Inspection on 15/01/07 for Avalon Residential Home

This inspection was carried out on 15th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Other inspections for this house

Avalon Residential Home 26/08/08

Avalon Residential Home 24/08/07

Avalon Residential Home 05/03/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Avalon Residential Home 17 Barnwood Road Gloucester Glos GL2 0RZ Lead Inspector Sharon Hayward-Wright Key Unannounced Inspection 12:30 15th January 2007 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 Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 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 Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avalon Residential Home Address 17 Barnwood Road Gloucester Glos GL2 0RZ 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) 01452 417400 ARTI Services Ltd To be appointed Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 27/03/2006 Brief Description of the Service: Avalon is a detached Edwardian property situated on the corner of a residential road and the main Barnwood Road into Gloucester City. The House has been extended to offer personal care for fourteen elderly people. All bedrooms are for single use, although there is one bedroom that would be large enough to accommodate a couple if this was required. All bedrooms are en-suite. On the ground floor there is a sitting room, dining room and small sun lounge. Access to the first floor is via a main staircase that has been fitted with a chair lift. Outside of the building there are various places to sit and to the rear a small garden with an enclosed patio area with chairs and sun shades for use in the summer. There is also a small car park to the rear. The home did not have a copy of either their Statement of Purpose or Service Users Guide on display in the home. The fee ranges per week are from £400 to £450. Extras not included in the fees include chiropody and hairdressing. This information was given to the inspector prior to the inspection. Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two Inspectors carried out this inspection over 1 day in January 2007. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Since the last inspection the home has a new Registered Provider and is looking to appoint a manager and apply to the Commission for Social Care Inspection for them to be considered for registration. The Acting Manager was available during the inspection as were other members of the home team. A total of 27 standards were inspected. Service users were observed and spoken with to ascertain their views on the care and services provided. A number of surveys were sent to the home prior to the inspection for service users, staff and visitors to the home. Of these, nine visitors returned theirs. The majority had positive comments to make about the home; one said ‘they feel that the care and kindness is first class and a happy atmosphere’. Another comment was that they ‘always hear complaints about food and there is not always enough staff on duty’. The comments received from staff during the inspection all indicated they are happy working at the home. Staff surveys had a mixture of comments that are mentioned in the body of the report. Seven service users returned their surveys and their comments have also been used later in the report. The Acting Manager and care staff were spoken with throughout the inspection and were helpful and co-operative. Feedback on the inspection findings was given on completion of the site visit and a number of serious issues were identified at this inspection. The Registered Provider met with the inspector following this and is in the process of devising an improvement plan to address the areas identified. What the service does well: Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 6 Avalon is a home with a small number of places that service users find homely and friendly. The position of the home enables independent service users to access the local city and a public transport route is situated on the main road outside the home. Several of their staff members have worked at the home for a number of years resulting in consistency for service users. Service users said they find the staff helpful and friendly. What has improved since the last inspection? What they could do better: The home needs to train a member of staff to undertake pre admission assessments to ensure that the needs of the service users will be met. Arrangements for admission to the home also need to be reviewed so that the appropriate records are devised. The home needs to ensure that care plans and risk assessments are completed and kept under review for all service users. Medication systems in the home need to be reviewed, to ensure that correct and safe administration practices are undertaken by the staff. The staff need to ensure that the dignity of service users is promoted. An activities programme needs to be arranged in conjunction with the interests, choices and needs of service users. Service users need to be given more choice over their daily lives to include meal choices, bathing and activities. Arrangements for planning and preparation of food need to be reviewed to ensure safe working practices and service users’ choices are taken in to account. Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 7 The home should display a copy of their Statement of Purpose, Service Users Guide and complaints procedure where service users and visitors to the home can all have access. Arrangements for staff training and supervision need to be reviewed so all staff receive instruction and direction. The home needs to appoint a suitably experienced and qualified person to be the manager of the home who will provide leadership to the staff and make certain the home is run in the best interests of the service users. Improvements are needed to the environment to make the home a safer and pleasing and pleasant place for service users to live. Recruitment checks need to be improved to make sure the home does not place service users at risk. 