Inspection on 26/08/08 for Avalon Residential Home

This inspection was carried out on 26th August 2008.

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.

Other inspections for this house

Avalon Residential Home 24/08/07

Avalon Residential Home 05/03/07

Avalon Residential Home 15/01/07

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 23/11/2008.

CARE HOMES FOR OLDER PEOPLE Avalon Residential Home 17 Barnwood Road Gloucester Glos GL2 0RZ Lead Inspector Pauline Lintern Unannounced Inspection 26th August 2008 10:00 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.V370265.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.V370265.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 Mrs Laura Agolli Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th August 2007 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 older 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. There is a small rear 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 Statement of Purpose and Service User Guide are displayed in the hallway. Further copies are available from the manager. The fee ranges per week are from £360 to £435. Extras not included in the fees include chiropody and hairdressing. This information was given to the inspector after the inspection. Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star. This means the people who use this service experience adequate quality outcomes. The unannounced visit for this inspection was made on Tuesday 26th August 2008 from 9:30 am to 3:00 pm. The manager, Mrs Agolli, was available during this period. As part of this key inspection one of our pharmacist inspectors looked at some of the arrangements for the management of medicines. The pharmacist looked at some stocks and storage arrangements for medicines, some medication records and procedures. We spoke to one person in the home about their medication and saw a carer administer some medicines. We talked with the manager and one of the carers about medication administration in the home. At the time of the inspection there were thirteen permanent older people and one person on respite care. During the visit, it was possible to talk privately to the people using the service. We also had the opportunity to meet with one visiting relative. The manager confirmed that staffing levels were currently at full capacity. We met with three staff in private to obtain their views. As part of the inspection process, Mrs Agolli was sent an Annual Quality Assurance Assessment to complete. Mrs Agolli completed this thoroughly and in detail. Some of the document’s content is taken into account within the evidence sections of this report. Survey forms were sent to the home to be distributed to the people living at the home and health care professionals. We received seven responses from people using the service and three from health care professionals. During the inspection, we looked at documentation in respect of care planning and delivery, complaints, training and recruitment, risk assessments and health and safety records. Interactions between staff members and the people using the service were observed throughout the day. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and taking into account the views and experiences of people using the service. Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home must submit an application for the manager to become registered with us, as a fit person to manage the service. Care plans could be further improved, by ensuring that sufficient information relating to specific conditions such as diabetes, is clearly detailed. Some improvements in some medicine records and practices were identified. Maintaining a record of how an activity was received will enable the manager to make a clear evaluation of what is successful and what is not. The subject of resuscitation must be removed from all documentation. Any person wishing to pursue specific instructions related to resuscitation must discuss their views with their GP, not with the staff at the home. Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 7 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.V370265.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.V370265.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): NMS 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective new people are assured their needs can be met within the home through a clear assessment process. Information about the service is available. EVIDENCE: Evidence indicates that people are not admitted to the home unless assessed fully and the home is confident that they are able to meet their needs. Assessments from placing authorities and discharge summaries from hospitals are gained, as appropriate. Records showed that the manager was not satisfied that sufficient healthcare checks had been made for one person due to be discharged from hospital. This resulted in the manager insisting these were completed, before the person moved into the home. Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 10 We examined the pre-admission assessments of two people who were recently admitted to the home. Both assessments contained details about their care needs. Both were dated and signed by the person completing the assessment. Mrs Agolli showed us copies of letters, which had been sent to people following their initial assessment, confirming if the home could currently meet their needs or not. Records confirm that the overall aim for the person staying for a respite period is to ‘Maintain a safe and secure environment to enable a safe return home’. Avalon Residential Home DS0000068030.V370265.