Inspection on 05/03/07 for Avalon Residential Home

This inspection was carried out on 5th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Avalon Residential Home 26/08/08

Avalon Residential Home 24/08/07

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 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 11:00 5 & 27th March 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Avalon Residential Home DS0000068030.V330205.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.V330205.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 apply to the Commission to be considered for registration. Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st January 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 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 revised 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 £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.V330205.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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. This inspection took place in March 2007 and involved two visits to the home on 5th March and 27th March. A pharmacist inspector completed an inspection of the medication administration systems on 5th March. The reason for this unannounced inspection was to check on 26 requirements issued at the previous inspection in January 2007. Since the last inspection a new manager has been appointed. The manager and the previous owner who has been hired as a consultant were present during the first visit. Time was spent observing the care provided to people living at the home, chatting to them about the care they receive and to staff about the care they provide. Records were examined including care plans, personal information, staff files and health and safety systems. A walk around the environment was conducted on the visit on 5th March. The pharmacist inspector examined some stocks and storage arrangements for medicines, a sample of Medication Administration Record (MAR) charts, other medication records, the medicine policy and procedures. The pharmacist inspector saw the administration of some medicines to service users at lunchtime in various parts of the home. There were discussions with the acting manager and a member of staff who is acting in a consultancy post. Six service users were spoken to. What the service does well: What has improved since the last inspection? Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 6 The Statement of Purpose and Service User Guide have been reviewed and amended. Each person has a copy and the documents are displayed in the hallway. The complaints procedure is included in the Service User Guide. New care plans and risk assessments have been put in place, which are being regularly monitored and reviewed. The arrangements for planning and preparation of food have been reviewed which includes employing a new cook. She is putting in place safe working practices and ensuring that service users’ choices are taken into account. Staff have had training in the protection of vulnerable adults, infection control and the safe handling of medication. A new manager has been appointed to the home and she is registered to complete a NVQ Level 4 Award in Care and the Registered Managers Award. Improvements have been made to the environment to make the home a safer and pleasant place for service users to live in. Staff have attended training and been assessed about the safe handling of medicines. Medicine trolleys have been purchased to provide a safer way to administer medicines around the home. What they could do better: People living at the home need to be given a choice about whether they would like to participate in activities. Giving them samples of a range of appropriate activities to try may help. Detailed records of the food eaten by people needs to be kept so that an assessment could be made about whether their dietary and nutritional needs are being met. Recruitment and selection procedures must be changed so that only staff with a povafirst and/or Criminal Records Bureau check and two references are allowed to work in the home. This will help to safeguard people living at the home from possible harm. Some more attention to detail is needed on some medicine records and plans so that there is always quite clear information about all medicines service users receive. The report identifies a few improvements to keep medicines safely. Avalon Residential Home DS0000068030.V330205.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.V330205.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.V330205.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 & 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User Guide provide people with information about the services provided enabling them to make an informed decision about living at the home. After a comprehensive pre admission assessment of need the home will be able to consider whether it can meet the needs of the proposed service user. EVIDENCE: Since the last inspection the Statement of Purpose and Service User Guide have been reproduced and copies displayed in the communal areas of the home. These documents comply with the Care Home Regulations. The home had voluntarily stopped new admissions to the home until the issues identified at the last inspection were resolved. During this inspection a request was made by the provider to admit a person for a respite period of 8 days. Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 10 This person is self-funding and so the home had completed their own assessment identifying that they need to use a ground floor room. This assessment also indicated that the person is ‘accident-prone’. The manager was advised to investigate this further before admitting the person. She stated care plans and risk assessments would be developed as a matter of course upon admittance. Agreement was reached that this person could be admitted. Following the site visit on the 27th March 2007 the Commission is happy for the home to start re-admitting service users providing a pre admission assessment is completed to ascertain if the home is able to meet the needs of the proposed service user. A letter has been developed for the manager to use when accepting new admissions identifying that their needs can be met by the home. Intermediate care is not provided in this home. Avalon Residential Home DS0000068030.V330205.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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Quality in this outcome area regarding medication is adequate. This judgment has been made using available evidence including a visit to this service by a pharmacist inspector. Since the last inspection the systems used for care records have been reviewed and improved, however further detail is needed in places to ensure staff have all the information required about the care needs of service users. The arrangements in place for handling and managing medicines generally make sure that people who use the service receive their medicines safely. Some points are identified where more attention to detail is needed so that medicines are consistently well managed. EVIDENCE: Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 12 The care plans for six service users were examined and two in detail. Since the last inspection the home has made vast improvements to the format they use. This format has an assessment of need that had evidence of reviews. Care plans are in place, however for two service users these did not contain enough detail about their medical condition and how it affects their daily lives. One of these service users and another service users did not have a care plan specifically for wounds even though they are mentioned in the daily records. A daily routine has been devised for all service users but only six were examined. Daily records are maintained however the staff in the home need to be mindful about how they describe service users ‘moods’ in these records as they should be non-judgemental. Risk assessments were seen in place for falls and for other areas identified as being a risk. However two service users whose care was examined in detail require risk assessments for the risk of wandering especially at night for one of these service users. The home has completed records relating to whether service users wish to be resuscitated. The Commission would not expect a care home which provides personal care to undertake this as if the service user wishes to be resuscitated the staff would need to be trained and the home would need the appropriate equipment in place. Good practice that the home is following is to obtain details of next of kin and if they wish to be contacted in an emergency and details of the service users plans following their death. One-service users care records contained details of pressure relieving equipment the community nurse had obtained. In the six care plans examined all had their weight checked monthly. A record was also in place for service users that have creams prescribed by the GP. Evidence was seen of health professional visits, to include GP, Community Nurse, Chiropodist and Dentist. A GP from a local practice was visiting the home during the second site visit. Pharmacist inspection 5th March 2007; This home uses a monitored dose system (MDS) for medicines provided by a local pharmacy. Printed medicine charts are provided each month as part of this. A sample of the records showed these were all signed that medicines had been given to service users according to the prescription directions. Records are also kept for medicines received and returned to the pharmacy. Medicine trolleys have recently been brought into use so that medicines and records can be taken around the home safely when medicines are administered. At lunchtime the pharmacist inspector watched a safe method being used to give service users their medicines. Locked storage is provided for other stocks of medicines. Staff who handle medicines have now received training and passed an assessment. There is a medicine policy and procedures in place so staff have the information as to how the home expects them to handle medicines. When speaking to two service users, one lady had no complaints about the staff and said they are very good and always give her medication. One gentleman knew all about the painkillers he takes; staff checked with him what Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 13 he needed at lunchtime. A few service users self-administer some of their medicines following completion of a risk assessment to confirm this is safe. A regular weekly audit check of medication systems would help highlight and deal with some of the following issues which were identified as needing attention: • The strengths of two tablets were not included on one medicine chart where staff had written in the medicines. • The dose given is not always noted where a variable dose of one or two tablets, for example, is prescribed. • When medicines are prescribed ‘as required’ a plan or protocol is needed for each person to explain to all staff how the medicine is used for the benefit of that particular person. • The Becodisk strength was wrongly described as 200mg instead of 200 micrograms in one care plan. It was not clear if the service user was using this medicine, which was marked as self-medicating but no supply had been given to her. • A new section of the medicine chart must be used for any changes rather than altering an existing entry otherwise it can be difficult to tell exactly what doses have been given. • Staff need to write the date of opening on all medicine containers (except the MDS packs) in order to be able to rotate stock according to the manufacturer or pharmacy directions as well as provide a system to carry out audit checks