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. The summary of this inspection report can be made available in other formats on request. Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 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 Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 & 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The arrangements for admission to this home are not satisfactory and can potentially place service users at risk, as the home cannot demonstrate their needs can be met. EVIDENCE: The home did not have a copy of their Statement of Purpose or Service Users Guide on display. A copy was available in the office but had not been updated as it made references to the National Care Standards Commission. The home should consider displaying copies of these for service users and visitors to read. Terms and conditions were not examined at this inspection however consideration should be given to ensuring the homes terms and conditions meet the new Care Homes Regulations that came into force in September 2006. Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 10 The home has recently had two admissions and their pre admission assessments completed by the home were examined. One was not completed in full and lacked detail about care needs. The other assessment had identified care needs but did not specify enough information and it contained conflicting information to the care plans completed by Community and Adult Care Directorate (CACD). One assessment mentioned that a specialist assessment was required, however the home had not obtained further details about why this was needed. As these assessments lacked the appropriate information needed the home is not able to provide confirmation that they can meet their needs and there was no copy of CACD assessment of needs available. The home was also not able to prove that they had written to these service users or their family to confirm they can meet their needs. These service users could not remember if they visited the home prior to moving in but they said they knew of the home as it is close to their own home. The Registered Provider confirmed following the inspection that prospective service users are invited to visit the home prior to moving in. Intermediate care is not provided by this home. Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 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. 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. The home does not have a clear or consistent care planning system in place, therefore the staff do not have up to date information available to them about the needs of the service users. The medication practices in this home are unsafe and potentially place service users at risk. Staff need reminding about the importance of ensuring all service users dignity is maintained. EVIDENCE: The care of four service users was examined in detail and this included reading care records, speaking to service users and staff. Other care records were examined. None of the four service users had an ongoing assessment of need in place. Two service users had been reviewed by Community and Adult Care Directorate (CACD) and care plans were in place. The home had not conducted Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 12 any reviews for service users. One service user had care plans in place but they had not been reviewed since March 2006 and the other service user’s care plans had not been reviewed since October 2005. The home is therefore not able to prove that the care they provide to these service users is up to date and meeting their current needs. The home has reviewed how they record daily records recently and now each service user has their own sheet. The two recently admitted service users did not have any risk assessments in place even though care plans completed by CACD indicated they were needed, for example a falls risk assessments. One of these service users did have a partially complete moving and handling assessment, however the other service user did not have one. One of the remaining two service users did have a risk assessment completed very recently but the tool used did not have a key to explain the meanings of the scores obtained. It also said actions had to be taken to ensure their safety but this had not been done for example hourly checks at night. The home does not have waking night staff at the time of this report. One service user had a pressure sore risk assessment in place but this again had not been competed in full and is a nursing tool, which is not appropriate to this home unless training has been provided in its use or false scoring can lead to the incorrect risk factor being identified. Each service user had a sheet to record health professional visits. A concern received prior to the inspection stated that not all the information relating to service users’ GPs was up to date. This must be addressed to ensure that service users receive prompt medical attention when required. During the inspection a GP was visiting a service user. The Acting Manager was able to show the inspectors a new format that the home intends to use for all service users. Seven surveys were received from service users and one question asked “Do you receive the care and support you need”. Four said always, two said usually and one said sometimes. Another question asked service users if they receive the medical support they need and five said yes, one said usually and one said sometimes. Medication systems used by the home were observed and examined. Two medication rounds were observed and at both the member of staff did not ensure the medication was secure. This practice potentially places service users at risk of errors. The Medication Administration Records (MAR) were examined and found to contain details of medication received into the home and administered, however the returned records were not examined. Several service users are able to self-medicate all or parts of their medication but the appropriate risk assessments and consent forms were not in place. A service user on respite care self medicates but again this had not been reviewed during their stay. The Acting Manager said lockable facilities are provided in service users rooms. Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 13 Some hand written entries were checked and signed by a second member of staff. Consideration must be given to ensuring this takes place all the time to reduce any risks of transcription error. Several service users are receiving controlled medications and the appropriate storage is provided. The register used contained the correct information in relation to administration however this was not recorded on the MAR sheet. Consideration should be given to ensuring both records are completed. A specimen signature list is available along with information about expiry dates of medication and the medication themselves. Eye drops and liquid medication all had dates of opening on them. However, several eye drops were left on the shelf in the room where the medication is stored and the door to this office is left open, all medication must be stored securely at all times even if waiting to be returned to the local pharmacy. The homes drug reference book is dated March 2005 and consideration should be given to obtaining a more up to date book. The homely remedy was lasted reviewed in August 2005 and is not for individual service users. This should be updated and the service users GPs’ consulted. The homes medication policy was devised in March 2005 and has not been reviewed. The Acting manager said that only three members of staff can administer medication and that they have had training from the pharmacy they use. The home must consider providing training for staff in the safe handling and administration of medication. Service users spoken with all said they have their privacy and dignity maintained by the staff. Two service users spoken with had telephones in their rooms. However one service user that requires supervision with personal care was found not to have had a shave that day and was still wearing their pyjama top late in the afternoon. Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Social and recreational interests and needs of service users are not being met by the home. Service users are able to make limited choices about their daily life within the restraints of the home. Dietary needs of service users are not well catered for with little evidence of a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: From discussion with service users it was evident that the home does not have an activities programme. One service user is able to go for a walk and they confirmed that the staff had escorted them until they were certain they were safe to go alone. Another service user said they were happy to provide their own activities and stay in their room. Staff said they have provided activities in the past but service users did not want to attend. The local library service visits the home on a regular basis to provide books for service users. The Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 15 hairdresser visits the home at least once a week. Staff said that the majority of service users tend to sleep a lot. The home must look at ways of providing stimulation for service users. The staffing levels do not facilitate service users by supporting or enabling service users to participate in activities. There was no evidence to suggest that the home is meeting the spiritual needs of the service users. Of the seven service users surveys received, a question asked them “ Are there activities arranged by the home that you can take part in?” One said always, two said usually, one said sometimes and one said never. Visitors were observed coming into the home. One visitor said they come to the home twice a week and they are very happy with the care provided. One service user is able to go out independently and another said their family take them out often. Service users have very limited choices over their daily lives. From discussions with service users and staff, service users have a bath on a specific day and time each week. From observations in the home the main activity of the day for the majority of service users is coming down to the dining room for their meals and then returning to their rooms where they receive a hot drink. Service users personal possessions were seen in their rooms. The kitchen was examined as part of the tour of the home see Standard 19 for further details. No menus were displayed around the home. Copies of menus were sent to the Commission prior to the inspection. There appeared to be very little planning for meals as one inspector observed two staff members deciding what to do for the following days lunch. A member of staff cooks the meals each day. No choice is offered at the main meal of the day but service users did say they could choose what they have at breakfast and teatime. Staff said alternatives are offered if the service user does not like what is offered for the main meal of the day. The home maintains individual records of what service users have for teatime but not lunchtime. One service user requires a special diet but it was noticed on that day they were not able