Inspection on 01/03/07 for Avandale Lodge Nursing Home

This inspection was carried out on 1st 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

Avandale Lodge Nursing Home 16/09/05

Avandale Lodge Nursing Home 14/04/05

Avandale Lodge Nursing Home 07/12/04

Avandale Lodge Nursing Home 15/04/04

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

CARE HOMES FOR OLDER PEOPLE Avandale Lodge Nursing Home Manchester Road Lostock Gralam Northwich Cheshire CW9 7QA Lead Inspector Anthony Cliffe Unannounced Inspection 09:00 1 and 2 March 2007 st nd 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 Avandale Lodge Nursing Home DS0000018754.V326254.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. Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avandale Lodge Nursing Home Address Manchester Road Lostock Gralam Northwich Cheshire CW9 7QA 01606 48978 01606 48997 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) www.schealthcare.co.uk Southern Cross Healthcare Services Limited Care Home 48 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (48), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (13) Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 48 service users to include: * Up to 48 service users in the category of DE(E) over the age of 65) * Up to 13 service users in the category of MD(E) (Mental disorder excluding learning disability or dementia, over the age of 65) * 2 named service users in the category of DE(Dementia) 16th September 2005 Date of last inspection Brief Description of the Service: Avandale Lodge is a two-storey, detached purpose built nursing home in its own grounds. Bedroom accommodation is all single with en-suite facilities. There are lounge and dining facilities on both floors, with access to both floors via the staircase or passenger lift. The home is in a residential area close to Northwich and is on a local bus route. Fees range from £417 to £609 per week. These do not include hairdressing or chiropody. Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on the 1st and 2nd March 2007 and lasted 16 hours. A Regulatory Inspector carried out the visit. This visit was just one part of the inspection. Other information received was also looked at. Before the visit the home manager was also asked to complete a questionnaire to provide up to date information about services provided. Questionnaires were provided for residents, families, and health and social care professionals to find out their views. During the visit various records and the premises were looked at. A number of residents and staff were also spoken with and they gave their views about the service. One requirement remains outstanding from the previous site visit. What the service does well: What has improved since the last inspection? Staff records and the staff rota recorded the number of hours each member of staff is employed for each week. Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 7 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 Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 8 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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available for residents and their representatives so they can make a choice about where they live. Residents’ needs are assessed prior to moving in so appropriate care can be provided to them. EVIDENCE: Avandale Lodge accommodates mainly people from the Northwich area and is welcoming to anyone from outside the area or with a disability, different ethnic or cultural needs or sexual orientation. Residents or their relatives were provided with a copy of the service users’ guide and statement of purpose on request and copies of this and the most recent inspection report were available in Avandale Lodge. This contained a copy of the contract for the facilities and services provided to residents. The information was provided in an information pack containing information about Southern Cross Healthcare and the facilities available at Avandale Lodge. Information could be provided in different formats on request to head office. Survey’s returned from residents prior to the site visit confirmed that they had Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 9 received information on Avandale Lodge that helped them or their relative to choose to live there. Three files were examined of residents who recently moved into Avandale Lodge. The residents had met with the manager or registered nurse to discuss their care prior to moving in. Southern Cross healthcare uses a very detailed information gathering documents to record the information gathered on residents. This included information on their physical and mental health. Copies of these documents were on residents’ files. Copies of social workers assessments and care plans were on file with information from the NHS hospital the residents were staying at. Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 10 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 good. This judgement has been made using available evidence including a visit to this service. Detailed records of care, liaison with health and social care professionals and good medicine management ensures residents’ health and welfare needs are met. EVIDENCE: The care files of three residents were examined. Each care plan had a pre admission assessment of physical and mental health and an assessment by the social worker or nurse assessor. From looking at care plans, observing staff working practices and talking with residents, staff and the health needs of residents were met. There were good examples of care plans in place that monitored residents’ health. Care plans were in place to monitor eating and drinking, risk of developing pressure ulcers and assistance with personal care. Good practice in routinely monitoring residents physical health were in place and residents’ blood pressure and weight were being introduced and the manager provided a draft care plan to be used to monitor these. There was a general risk assessment in place for most residents that they were at risk of choking themselves on the lead to the nurse call system. Most bedrooms did not have a Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 11 lead plugged into the nurse call system. The acting manager said that there were residents who could use the system independently and agreed to revise the practice of having a general risk assessment in place and look at other methods of residents seeking help from staff. Medicines management