on remaining stock. There was a pot of Asasantin capsules on the trolley with no label or opening date. There was also a pack of Persantin Retard capsules with no opening date. The manufacturers state that both these medicines must be used within six weeks of first opening the container. • The record for one person taking Didronel PMO must note what component is being taken as the treatment pack contains two different tablets. • Two doses of Movicol were noted as given to a service user but this was not printed on the medicine chart and there was no stock labelled for this person. This was not included in the care plan. • The special dietary needs for one person were noted as dairy and wheat intolerance. As some medicines may contain gluten this needs checking with the pharmacy. The manager said there were no other diversity needs for people in the home. • A skincare plan for a service user lists three creams but no directions as to when and where to use. Another skincare plan lists medicines used that are not included on the medicine chart. • There were no risk assessments for self-medicating creams or an inhaler. Suitable locked storage must be provided. A record must be made on the medicine chart when a supply is given to the service user to look after. This is helpful as part of the checks to show that the person is using the medicines correctly. • A dispenser of cream was left on the side table in one bedroom. When medicines like creams are kept in bedrooms there must be an arrangement that is safe for all people in the home. Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 14 • • • • • • • • • • The controlled medicine cupboard in the office needs fixing tightly to the wall (perhaps with larger bolts) as this was loose and could be moved. There were some discrepancies in the controlled medicine record book. Some pages showed that items were still in stock but this could not be found although some records were found in the separate returns book. On page 97 the stock was shown as 14 patches (not found). There were records in the returns book for 34 patches. On page 38 the stock was shown as 5 patches (not found). There was a record for 3 in the returns book so 2 are not accounted for. There was stock showing on pages 40 and 41 but this was not in the cupboard. The returns book indicated all these were returned to pharmacy. It is important that the remaining stock is accurately shown in the record book so this means also recording returns in here as well. The upstairs medicine trolley is waiting to be fixed to the wall before being brought into use and the manager confirmed this would be done in the next week. A locked fixed container is needed to keep medicines safely in the domestic fridge. The locks need replacing on the medicine cupboards under the bench in the office, as the locks fitted are not working very well. Medicines that are swallowed need storing separately from those applied externally to avoid cross contamination. In the medicine policy section about requests for medication it states ‘request label for medicine chart’. This is not acceptable. Any changes to medication can be handwritten on the medicine chart with two staff checking and signing as correct (as they had been doing). The homely medicine policy needs to list exact medicines to use, as terms such as ‘throat sweets’ are not sufficient. A protocol listing the medicines and dose is needed. Some staff need to sign the signature list dated February 2007 so that if needed, the person who has signed a medicine record can more easily be identified. The medicine reference book needs updating and the manager said she would order the March 2007 edition. No concerns were expressed by service users in relation to privacy and dignity. Staff were seen knocking on service users doors prior to entering their room. Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 15 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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is working towards meeting the recreational interests of the service users. Following the appointment of an experienced person to provide meals for service users, this will help to ensure service users receive a wholesome and nutritious diet based on their needs and choices. EVIDENCE: Two house meetings were scheduled in January and February discussing with people what activities they would like to be provided. Staff said that people did not wish to have any activities arranged for them during the day. One person continues to take daily walks. There was no evidence that activities have been offered to people living at the home so that they can make an informed decision about whether they wish to have activities or not. On the second visit to home another service users meeting was planned for the afternoon and the activities person said she plans to discuss outings with them. She said she has taken service users out on walks and this Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 16 was documented in service users daily records, however she feels at the moment service users are reluctant to take part in activities as they have not had a designated person before. The home is working towards addressing the requirement issued at the last inspection to provide activities for service users based on their choices and needs. Visiting to the home remains unrestricted and two visitors were seen speaking with a service user during the second visit to the home. Service users confirmed they can make choices about their daily lives and this includes choosing where they eat their meals. Two service users said they prefer to stay in their rooms and not join in with other service users. A new cook has been employed to prepare the main meal of the day. She has prepared a menu which she is amending as she gets to know service users living at the home. One service user chooses to have a gluten free