to have a choice over their pudding as the home had run out of their dessert. With proper planning of meals the home would not run out of food needed to cater for service users with special dietary needs. No evidence was seen to show the home asks for the service users input in to devising the menus. The inspectors joined the service users in the dining room when they were about to have their pudding. Service users sent their puddings back to the kitchen, as they did not like what was being offered. The staff offered the service users an alternative. Service users spoken with had a mixed response to the food provided by the home, it ranged from ‘very good to being awful’. One service user said it depended on which member of staff was cooking that day to the quality of the Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 16 meal. The staff did say the Provider does have plans in place to appoint a cook so they do not have to prepare the food as well as provide personal care. Service users did confirm that drinks are provided throughout the day and one service user had a jug of water in their room. Service users said they could choose where they eat their meals each day with the majority of service users choosing to eat in the dining room. Service users surveys asked if they liked the meals in the home, four said always, one said usually and two said sometimes. A visitor’s survey said ‘that they hear complaints about the food’. Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The complaints procedure is not accessible to service users or visitors which could prevent them from having their views listened to and acted upon. The systems in place to protect service users from abuse are not satisfactory and potentially place service users at risk. EVIDENCE: The home did not have a copy of their complaints procedure displayed in the home. The information sent to the inspector prior to this unannounced inspection said they had not received any complaints. The Commission has received some concerns prior to this inspection and they were investigated during this inspection. Two service users said they would know who to speak to if they were unhappy. A visitor to the home said they had no cause to make a complaint but would not know who to go to. Service users surveys indicated the majority of service users would know who to speak to if they were unhappy and how to make a complaint. Several of the visitors’ surveys said they were not aware of the homes complaints procedure. And the vast majority said they have not had to make a complaint. Consideration should be given to the home making their complaints procedure accessible to service users and visitors to the home. Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 18 The home has not provided any training to staff in the protection of vulnerable adults. Since the last inspection the home has appointed new staff and some have not worked in care before. The home’s policies and procedures were not checked at this inspection but the pre inspection questionnaire did not have dates of reviews of any policies and procedures in the home. The staff surveys received had not all answered questioned that related to policies and procedures for the protection of vulnerable adults. As documented in this report there are areas of poor practice that could indicate the staff would not have the knowledge about how to implement procedures to protect vulnerable adults or who to contact. The home has not had to refer any staff to the POVA list. Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment does not provide a safe, clean or pleasant place for service users to live in. EVIDENCE: As part of the tour of the home the kitchen was also viewed. Records relating to health and safety checks were examined. The home is not recording fridge and freezer temperatures on a regular basis and the fridge temperatures were over the safe limit but the staff had not done anything about it. One freezer had a build up of ice and needed to be defrosted but the staff said they do this regularly. The cleaning rota was also not up to date. No evidence was found to suggest that the staff are probing hot food to check on the temperature. One service user has their meal re-heated again this is not probed to check it is at the correct temperature. This is unsafe practice and can potentially place Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 20 service users at risk of food poisoning. Staff were also seen to be entering and working in the kitchen without wearing protective clothing, this is discussed further in Standard 26. Staff said they have undertaken basic food hygiene training. Several issues were identified with labelling of food products. Prior to the inspection the Environmental Health Department (EHO) was contacted to discuss some concerns received by the Commission prior to the inspection. Following this inspection EHO visited the home to inspect the kitchen area, therefore no requirement in relation to health and safety checks have been made only that the home must address any requirements issued by EHO. A tour of the rest of the building took place and several service users rooms were examined. At the rear entrance to the home the carpet along the passage away outside the kitchen had a large ‘bleach stain’ on it, which makes it look unsightly. Three service users rooms had odours and these were identified to the Acting Manager during the inspection. One service user’s room had a lot of debris on the floor and the toilet area was not very clean. This service user said this was unusual as normally their domestic who is on holiday does a very good job. The majority of service users surveys all said the home is always clean and fresh. All rooms have en-suite facilities and a bathroom