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): NMS 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each person using the service has a care plan, which generally reflects his or her assessed needs. However some people’s needs may not be fully addressed due to insufficient information relating to specific conditions or healthcare referrals. There are generally suitable arrangements in place for the management of medicines yet there are some weaknesses where more attention to detail is needed in order to reduce the risk of mistakes occurring with medication. People told us that they are treated with respect and that their privacy is upheld. EVIDENCE: The care of two people using the service was examined in detail. Plans covered all aspects of the person’s needs, such as diet, mobility, sleeping patterns, communication, allergies, religion, health needs, medication and Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 12 social needs. Care plans are kept under review. Personal likes and dislikes are also recorded. One person told us ‘they know what I don’t like, chocolate and peas’. Daily records were sampled and we saw that they recorded events that have taken place, any appointments and if the person has eaten well. One record sampled recorded that the person had slipped in the toilet and caused an injury to their knee. Records showed that the appropriate action had been taken and the event had been recorded in the accident book. Risk assessments are completed for individuals needs including manual handling, risk of falls and skin care. Evidence shows that there is regular input from healthcare professionals for example: GP, dentist, district nurse, the falls clinic, chiropodist and the dietician. One care plan examined stated that the person had been referred to a dietician. The manager confirmed that this had taken place. However, the care plan did not include the outcome of the assessment or the action needed. The care plan for another person did not clearly specify how their diabetes was to be managed or offer guidance to the reader. Another person’s plan stated that they were referred to the falls clinic but again it did not provide details on the outcome of the assessment. The register provider, later confirmed in writing that the physiotherapist had since carried out a review and provided the home with techniques to use. Care needs to be taken to ensure sufficient information is included to enable the person’s needs to be fully met. People confirmed that if they were unwell, staff would arrange for them, to see the appropriate health care professional. Evidence of this is in the daily records and care plans. One person told us that they were able to pick the doctor of their choice. A new residents appointment book has been developed and located in the office, to ensure that residents appointments are not missed. The AQAA states that a new form has been developed so that health aids are reviewed monthly to ensure they are in good working order. All new staff receive skills for care induction and other mandatory training. Weights are regularly checked and records kept. Staff who have undertaken special training in the safe handling of medicines were responsible for the management and administration of medicines for people living in this home. The manager has begun additional assessments of these trained staff to make sure their competence is maintained. This needs Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 13 extending to all staff so that there is a regular check that staff are following safe practices when dealing with medicines. We saw records of weekly checks the manager makes of the medicine trolley and medicine charts. The pharmacy provided many medicines each month in special blister packs called a monitored dose system (MDS). These help staff to see easily what medicines need administering on a particular day and time and what medicines have been administered. Each month, as part of this system, the pharmacy printed a record of all the medicines the doctor has prescribed, with a chart. Staff recorded on this, when they administered each medicine. Staff generally recorded the medicines received into the home on these charts and there was a separate book in which medicines disposed of via the pharmacy were recorded. We saw that the allergy sections of the medicine records were completed and there were photos with each record to help the staff to check they were giving the medicines to the right person. Complete and accurate records about medication are important so that there is a full account of the medicines the home is responsible for on behalf of the people living there. Also, so that people are not at risk from mistakes, such as receiving their medicines incorrectly. We found that these records were generally suitably kept during the three and a half weeks before this inspection, which was the period we looked at. We made some checks by counting the tablets or capsules remaining in the trolley and found these often agreed with the administration records. In a few cases the counts did not agree completely with the records or the packs did not have an opening date and time to allow these checks to be made. We pointed out these examples to the manager. The records also indicated that all the medication needed had been in stock during this period. On the day of the inspection we saw that the morning and lunchtime medicines were administered at the correct times. We spoke to one person who told us that he/she had medicine for pain and that the staff always give him/her the medicines and are ‘very good’. We saw that staff had written him/her a list of the medicines and their actions in large print by the bed so as to help him/her understand the medicines he/she received. We identified the following particular issues for attention – • We clarified with one of the staff that one person had received their medicines on the morning of the inspection, as the records had not been signed to show this. • We found records for some medicines for four people were signed as administered on the evening before the inspection but the tablets or capsules were still in the blister packs for that day and time indicating they had not actually been taken. The manager said that in some cases people had refused the doses. If this was the case the records must be marked to accurately show this rather than initials, which is the method to indicate the medicine was actually administered. Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 14 • • • • • • We found three gaps in the administration records for one person and one gap for a weekly medicine for another person. This means we do not know if these people received their medicines or they were missed for some reason. One tablet was still in the blister pack for this day and time so probably had been missed but the other tablets were not packed in blister packs so we could not tell. We found that staff normally recorded medicines received into the home but this was not done for the medicines received each week for one person who was on respite care. Also details of the quantity of a new medicine received for one person the day before the inspection had not yet been recorded. This would be a breach of regulation 13(2). Where people were prescribed medicines to use ‘when required’ there were some additional protocols in place to help give direction to staff about the use of the medicines for each person. Some of these needed reviewing and updating. For example, we found that not all medicines prescribed to use ‘as required’ were included or a protocol still included a medicine that was no longer prescribed. In another case the protocol included information about one laxative but this was not printed on the current medicine chart as the medicine had been changed to another laxative at another dose. The protocol for using a medicine for indigestion for another person stated a dose that was different to that printed on the label on the medicine bottle. The product was not printed on the latest medicine administration record. Other protocols needed more information to give adequate directions, for example, whether to use one or two tablets. The protocols could usefully include information about how much choice and direction the people themselves are able to say about the medicines they need. There were review dates on the protocols but it was not clear if these were the date the protocol had actually been reviewed or the date when the review was due. If the latter was the case then a number of protocols were beyond their stated review date. We noted that records for one person contained information in a summary medical history about a likely/moderate allergy to a particular medicine causing abdominal pain. We advised the manager to discuss this again with the doctor as this person had recently received some tablets containing this particular medicine as one of the ingredients. Records indicated stomach pain as a reason for a recent doctor’s visit. Following a risk assessment some people were looking after some of their medicines. We looked at some assessments about this and in one case found two products that the medicine chart stated as self-medicating were not included in the risk assessment. No records were made when the medicines were handed over to people to look after themselves. These are needed so as to have a complete audit trail of these products. Medicines were stored safely at the correct temperature and there were proper storage arrangements for controlled medication. Checks we made with the controlled medicine record book were in order and we saw evidence of random checks the manager had made. Medicines that require refrigerated storage Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 15 were in a locked container in the fridge but we strongly recommend that this container be attached to the fridge shelf. We saw in one bedroom that there were some opened containers of creams or ointments. This needs a risk assessment to make sure this is safe for everyone in the home. We found that eye drop containers were dated when first opened to use and were replaced every month to reduce risks from using contaminated drops. Some other medicines containers did have opening dates written on them; this is good practice for all medicine containers but was not always in place. We pointed out to the manager that some of the creams and ointments in the upstairs medicine trolley had been in use for a long while and may need replacing to reduce contamination risks. There was information from the pharmacy about recommended time limits for opened containers of medicines. There was a medication policy and procedures available so that all staff were aware of how the manager expected medication to be handled in a safe way. There was a protocol for using homely remedies. This should be reviewed again as we considered some medicines listed might not really be suitable because of possible interactions with other prescribed medicines or the medical condition of some of the people living here. (The pharmacist who supplies the home would be a good source of such advice.) We advise that this list should include just a few simple items and these must be fully defined by also including the formulation and strength of any medicine (for example paracetamol caplets 500mg). A call system/intercom is available throughout the home. People told us that staff would come quickly if they call them. It was noted that staff had ensured the call bell was positioned over one person’s arm chair to ensure that they had easy access to it, if needed. Care plans include clear guidelines on how to carry out an individual’s daily routines. This includes preference to bathing or showering and encourages people to maintain their independence where possible. One person told us ‘the staff are good and treat us really well, they help me with my bathing’. Other comment included: ‘I am really quite independent’ and ‘the same staff member helps me and she is lovely, she also cuts my nails and puts varnish on them for me’. We asked healthcare professionals in our survey forms; are you able to see your patients in private. All three reported ‘yes’. When asked if they are satisfied with the overall care provided to people within the home. All responded positively. Within some care plans, some people have signed as to whether they wish to receive resuscitation, if required. It is necessary for any decisions of such enormity, to only be undertaken by the GP. This information should be removed from the care plans. Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 16 Throughout the day, staff members were observed treating the people they support with respect and dignity. During lunch time staff were offering support to people and offering choices with regard to food. For example one person asked for gravy, although this was not on the menu. This was brought to them straight away. One person told us, ‘I am so happy now, I want to stay with this lady (manager).’ Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 17 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): NMS 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to offer activities to suit the needs and interests of the people they support. Links with family and friends are encouraged. People are able to exercise choices and follow their preferred routines. Meals are varied and well balanced. EVIDENCE: The activities programme for the week of our inspection included: a get together in the lounge-watching television or listening to music, wine and cheese tasting, ‘connect 4’ game and weather permitting a walk around the garden. Staff keep a record of who has participated in activities, equipment used, and the benefits of the session. There is a space on the form for evaluation, although on the records sampled, this had not been completed. It was suggested to the manager that the evaluation section be completed to enable the home to assess, which activities were successful and which were not. Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 18 Other activities that have taken place have included: listening to wartime music, table ball, coffee mornings, making cakes and trips to the shopping centre. Mrs Agolli reported that she is planning to hold a talent show or a mini Olympics for the people they support. Some people told us that they choose not to join in the activities on offer, preferring to stay in their rooms, reading or watching television. One person commented: ‘I like my own company and I have my newspaper to read and my daughter comes in to see me’. Another person added that they prefer to have their meals in their room and that this decision is respected. One person commented in the survey form ‘I can go out when I want and come back when I choose’. Within surveys; one person using the service commented: ‘I am quite happy to look out of my window, seeing visitors come’. Other comments include: ‘I don’t really like activities’, ‘we used to have arranged activities such as bingo, raffles, video nights and themed dinner sessions such as Indian, where the staff dressed up in traditional costumes. Unfortunately the staff member who arranges this has left and no such activities now exist.’ The manager told us about a new Mobility Activity Plan (Best Foot Forward), which has been devised by the home to ensure that best possible outcomes will be achieved by promoting respect, dignity, choice, safety, respect and fulfilment for the people they support. Each individual plan will be tailored to each person’s needs and realistic goals achieved, with the person’s consent. This may include increased mobility by walking along the hallway or garden to reduce stiffness and to build on a person’s confidence. During our visit to the service, we had the opportunity to talk to one visiting relative. They confirmed that they are generally happy with the service provision and that the home would tell them if there was a problem, although to date this had not been necessary. They confirmed that if they had any concerns they knew whom to approach. Records relating to health and safety checks and food were examined and all were in place. The temperatures of hot and cold food are regularly checked and recorded. The manager explained that the cook had recently left the home, and as yet they have not been replaced. She added that she is currently undertaking the preparation and cooking of meals herself with the help of a senior member of staff. At the time of our visit, it was reported that the oven was not working and they were waiting for it to be repaired. Mrs Agolli explained that they were coping, by cooking meals on the hob of the oven; therefore some changes to the agreed menu had been necessary. Lunch on the day of our visit consisted of sausages, chips and egg with bread and butter. Mrs Agolli reported that during residents’ meetings the people using the service are Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 19 asked if they have any preferences regarding foods. Minutes from the last meeting showed that rabbit had been raised as an option and people had expressed their views on how they would like it to be cooked. The AQAA states that the home is currently reviewing the menu to provide more choice. A copy of the proposed menu was shown to us. This included a vegetarian option. The manager explained that she has plans to introduce a ‘points’ scoring system, to enable the people living at the home to score meals received. Within the AQAA, it confirmed that areas where the home have improved over the last twelve months have been, that staff have received training on assisting people to eat and drink so they are aware of the importance of feeding at the pace of the people they support. They have also attended a human ageing course so staff have more knowledge of residents feelings / insecurities when entering a residential home. The factors that affect everyday living such as poor eyesight, affecting service users mobility and eating, were also covered. One person living at the home told us ‘what the boss does is nice, lovely food and you can ask for a cup of tea at anytime.’ Another person added, ‘they know what food we like’. Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 20 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): NMS 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People told us that they are able to raise concerns if they wish and feel confident that they will be listened to. Policies and Procedures are in place to safeguard people who use the service. EVIDENCE: The AQAA states ‘the home has a clear and accessible complaints procedure, which is displayed on notice board, and confirms that complaints will be dealt with promptly and effectively in 28 days. All service users have received a copy of the complaint procedure which is kept in their rooms. Some of the complaint procedures are in large print to enable the service users with poor eyesight to read and understand it better.’ The Statement of Purpose and Service User guide informs the reader on how to make a complaint or raise a concern if they wish to do so. People using the service confirmed that they knew who to speak to if they had concerns or worries. One person told us, ‘I have no worries or complaints.’ Another commented ‘I would talk to my son if I was worrried’. Within surveys 100 of people living at the home, confirmed that they know how to make a complaint. Three healthcare professionals confirmed that they had not received any complaints about the service. Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 21 The home has a complaints log and a suggestions box, which is located by the front door. The manager takes responsibility for auditing any complaints they may receive. Mrs Agolli confirmed that the home has not received any complaints in the last twelve months. The home has policies and procedures in place for staff in relation to safeguarding the people they support at the home. Staff members we met with confirmed that they had attended Protection of Vulnerable Adult (POVA) training. Abuse awareness is also included within the National Vocational Qualification in Health and Social Care. Staff members confirmed that they knew about the home’s ‘whistle blowing’ policy. The home has not referred any staff to the POVA list. All new staff are only appointed following receipt of a satisfactory check with the Criminal Records Beaurea and POVA First. This ensures their suitability to work with vulnerable people. Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 22 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): NMS19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a clean, comfortable and homely environment for the people who live there. EVIDENCE: As part of the inspection process, we toured the home. We were invited into some people’s bedrooms and had the opportunity to talk to them about the facilities they are provided with. Generally, people appeared happy with their bedrooms and they confirmed that they had everything they needed. Some people had their own small items of furniture and personal photographs, pictures and ornaments of their choosing. Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 23 One person confirmed ‘they keep it clean here’. One room was found to be odorous, however it was noted that the provider was cleaning the carpets early in the morning, which immediately removed the odour. Carpets are regularly cleaned. Another person using the service told us ‘it’s nice and clean here’. There is one shared room within the home. The manager reported that both people using the room were given the choice to share. We met with both people who confirmed that they had been consulted about sharing and both told us that they were very happy with the arrangement. One person said ‘I wouldn’t want to be alone now’. The manager explained that they recently switched locations of the dining room and lounge to provide more space. The dining room has been redecorated and a new carpet has been fitted. Three people have also had their bedroom carpet replaced. The home employs a cleaner Monday to Friday each week. One person living at the home commented in their survey, that their relative had reported to the manager that their basin and toilet were not clean. They added that since that occasion, it had improved. Six of the seven surveys returned from people living at the home reported that the home is ‘always’ clean and fresh. Air freshner self devices are situated around Avalon. The home has a waste contract in place to dispose of incontinence pads. Staff are supplied with protective equipement such as gloves and aprons. The home has an Infection control action plan in place. There is an Infection Control Policy in place. Staff report that they have attended training in Infection Control. People using the service told us that they are happy with the laundry facilities. Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 24 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): NMS 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Evidence indicates that staff members are properly recruited, inducted, trained and supervised. EVIDENCE: The manager confirmed that the home is currently fully staffed. Staff members we spoke to confirmed that there is sufficient staff on duty to meet the needs of the people living there. One staff member commented: ‘generally there is enough staff on duty.’ Other comments were ‘there is enough staff to care for everyone’, ‘there is enough staff generally unless someone is ill’ and ‘there is enough staff to attend to the call bells’. The majority of people living at the home spoke well of the staff team. Comments included ‘the staff are good and treat us really well’ and ‘the staff treat me nice’. One person living at the home reported that they did not like it when a staff was on their mobile phone all the time. Staff members report that they all get on well together and that communication between them is good. One person told us ‘we have a communication book, which we use at the handover of each shift and we discuss each person living in the home individually, to ensure information is passed over’. Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 25 As part of the inspection process, the recruitment records of four staff were examined. Records demonstrate that staff have been recruited, inducted, trained and supervised properly. Any gaps in employment history are explored and recorded. The application forms now include a section where any cautions received are recorded. New staff members receive an induction. One staff member told us that they had shadowed a more experienced member of staff during their induction, until them were deemed competent to work alone. Another staff member reported that she felt there was always someone available to ‘check things out with’ if they were unsure. Within the AQAA, it states that 75 of staff have achieved their NVQ level 2 or above in Health and Social care. One member of staff we spoke to confirmed that they have finished their NVQ level 2. Another staff member told us that she was due to start her NVQ level 3 in September 2008. Evidence shows that staff attends mandatory training such as manual handling, fire awareness, abuse awareness, first aid, basic food hygiene and health and safety. Staff confirmed that they have also attended training in Infection Control, Human Ageing and COSHH. One staff member reported that they are currently looking to access a course on dementia and diabetes. The manager confirmed that staff have been provided with information leaflets on managing diabetes. The home keeps a training log so it is easy to identify when refresher courses are needed. Manual handling refresher training takes place yearly. Staff confirmed that the refresher course had just recently taken place, along with infection control and first aid. Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 26 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): NMS 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home must submit an application to the Commission to enable the manager to become registered, as the fit person to manage the service. The home is run in the best interests of the people living there. People living at the home have their financial interests protected. Provision for health and safety is very good. Staff receive regular supervision. EVIDENCE: Mrs Agolli confirmed that she is in the process of gathering the information necessary for her to submit her application to be registered with the Commission. She confirmed that she has completed her NVQ level 4 and her Registered Managers Award (RMA). Mrs Agolli reported that she has the Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 27 opportunity to attend training such as ‘Early Signs of Illness’, which she completed with a senior member of the staff team. Staff members told us that the manager is approachable and supportive. One person using the service commented ‘we have the nicest ‘boss’ we have ever come across, they will do anything for us at anytime’. Resident’s meetings take place regularly. The last one took place at the end of June 2008. Minutes demonstrate that the views of the people living at the home are sought and listened to. The home securely holds personal money for some of the people living at the home. Cash records held for two people were sampled. Both the records of transactions and the cash held were found to be correct. Questionnaires have been sent out to the people using the service and their relatives. The returned surveys were sampled. It was noted that the surveys were not dated, which could make it difficult to ascertain, which audit they related to. The manager confirmed that she would make sure the dates were included on the surveys. Mrs Agolli confirmed that she will be collating the responses from the recent survey and would then provide feedback to the people they support and their relatives. Staff members told us that they have the opportunity to attend regular team meetings and receive regular one to one supervision with their line manager. Supervision records show that care practices, training and personal development is discussed within the meetings. Records relating to health and safety checks were examined and found to be in order. A check was completed on small portable electrical appliances on 12/3/08. The manager confirmed that the home has a contract with a Gas service company, who complete regular checks at the home. Regular audits of accidents are now taking place, the last one being on 1/4/08. The audit showed that there have been thirteen accidents, since the previous audit. Preventative measures are identified as a result of the audit. The home has a detailed fire risk assessment. Regular checks on fire fighting equipment takes place and staff regularly receive fire instruction. Window restrictors are on all upstairs rooms. We suggested that the manager contacts the local Environmental Health Officer to ensure they continue to comply with the most recent legislation. The home has a current environmental risk assessment in place dated 6/2/08. This has been signed and dated by the person who carried out the assessment. Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 28 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15 (1) Requirement Timescale for action 26/10/08 2. 3. OP7 OP9 15 (1) 13(2) 4. OP9 13(2) Care plans must include sufficient information on the management of specific conditions such as diabetes. Any statements relating to 26/09/08 resuscitation must be completed by the GP. 15/10/08 Keep clear and accurate records about medication administered to people living in the home. This will help to make sure people receive the correct levels of medication. (This particularly refers to the gaps identified and where records were signed but the person may have refused as the tablets were still in the packs). Review and update the existing 15/10/08 protocols used for medication prescribed with a ‘when required’ direction so that there is clear written direction to staff on how to make decisions about administration for each person and medicine. This will help to make sure people receive the correct levels of medication in accordance with their needs and DS0000068030.V370265.R01.S.doc Version 5.2 Avalon Residential Home Page 30 5. OP31 8 planned actions. The manager of the home must submit an application to the Commission to be considered for registration. This is to ensure the home is run in the best interests of people who use the service. 26/10/08 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. 4. 5. Refer to Standard OP9 OP9 OP9 OP12 OP38 Good Practice Recommendations Keep a record each time medicines are given to people to look after themselves when they are self-medicating. Review with the pharmacist or doctor the suitability of some medicines included in the homely remedies protocol. Securely attach the locked box for medicines in the fridge to the shelf or body of the fridge Complete an evaluation of how successful an activity has proven. Ensure that the window restrictors in use comply with the current legislation. Avalon Residential Home DS0000068030.V370265.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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