the inspection coincided with the evening meal. Records suggested that a cooked lunch had been provided. Other records were able to confirm that residents had been offered a choice at tea. Meals were served in the dining area in the lounge or in another area in line with residents’ preferences.
Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 Page 14 Discussions with residents and examination of records suggested that they have different levels of independence in relation to finances. Some are able to maintain control over their own finances while others rely on family members for assistance. Information is available on advocacy services although no one currently uses these. The kitchen was noted to be clean and well organised. The fittings in the kitchen have been refurbished over the past few months. Food is purchased from local shops on a weekly basis and food storage areas were noted to be organised and well stocked. Nutritional information in respect of residents is included within care plans. Comments on the quality of food provided included: ‘The food is very good’ ‘There is nothing wrong with the food’ ‘There are no complaints about the choice of food’ ‘On the whole food is good’ Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 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): 18 Residents are protected in the main from abuse although the recruitment procedure does not provide complete protection. This is outlined in Standard 29 of this report. EVIDENCE: A requirement at the last inspection highlighted the need for staff to sign the procedure for the protection of vulnerable adults. This has been included within an induction booklet that has been completed by all staff members. The booklet includes the responsibility of staff to respond in writing to questions about aspects of abuse and action they should take in the event of allegations made. Staff have also got access to the whistle blowing procedure that is prominently displayed in a staff area. Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 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): 21,22, 24 and 26 Residents do not benefit from bathing facilities that meet their needs. Residents do not benefit from an environment that is completely free of offensive odours although in the main the environment is clean and hygiene. One room contains a headboard fitting that is not safe. EVIDENCE: The majority of bedrooms were viewed. One bedroom has a headboard that is attached to the bed. This is loose and is made of metal, which could present a hazard to the resident. It is required that this is replaced. Avalon has a total of three bathrooms each one in close proximity to bedroom areas. Two bathrooms are not in a useable state with the result that only on bathroom is available to residents. A bathroom on the upper floor is to be refurbished with the Manager intending to install a walk-in shower in this area. It is required that this proposal meets the needs of residents and this must be determined through an assessment of needs by a qualified person.
Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 Page 17 A laundry area has been provided. This is separate from the main building and does not come into contact with food preparation areas. The laundry has industrial appliances installed and systems of storing laundered clothing are in place to minimise the loss of clothes. The majority of the home is free of offensive odour with the exception of one bedroom. Air freshener dispensers have been installed since the last inspection to provide a timed dispensing of air freshener in some areas. As stated one bedroom does have an odour, which in the view of the Inspector is long, established. It is required that the cleaning schedule is adapted to any particular attention to this room and that the continence needs of the resident occupying this room are re-assessed as outlined in Standard 8 of this report. Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 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, 29 and 30 Staffing levels are maintained. Residents are not protected by the home’s recruitment procedure. Residents benefit from a staff team that has received induction training. EVIDENCE: Staff on duty during the two days of the inspection included a mix of care staff and ancillary staff as well as the Manager and Deputy Manager. This met the staffing levels as laid down in the home’s staffing notice. The home has experienced a shortfall in staff of late with a number of established staff having left the employ of the home in the past few weeks more or less at the same time. New staff had been recruited but did not remain in the role too long after this. As a result, the home is undergoing a recruitment drive to fill two vacancies. A staff rota is available and outlines the designation of staff members. Recently some staff have worked hours that would be considered to be excessive if they continued over a few weeks. This will be monitored in future visits to the home. While staffing levels are being maintained, the Manager was reminded of the responsibilities to inform the Commission for Social Care Inspection of any shortfalls in staffing levels under Regulation 37 of the Care Home Regulations. A requirement at the last inspection highlighted the need for a reference to be obtained for one member of staff from their previous employer. This was
Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 Page 19 raised given that the individual had worked in a residential care home. This has been addressed. A total of two personnel files relating to newer members of staff were examined. A third was requested but could not be located on the premises. This was addressed during the second part of the inspection. This is raised as a requirement in this report. No references were available in either of the two files examined and application forms were incomplete in relation to past experience of staff and well as the personal qualities staff could offer to the residents living in Avalon. In addition to this, there was no information, which could verify the identity of the staff members involved. This is raised as a requirement in this report. An induction booklet for all staff has been devised. Evidence suggested that all staff had completed this. The induction booklet includes reference to the statement of purpose of the home, its aims and objectives, confidentiality, medication and the procedure for dealing with allegations of abuse. Staff have completed these induction books retrospectively. An additional booklet has been devised for senior staff including their specific responsibilities for this role. Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 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 and 38 Residents benefit from an accountable and more secure system for dealing with their finances. Residents benefit from an independent method for gaining their views. Health and safety systems still do not protect staff and residents. EVIDENCE: A requirement at the last inspection requested an accountable system for monies received by residents’ relatives to be received by the home. A system has been introduced enabling such monies to be accounted for. The home receives an annual audit from an independent agency. The last audit was conducted in November 2005. The audit has sought to examine all systems in place. A number of deficiencies the health and safety arrangements remain. A certificate for testing the electrical wiring of the home has not yet been
Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 Page 21 obtained and this remains as a requirement although it is understood that this will be available in January 2006. Risk assessments in relation to the hazards facing residents linked to their needs were not available in all cases. In addition to this, a cleaning cupboard does not have a lock fitted. These are raised as requirements in this report. At present, staff do not have uniforms. It is understood that these have been ordered yet not received. It is recommended that these be issued to staff. Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X 2 X 2 X 2 STAFFING Standard No Score 27 3 28 X 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 1 Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 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. 1 2 3 Standard OP7 OP8 OP8 Regulation 15 12 12 Requirement The care plan relating to the resident identified the inspection must be made available Evidence must be provided in records that residents are bathed according to their needs Evidence that there is an ongoing liaison with a Continence Advisor must be produced in relation to the resident identified during the inspection Records relating to the administration of controlled medications must be countersigned An suitably qualified individual must assess the proposed changes to the upstairs bathroom to ensure that these meet the needs of residents The headboard identified during the inspection must be replaced The source of the odour in one bedroom must be identified and eradicated Two references must be available for all members of staff including proof of their identity
DS0000061380.V264216.R01.S.doc Timescale for action 23/12/05 23/12/05 15/01/06 4 OP9 13 23/12/05 5 OP22 23 31/01/06 6 7 8 OP24 OP26 OP29 23 13 17 23/12/06 15/01/06 31/01/06 Avalon Care Home Version 5.0 Page 24 9 10 11 OP38 OP38 OP38 12 23 13 A lock must be installed on the cleaning cupboard door A certificate confirming the safety of the electrical wiring in the home must be produced Risk assessments relating to the daily routines of residents must be made available 23/12/05 06/01/06 15/01/06 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 OP7 OP10 OP26 Good Practice Recommendations A summary sheet enabling relevant information concerning residents to be passed on in the event of a hospital admission should be devised Residents should be offered the option to have keys to their bedrooms with reference to their risk assessments Staff should be issued with the uniforms that the home has obtained Avalon Care Home DS0000061380.V264216.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House 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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