is on each floor. One room can be used as a double when a couple wish to share. A service user said that the conservatory is out of action in the winter but it is a nice place to sit in the summer. The lounge area is looking tired in places as the main window looks like it has condensation on it all the time and it is difficult to see out of it. One of settees and two chairs are heavily stained and both inspectors sat on them and found it difficult to get out of them, which would make it hard for service users with reduced mobility to use them. No service users were seen entering the lounge during the inspection. Only one service user had a risk assessment in place for radiator guards but at the time of the inspection the guard had not been fitted. All service users must have a risk assessment completed if a radiator guard is not fitted to radiators in their room and communal areas. It was noticed that two service users on the first floor did not have window restrictors in place; this could pose a risk as one service user had impaired sight and the other was confused. Risk assessments must also be completed on service users that do not have restrictors fitted to their windows. One toilet down stairs did not have a lock fitted, which could pose issues for service users privacy. Both communal rooms downstairs are fitted with door guards that will automatically shut the door if the fire alarm is activated. On shutting the Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 21 dining room door it was noticed that the door would not close properly, again this could pose a risk to service users and staff if a fire broke out in the building. The home must check all fire doors to ensure they close properly. Staff had also propped open the lounge door with a stool even though the door guard was in place. This practice could potentially place service users and staff at risk. It was also noticed that staff handbags are stored by the small office and in easy reach of any one visiting the home. Facilities for staff to store their personal items must be provided. The laundry is situated outside the home to the side, liquid soap should be provided. No laundry was seen being transported at this inspection. No infection control procedures were seen as the staff were walking in and out of the kitchen and preparing food without wearing protective clothing. The member of staff cooking the food did have a cloth apron on. This can lead to cross contamination as staff also assist service users with personal care. The home must ensure that infection control procedures are put in place and provide training for staff. Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff on duty is not meeting all service users needs. The standard of vetting and recruitment has seriously declined since the last inspection with not all the appropriate checks being carried out, which potentially can leave service users at risk. Improvements are needed with staff training to ensure they are competent to fulfil their job roles. EVIDENCE: On the day of the inspection there were two care staff on duty and the Acting Manager had arrived at the home just before the unannounced inspection had started. From talking with the staff, two staff take over from the sleep-in night staff and they have to prepare breakfast as well as assisting service users to get up. Copies of the off duty were sent to the Commission prior to this inspection but they were not clear on how many staff should be on duty. Staff have to undertake other duties to include preparation of meals and laundry. This may be a reason why activities are not being done with the service users as staff do not have time to complete all their tasks. Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 23 The home employs a domestic but no one had turned up to assist with cleaning on this day, however some cleaning was undertaken by the Provider’s partner who was visiting the home that day. The home must review their staffing levels to ensure the needs of service users are being met. Following the inspection the Registered Provider said the home will soon be commencing one waking night staff and one sleep-in and that changes to the duty rota will make it easier to understand, and the staff will have set shifts. Feedback from service users all said the staff are very ‘helpful and friendly’. A comment on one of the visitors surveys said that there is not always enough staff on duty. A comment received on a staff survey said that ‘better communication is needed between staff and more training’. Another comment was that ‘staff are being asked to do more than their job description for example cooking and cleaning’. A further staff comment was that ‘they provide good care to the service users’. Two care staff have NVQ 2 training at the moment, however the preinspection questionnaire indicated that future plans will include more. The personnel records of recently appointed staff by the new Registered Provider were examined. None of the three files contained all the checks required by the Care Home Regulations. Two did not have a Criminal Records Bureau Disclosure (CRB) or POVA checks. One only had a part completed application form and only one reference. Another one did not have any references only an application form and they had been working at the home the week prior to the inspection. Also another proposed member of staff had been at the home for induction but had not completed an application form, no references were obtained and no CRB or POVA check. During the inspection the inspectors noticed another member of staff and asked who they were. This person had come into the home to complete a CRB/POVA application and had been helping the staff with the washing up. This practice places service users at risk of possible abuse if pre-employment checks are not carried out. The Acting Manager said that induction training does take place but no records were seen to prove that it is happening or that new staff are appointed a mentor/supervisor. Four staff have completed two different training courses since the new Registered Provider took over. Certificates were seen of several courses that are still in date for a number of staff to include basic food hygiene, moving and handling and first aid. The pre-inspection questionnaire indicates that there are plans for future training. One comment on a staff questionnaire said more training is needed. Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of suitably qualified manager and leadership has resulted in service users not receiving a quality service from the home. The health, safety and welfare of service users and staff is not promoted and protected and can potentially place them at risk. EVIDENCE: Since the last inspection the home has had a change of Provider and two managers. Both managers only lasted for short periods of time. The new Registered Provider is looking to recruit a new manager. Since the last Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 25 inspection a number of serious shortfalls in the service provided by the home has been found at this inspection. The Registered Provider met with the inspector following this inspection and is putting an improvement plan in place. The home must appoint a suitably qualified person to be considered for registration by the Commission. A service user said they would know who to speak to if they were unhappy and the majority of service users surveys said the same thing. No quality assurance systems are in place in the home and this includes monitoring and obtaining the views of service users, staff and visitors to the home. The Registered Provider has not undertaken regulation 26 visits even though they are visiting the home on frequent occasions. These visits are designed to enable the Provider to check on records, speak to service users and staff and help to identify any issues that may arise. The home stores money for several service users in a secure facility. Those checked were all correct and the appropriate records were in place. Receipts kept tend to be combined, for example from the hairdresser. Records relating to staff supervision were examined and this showed that no sessions have taken place in some cases as far back as June 2005 with the most up to date session being February 2006. The Acting Manager said she has completed a supervision session recently but has not written up the records as yet. The vast majority of records examined during this inspection were not up to date. The home stores photographs of service users upstairs and not in an accessible place for any new staff. Consideration should be given to placing these on their Medication Administration Records and care plans. Accident records were also examined and it was found that one service user is having a number of falls; this service user is now in hospital. During the inspection the staff were receiving training in the use of a new moving and handling aid. Fire training records were examined and found that fire instruction had been given verbally in January 2007. See Standard 30 for further information about training. Fire checks were also examined and found that fire alarm testing is happening weekly but no evidence was available to prove the home is checking their emergency lighting as stated on their pre inspection questionnaire. Fire equipment was serviced last year. The homes fire risk assessment has not been reviewed since June 2005. Portable Appliance Testing was due in December 2006 and a Gas service has been completed. No evidence is in place to suggest that the water temperatures are checked or that the home is complying with Legionella testing. An electrician was visiting the home to repair a broken light in one of the bathrooms. Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 26 No COSHH data sheets were available as stated on their pre inspection questionnaire. Gloucestershire Fire Safety team have been requested to visit the home following concerns received prior to this inspection. Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 27 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 2 X 1 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X 3 1 2 2 Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation 14(1a & b) Requirement The registered person must ensure that the needs of any proposed service user are assessed by a suitably qualified or trained person and obtain a copy of this assessment. The registered person must confirm in writing to the proposed service user that having regard to the assessment the home is able to meet their needs. The registered person must ensure that all service users have an ongoing assessment of need that is kept under review and updated when necessary. The registered person must ensure that all service users have care plans pertinent to their needs and that these are kept under review. And updated as necessary. The registered person must ensure that any risks to service users are identified and a risk assessment is devised, kept under review and updated as required. DS0000068030.V320642.R01.S.doc Timescale for action 15/01/07 2. OP3 14(1d) 15/01/07 3. OP7 14(2a&b) 15/01/07 4. OP7 15 15/01/07 5. OP7 13(4b) 15/02/07 Avalon Residential Home Version 5.2 Page 29 6. OP9 13(2) 7. 