diet and the cook ensures that wheat free bread, cakes and biscuits are provided. She said she discusses alternatives to the main meal should they be necessary. Occasionally a separate record is being kept of any alternative meals provided. Dietary records for people should provide sufficient detail so that it can be determined whether the diet is satisfactory or not. Some entries indicate roast or the main meal and provide no evidence of the vegetables provided. Records appear to have improved for the latter half of February. This must be sustained. On the whole service users spoken with were happy with the meals provided, however one service user said they only had a small portion of potatoes at one meal and this was not enough. Another service user said she does not eat the same meals as the other service users due to their own choice but is happy with what the home provides for them. Two service users said the food is ‘marvellous’. Avalon Residential Home DS0000068030.V330205.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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improved access to the complaints procedure will give people involved with the home confidence that there are systems in place to resolve any concerns they may have. Staff are having access to training which will increase their awareness of issues surrounding the safeguarding of vulnerable adults. Recruitment and selection procedures need to be significantly improved to ensure that people living at the home are safeguarded from possible abuse. EVIDENCE: Since the last inspection the complaints policy and procedure has been amended. The procedure is also displayed in the communal areas of the home. All policies and procedures have been reviewed and each member of staff has been given personal copies, which include this procedure. Concerns identified prior to the last inspection were upheld and as a result of that inspection a number of breaches of the regulations were identified. As a result of that inspection an urgent action letter was sent to the provider outlining issues that needed to be dealt with. The provider maintained close contact with the Commission for Social Care Inspection giving regular updates of when requirements had been actioned. Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 18 The manager said that some staff have completed training in the protection of vulnerable adults and that this training has been scheduled for the remainder of the team. Discussions with staff indicated that they have a satisfactory understanding of how to recognise and report suspected abuse. Recruitment and selection procedures are not protecting people living at the home from possible abuse. People are working in the home without a povafirst check or Criminal Records Bureau check and without two references. See Standard 29. The manager said that if staff work without these documents in place she will make sure she is in the home supervising them. Staff confirmed this. However the manager started work in the home on 22nd January 2007 without a povafirst check. The CRB check arrived a month later. She also has only one reference on file. This practice is potentially putting people living at the home at risk of possible harm. Avalon Residential Home DS0000068030.V330205.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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Significant improvements to the environment are ensuring that the home provides a safe and clean place to live. EVIDENCE: A walk around the building was completed on the first visit to the home. The home was clean and tidy. A cleaner is being employed and was observed cleaning communal areas and bathrooms. Since the last inspection, an Environmental Health Officer, a Fire Service Officer and Health and Safety Executive Officer have visited to inspect the home. Their recommendations have been forwarded to the home for implementation. Follow up visits may be carried out. Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 20 The cook and manager confirmed that they are complying with requirements from the Environmental Health inspection. A zapper has been installed in the kitchen and fly screens were due to be fitted to the window. A new freezer has been provided. Fridge and freezer temperatures and cooked food temperatures are being recorded on a daily basis. The cook was appropriately dressed apart from a hat. She commented that hats had been ordered. Staff were observed wearing tabards whilst preparing the evening meal. The cook said she is putting in place a new cleaning schedule. A hazard analysis had been completed and amended by the cook. The cook has attended a ‘safe and better business’ course. The manager said that she prepares the main meal on a Saturday. She has not completed Basic Food Hygiene Training and until she has completed this she must not prepare meals in the home. Staff confirmed that they are completing an Infection Control course. Recommendations from the Fire Officer included ensuring fire doors close properly, fire signs are displayed around the home and self-closing devices are put on bedroom doors. Signs were evident around the home, the doors in the dining room and lounge now close securely and self-closing devices are going to be fixed to the appropriate rooms. In addition all bedroom doors are being fitted with new fireproof strips. The manager confirmed that the windows with condensation in the lounge are being looked at with a view to replacement. Carpets in communal areas are also due to be replaced. The manager confirmed that radiator guards are being put onto all radiators that require them. Radiators in some bedrooms were observed to have covers. Window restrictors have been fitted to all first floor windows. Staff have also been provided with a lockable cabinet in which to store their personal belongings. Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 21 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Changes have been made to the staff team to meet the needs of people living at the home. The home must ensure that all the appropriate checks for a safe recruitment procedure are being carried out to reduce any risks to service users at risk. Staff are accessing training which will provide them with the knowledge and skills to fulfil their job roles. EVIDENCE: There have been significant changes to the staff team since the last inspection. Waking night staff are now employed and a number of new staff have been appointed to ensure that the day shift has a full complement of staff. The team consists of some staff experienced in care and others new to the profession. A new induction programme is being introduced which complies with the Skills for Care Induction standards. Copies of this programme were available for inspection. Domestic staff and a cook have been employed since the last inspection significantly reducing the pressures on care staff. Two members of care staff cover each shift. Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 22 Two members of the care staff have a NVQ Level 2 Award in Care. Records for seven new members of staff appointed since the last inspection were examined and two files for existing staff. There are serious concerns about the recruitment and selection of staff. An urgent action letter was sent to the provider after the first visit to the home giving them two weeks to rectify matters. At the time of the first visit, records indicated that: • • • • • • • • A full employment history is not being obtained – any gaps in employment history need to be questioned people are being appointed without two written references in place verbal references are being obtained but there was no evidence of the content of these references. These references were not always being backed up with written references the reference request form does not request the reason why people left their former employment people are being appointed without a povafirst check people are working in the home without a Criminal Records Bureau check in place where people had worked previously in care checks were not being made about their reason for leaving that employment there was no evidence that proof of identity had been obtained for new staff. In response to the urgent action letter the provider changed the umbrella body that was processing their Criminal Records Bureau checks to ensure that a povafirst check could be obtained if they need to start a member of staff urgently. They confirmed that two members of staff were not allowed into the home until these checks had been completed and that Criminal Records Bureau checks had been obtained for all other people for whom they were outstanding. Following the urgent action letter the registered provider and manager have wrote to the Commission to detailing the changes they have made to their recruitment procedure and how they have address the issues listed above. If under exceptional circumstances the manager wishes to employ a person without a Criminal Records Bureau check they must first consult with the Commission. They must make sure all other checks have been completed and a Povafirst check done. They should put a risk assessment in place that indicates what duties the person can do and who is mentoring them whilst on shift. Staff have received training identified at the last inspection as a serious shortfall. This has included infection control, safe handling of medication and the protection of vulnerable adults. Staff also confirmed that they would be attending training in Basic Food Hygiene. Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 23 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): 31,33,35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A new manager has been appointed to home to provide leadership to staff and improve the service offered to service users. A revised quality assurance system is being put into place to ensure the views of service users are listened to and acted upon. Systems are now in place to ensure staff are appropriately supervised. Improvements have been made to ensure the health, safety and welfare of service users and staff is promoted and protected. EVIDENCE: Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 24 A new manager has been appointed to the home. She has experience of working with older people. She has registered to complete a NVQ Level 4 Award in Care and the Registered Managers Award. She is also attending a first line management course. She will be applying to the Commission to be considered to become the registered manager of the home. The manager has been working closely with a consultant to ensure the records within the home are relevant and up to date. This has included developing new care plans and risk assessments. There continue to be serious concerns about the way in which records and information for new staff is processed and collated. Unannounced visits by the responsible individual have now been put in place and a copy of the recent visit was supplied to the Commission. People living at the home take part in six monthly surveys. The last audit was completed in February and was based on the menus for the home. People were asked to give suggestions and indicate what their likes and dislikes are for a range of main meals. The manager said that a new menu was then being developed from this survey. The manager said that health and safety and medication audits are in place. The revised quality assurance statement indicates, “Service users and relatives views will be used to improve the service to residents”. Two service users said they were given questionnaires about the home the week of the second visit to complete. One service user said they did not want to change anything. The home stores monies and for a number of service users