and administration was examined. No errors were noted on medicine administration records. A monitored dosage system was used throughout the care home. The manager and operations manager audited medicines as part of the quality assurance system. Information was available for registered nurses on the side effects of medicines used. Registered nurses discussed how they could make medicine administration more individualised and not have a large task orientated medicine round. The manager clarified this was to be discussed amongst the staff team. Staff said that medicine administration had improved by the use of a red apron that warned staff not to disturb registered nurses when giving out medicines unless there was an emergency. Registered nurses said they were not routinely disturbed to take telephone calls that could be answered later. During the site visit a new method on gathering the experiences of residents was used. A small group of residents who could no longer used words or communicate their needs were watched for a period of two hours. Information on how they related to one another, staff, pets and their environment were recorded. This included staff interaction and practice. The findings of the observation were that there were positive interactions between residents, residents and staff and social interactions. Two residents were sleeping for the majority of the two hours but examination of their care records recorded underlying physical health problems as the reason for this. Staff practice was generally positive but there were two occasions were two staff members did not uphold the dignity of residents. As the staff members identified had demonstrated positive care practice to residents the incidents were discussed with the acting manager who agreed to speak with the staff concerned and provide further training if necessary. Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 12 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. Residents are supported in making choices about their lifestyle and they have control over their lives but the provision, coordination and recording of activities could improve so residents have regular activities based on their choice and preferences. EVIDENCE: Avandale Lodge employed an activities organiser for thirty hours each week She was not working at the time of the site visit. A weekly programme of activities was in place and the current weeks planned activities were on display on a notice board that included activities such as; darts, dominoes, nail care and knitting. Staff were involved in activities with residents. A resident said that staff would put on karaoke for them but activities could improve. The resident said, “ I really miss the activities and get bored as it can be a long day. We have to make our own entertainment. We can chat, watch TV or have a sing along. The thing I miss the most is going out into Northwich. We don’t get that regularly enough. It’s either not enough staff or bad weather. That could be improved upon. I have enough money to spend and could go out and buy things for myself. We aren’t asked what we like to do. The activities organiser is great and arranges things but we should be asked more what we want”. Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 13 Another resident said, “I miss the activities, there’s not as much going on as there used to. I get bored when the activities organiser is not here. She’s on her days off. Staff do other things like we had a karaoke before, but it’s down to the staff that’s around. We don’t go out as regularly as we used to. Everything else is fine, the care is good and staff lovely and we get on well. The meals are lovely and there is plenty to eat.” Nine surveys were returned prior to the site visit and said that activities were sometimes or never provided and the level of activities could improve. Two visitors spoke of the care of their relatives. One said, “I’m glad she’s back here and no longer in hospital. She gets the right care and attention from staff. In hospital staff didn’t talk to her because she’s mentally infirm. I’m happy she’s back here as staff who know her will properly care for her. This place is very good at the moment the acting manager and staff are great”. Another visitor said, “ Mum’s really improved since she came here. She is putting on weight and walking better. She smiles at you now when you talk to her. The acting manager was a big plus in us choosing here. We have been asked to do a biography, a detailed family history so staff know about her. The meals seem nice and mum never complains”. Residents’ surveys recorded that residents usually or always enjoyed their meals. Meals were seen being served and residents were generally asked what they would like for their meal. A staff member was seen serving residents their meals without asking them what they wanted. This was discussed with the acting manager who said it would be discussed with the staff member in question. Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. Information was available to guide residents and relatives on how to make a complaint and who to make it to. There were procedures and guidance available for staff to ensure that residents are protected from abuse, harm and poor practice. EVIDENCE: There was one recorded complaint received since the last site visit. A detailed response to the complainant was seen outlining the actions to be taken in response to the issues they raised. Information given by the manager identified that staff have received abuse awareness training and that further training in this was to be provided for staff that had not received it. The manager demonstrated how concerns about a resident were raised with the local council and residents’ family. Reviews were held at which agreements about the future care of the resident was decided and Avandale Lodge identified as the place the resident should live. Surveys returned by residents said they knew who to make a complaint to or knew about the complaints procedure. Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 15 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, 21 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standards of décor, furnishings and hygiene are good, providing residents with safe, comfortable and homely surroundings, but the repair and maintenance of aids in bathrooms needs to improve so adequate bathing facilities are available. EVIDENCE: There were separate lounge and dining rooms on each floor of the home. One of the lounges has been designated as a smoking area for residents. There were two enclosed garden areas at the home for use by the residents. One of these was equipped with garden tables and chairs, whilst the other garden had raised flowerbeds installed to enable residents to participate in gardening. This garden has also had a garden well and water feature supplied. Internally corridor areas had been decorated in different colour schemes. Bathrooms and toilet doors were painted yellow to help residents distinguish them from bedroom doors. The corridors had been given a theme by the use of Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 16 pictures. Examples of this were the life of Elizabeth Windsor and local pictures of Northwich. Residents’ bedroom doors had been personalised either with their photograph or picture they had chosen. All bedrooms had en-suite contained a toilet and hand washbasin. A bathroom on each floor fitted with a rise and fall chair was out of use due to them being broken. These were mainly used for residents who couldn’t get into and out of a bath unaided because of their mobility problems. The majority of the residents at the home required such assistance. The provision of suitably adapted bathing facilities was identified at the last site visit. No assisted shower facilities were provided. The operations manager was contacted regarding the repair of the bathroom equipment and agreed they would be repaired within one month. Due to the requirement not being met an improvement plan will be requested. All parts of the home were visited at this inspection and found to be clean, tidy and free from unpleasant smells. Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. A competent workforce is provided in sufficient numbers to meet residents’ needs. Recruitment and training of staff is robust so residents are protected and their health and welfare promoted. EVIDENCE: The staff rota confirmed sufficient registered nurses and care assistants were employed to meet residents` needs. There was a balance of registered mental and general nurses employed. The acting manager has supernumerary days on the staff rota. Twenty-eight care staff was employed. Of these fifteen had an NVQ level 2 qualification. Four staff had commenced employment and had been supervised through an induction programme, which included training on the protection of vulnerable adults. The records of these staff were examined. All contained appropriate identification documentation and completed POVA First and Criminal Record Bureau disclosures. All files had two written references. Files contained copies of the induction programme. Staff rotas contained details on the contracted hours staff was working. Staff files contained details of contracts of the hours they were employed for and training they had completed. A variety of training had been undertaken by staff Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 18 including, health and safety, infection control, fire safety, promotion of continence, managing challenging behaviour, adult abuse, moving and handling, dementia care, wound management, pressure ulcer care, nutritional care and drug administration. A staff member said of the training and supervision provided “I’ve had the ‘yesterday, today, tomorrow’ training. It’s really opened my eyes about the way I provide care. I no longer see residents as just a set of tasks but as individuals who have their own abilities. I now help them to be independent and don’t rush them. If something took times for them to do I would not rush them. I feel confident challenging staff on their practice and have asked the kitchen to provide more porridge when there’s not enough. I should discuss things like that with the manager. He listens to you”. Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. The home is well managed and residents views are taken into account so they have an influence in how the home is run. The practices in the home ensure that residents are safe and their welfare is promoted. EVIDENCE: Since the last site visit the registered manger had resigned and the deputy manager promoted to the acting manager. The acting manager is a registered nurse in mental health and had been employed as the deputy manager for a number of years. Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 20 There is a quality assurance system in place, which comprised of the manager completing monthly audits. He completed monthly audits on accidents, pressure ulcers, safety equipment, medicines, health and safety checks on the building, housekeeping and care planning as some examples. The operations manager then completed an audit every two months using the information provided by the manager to identify and or remedy issues identified by the manager. Quality assurance included residents meetings to gain their views on how Avandale Lodge is managed. Monies held on behalf of residents were managed safely and securely. Information provided by the provider in a pre inspection questionnaire and records held on site were examined. All the required maintenance and health and safety checks of the building and equipment had been completed other than the repair of bathroom equipment. Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 21 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 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 3 X 3 X 3 X X 2 Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP23 Regulation Requirement Timescale for action 01/04/07 OP23OP23 Sufficient numbers of baths or showers to meet the needs of residents who are old and infirm or physically disabled must be provided. (Timescale 05/12/05 not met) 8(1) The registered person must ensure that an application for a suitably qualified and experienced manager is submitted to the Commission for Social Care Inspection. 2. OP31 01/03/08 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. Refer to Standard OP12 Good Practice Recommendations The activities programme should be based more on residents’ social preferences, what they enjoyed doing and DS0000018754.V326254.R01.S.doc Version 5.2 Page 23 Avandale Lodge Nursing Home the social interactions that took place. This information should be used to further develop the range of activities offered to residents. Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Avandale Lodge Nursing Home DS0000018754.V326254.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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