8. OP9 OP9 13(2) 13(2) 9. OP12 16(n) 10. OP15 16(i) 11. OP16 22(5) 12. OP18 13(6) 13. OP19 16(j) 14. OP19 13(4a) The registered person must ensure that staff receive training in the safe handling and administration of medication to reduce any risks to service users. The registered person must ensure that medication is stored securely at all times. The registered person must ensure that a risk assessment and consent form is completed for all service users wishing to self medicate. These must be kept under review and updated as required. The registered person must devise an activities programme based on service users interests, choices and needs. The registered person must provide service users with a varied, suitable, wholesome and nutritious diet. The registered person must give all service users a copy of their complaints procedure and to any person acting on behalf of a service user if they request one. The registered person must ensure all staff receive training in relation to abuse and ensure that the homes policy is up to date with any latest legislation. To ensure service users are protected at all times. The registered person must ensure that the requirements issued by Environmental Health are addressed within their timescales. This will reduce any risks of cross contamination during food preparation. The registered person must assess all radiators within the home for the risk they present to service users and action taken to minimise any identified risk. DS0000068030.V320642.R01.S.doc 15/02/07 15/01/07 15/02/07 15/02/07 15/01/07 15/02/07 15/03/07 15/02/07 15/02/07 Avalon Residential Home Version 5.2 Page 30 15. OP19 13(4a) 16. OP19 13(4a) 17. OP26 13(3) 18. 19. OP26 OP27 16(k) 18(1a) 20. OP29 19 21. OP30 18(2) The registered person must assess all windows within the home for the risk they present to service users and action taken to minimise any identified risk. The registered person must assess all fire doors to ensure they are working correctly to reduce any risks to service users, staff and visitors to the home. The registered person must make arrangements to prevent the spread of infection in the home by providing training for staff. The registered person must make arrangements to keep the home free from offensive odours. The registered person must review their staffing levels to ensure that service users health; welfare and safety are being met. The Home must demonstrate that this is an ongoing process. The registered person must ensure that all employment checks as required in this Regulation are undertaken to reduce the risk to service users. The home must make arrangement so that all new staff are appointed a mentor/supervisor during their induction and maintain records of this. This mentor/supervisor must be experienced and able to fulfil this role. The new member of staff must not take service users out of the home alone until they have completed their induction period and the registered person is satisfied they pose no risk to service users. The registered person must DS0000068030.V320642.R01.S.doc 15/02/07 15/02/07 15/02/07 15/03/07 15/01/07 15/01/07 15/01/07 22. OP31 8 15/03/07 Version 5.2 Page 31 Avalon Residential Home 23. OP33 24 24. OP36 18(2a) 25. 26. OP37 OP38 17 13(4a&c) appoint a suitably experienced and qualified person to manage the home and apply to the Commission to be considered for registration. The registered person must devise a quality assurance review procedure to ensure that the home is being run in the best interests of the service users. The registered person must ensure that staff are appropriately supervised so they are able meet the needs of the service users. Records must be maintained of each session. The registered person must ensure that all records used in the home are kept up to date. The registered person must make arrangements to ensure the home and its equipment is safe for service users. 15/03/07 15/02/07 15/01/07 15/01/07 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 OP1 Good Practice Recommendations The home should remove all references to the National Care Standards Commission in their Statement of Purpose and replace with the Commission for Social Care Commission. The home should display copies of their Statement of Purpose and Service Users Guide in the home. The home should ensure that at least one member of staff is trained in assessing whether prospective service users will be able to have their needs met by the home. The home should ensure that all service users contact details for their GPs’ is up to date. The home should ensure that another member of staff checks and signs any hand written entries on the DS0000068030.V320642.R01.S.doc Version 5.2 Page 32 2. 3. 4. 5. OP1 OP3 OP8 OP9 Avalon Residential Home 6. 7. 8. 9. 10. 11. 12. 13. OP9 OP9 OP16 OP16 OP18 OP19 OP19 OP37 Medication Administration Records. The home should review their homely remedy policy and medication policy and obtain the consent of the service users GP’s to use the homely remedies. The home should obtain an up to date medication reference book. The home should display a copy of their complaints procedure on a notice board in the home for both service users and visitors to see. The home should devise their complaints procedures in formats suitable for their service users. The home should contact the local adult protection agency to find out about training for staff. The home should redecorate and replace the window and furniture in the lounge to make it more of pleasing place for service users to spend their time. The home should replace the carpet outside the kitchen where there is a bleach stain. The home should place photographs of service users on their care records and medication administration records. Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 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 © 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 Avalon Residential Home DS0000068030.V320642.R01.S.doc Version 5.2 Page 34 - 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. 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