in a secure facility. Records were seen of the monies stored and signed by staff. The manager has devised a plan to ensure all staff receives supervision. Records were seen of sessions undertaken so far. Health and safety systems have been reviewed. Systems within the kitchen have significantly improved. The fire logbook confirmed that weekly tests are taking place for fire alarms but that emergency lighting and fire extinguishers are being checked on a six monthly basis. The fire risk assessment was being reviewed at the time of the first visit and it was suggested that the frequency of tests should be included in this document. Fire training is provided by the home. The manager confirmed that she is arranging for fire training with an external provider. The Portable appliance tests were completed in December 2006. The provider and manager confirmed that the home has been tested for Legionella but are waiting for the results. The provider said they are planning to have temperature controlled values to fitted to hot water taps to reduce risks to service users. Consideration should be given to the home checking hot Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 25 water temperatures of taps service users have access too on a monthly basis and maintaining records of these. The manager said temperatures of service users baths are checked but not recorded. Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 26 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 3 X 2 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 2 Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement 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. This requirement has been repeated from the last inspection. 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. This requirement has been repeated from the last inspection. 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. Original timescale 15/02/07 partially met. Timescale extended. Keep clear and complete records of any medicines administered, DS0000068030.V330205.R01.S.doc Timescale for action 30/04/07 2. OP7 13(4b) 30/04/07 3. OP9 13(2) 30/04/07 4. OP9 13(2) 30/04/07 Avalon Residential Home Version 5.2 Page 28 5. OP9 13(2) 6. OP9 13(2) 7. OP9 13(2) 8. OP9 13(2) 9. OP15 17(2) Sch.3 (17) to always include the strength of each medicine, the actual dose administered, full directions of how to use, and details of any medicines that are given to service users to self-administer so that clear information is available about how service users receive their medication. Keep written protocols or plans for any medicine prescribed ‘as required’ so that clear information is readily available to staff about how service users are to receive their medication correctly. Improve the medicine storage arrangements by bolting the controlled medicine cupboard tightly flush to the wall, fitting better locks on the medicine cupboards under the bench and providing a fixed locked container for medicines in the domestic fridge. Following a risk assessment provide lockable storage for any service user who looks after any of their own medicines in their room. Keep accurate records in the controlled drug record book and make regular checks of the records. Investigate and resolve the discrepancies in the stock balances identified on pages 38, 40, 41 and 97. Review the homely medicines protocol so that the medicines used are fully described including the full name, dose form, strength and dose to use in order to make it clear what medicines can be given to service users. The registered person must ensure that records are kept of meals eaten by service users with enough detail to be able to DS0000068030.V330205.R01.S.doc 30/04/07 30/04/07 30/04/07 30/04/07 27/04/07 Avalon Residential Home Version 5.2 Page 29 10. OP15 18(1)(c) (i) 19 11. OP29 12. OP37 17 assess that their diet is satisfactory. The registered person must make sure that staff preparing meals for people have completed the necessary training. The registered person must ensure that all employment checks as required in this Regulation are undertaken to reduce the risk to service users. This requirement has been repeated from the last inspection. The registered person must ensure that all records used in the home are kept up to date. This requirement has been repeated from the last inspection. 27/04/07 19/03/07 30/04/07 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 OP3 Good Practice Recommendations The home should ensure that any areas identified on pre admission assessments for proposed service users are thoroughly investigated to ensure the home can meet the needs of proposed service user. Write the date of opening on all medicine containers (other than monitored dose system packs) so that stock can be used within the recommended shelf life and audit checks are possible. Keep medicines that are swallowed stored segregated from those applied externally to prevent cross contamination. Provide a March 2007 edition of the British National Formulary so that staff have up to date information about medicines they use. People should be offered a variety of activities to try out so that they can make an informed choice about whether DS0000068030.V330205.R01.S.doc Version 5.2 Page 30 2. OP9 3. 4. 5. OP9 OP9 OP12 Avalon Residential Home 6. 7. 8. OP29 OP38 OP38 they wish to participate or not. The reference request form should ask for the reason why people left their former employment. The home should check hot water taps service users have access to at least monthly and maintain records to ensure service users are not put at unnecessary risks. The fire risk assessment should indicate the frequency of testing for emergency lighting and visual checks for fire extinguishers. Avalon Residential Home DS0000068030.V330205.R01.S.doc Version 5.2 Page 31 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. 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