Inspection on 14/04/05 for Avandale Lodge Nursing Home

This inspection was carried out on 14th April 2005.

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 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

Avandale Lodge Nursing Home 01/03/07

Avandale Lodge Nursing Home 16/09/05

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 CW9 7QA Lead Inspector Denis Coffey Unannounced 14 April 2005 09:00 th 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 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 F51 F01 S18754 Avandale Lodge V220373 140405 Stage 4.doc Version 1.20 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 Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Healthcare Services Limited Care Home 48 Category(ies) of Dementia - over 65 years of age (48), registration, with number of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (13) Avandale Lodge Nursing Home F51 F01 S18754 Avandale Lodge V220373 140405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1 Within maximum of 48, 13 MD(E) beds for personal care only 2 Maximum of 48 persons accomodated aged 65 years and above Date of last inspection 07/12/04 Brief Description of the Service: Avandale Lodge is a two-storey, detatched purpose built nursing home. It is 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. Avandale Lodge Nursing Home F51 F01 S18754 Avandale Lodge V220373 140405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 7.5 hours. A tour of the home took place and the care and staff records were inspected. Six of the nine staff on duty, nine of the forty-eight service users, and three visitors were spoken with during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Avandale Lodge Nursing Home F51 F01 S18754 Avandale Lodge V220373 140405 Stage 4.doc Version 1.20 Page 6 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 Standards Statutory Requirements Identified During the Inspection Avandale Lodge Nursing Home F51 F01 S18754 Avandale Lodge V220373 140405 Stage 4.doc Version 1.20 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 &3 Residents are assessed and given information to make sure that they know their needs can be met at the home and what their rights and responsibilities are whilst living there. EVIDENCE: The written statement and terms and conditions of residency identifies the weekly fee payable, what this covers and what additional services are charged for. It also shows the insurance arrangements and the periods of notice required by both parties to end the agreement. The residents’ care records showed that an assessment to find out their care needs had been done before they moved into the home so that they, their relatives and staff knew their needs could be met at the home. Care plans had been drawn up to show how each resident’s needs would be met. Avandale Lodge does not provide intermediate care so standard 6 is not applicable. Avandale Lodge Nursing Home F51 F01 S18754 Avandale Lodge V220373 140405 Stage 4.doc Version 1.20 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,& 10 Effective care planning and monitoring means that residents’ social and healthcare needs are met prompty by the staff at the home. Staff ensure that residents’ dignity and privacy is respected and the medicines are well managed so that residents receive their correct medication. EVIDENCE: Each resident has an individual plan of care that shows how their needs will be met. These are reviewed each month and amended to show any changes to their health. Assessments on continence, nutritional needs and the risk of the resident developing pressure sores are made and kept up to date. This information provides staff with guidance on what care they need to give each resident. Records are kept of when residents are visited by their doctors and any other health care practitioners. Medicine records had been correctly completed and the balances of the medicines that were checked randomly were also correct showing that residents were receiving their correct medicines as prescribed. The medicines were stored securely in the home to keep them safe. Avandale Lodge Nursing Home F51 F01 S18754 Avandale Lodge V220373 140405 Stage 4.doc Version 1.20 Page 9 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 Although social activities are provided, these are limited and could be improved to ensure that all the residents can take part. Residents said the standard of the food available at the home is good. EVIDENCE: The activities co-ordinator employed at the home has been on long-term leave and one of the care assistants has been given responsibility for organising activities for service users. There were no records of activities undertaken from August 2004 to April 2005. The records for April showed that only a small number of service users had taken part in leisure and social activities. Relatives visiting the home at the time of this inspection said that they could visit whenever they wished and they were always made to feel welcome by the staff. The menus in use at the home show alternatives are available for the main courses at all meals. The menus were balanced and varied. Service users spoken with commented positively on the standard of food provided. Avandale Lodge Nursing Home F51 F01 S18754 Avandale Lodge V220373 140405 Stage 4.doc Version 1.20 Page 10 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Complaints are managed well and anyone making a complaint is assured that their concerns are taken seriously and acted upon. Improvements need to be made to the procedures for protecting residents from abuse to ensure that they are protected at all times. EVIDENCE: The home has received two complaints since the last inspection, and records were maintained of the actions and responses made to these. Investigations into one complaint showed that was partly upheld. The second complaint is currently being investigated. Three members of staff said that they had received training on the protection of vulnerable adults. However, two of them said that they did not know about the home’s whistle blowing policy and one said that they were unaware of the Department of Health’s document No Secrets, that identifies the different forms abuse can take and how to report this. Two of the staff spoken with said that they were aware of the ‘No Secrets’ document but could not recall its contents. All three of the staff said that they would report any alleged or observed abuse to the manager, but were not sure what they would do if this was not acted upon. Avandale Lodge Nursing Home F51 F01 S18754 Avandale Lodge V220373 140405 Stage 4.doc Version 1.20 Page 11 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 24 & 26 The good standards of décor, furnishings and cleanliness in the home provide people living at the home with safe and comfortable surroundings. EVIDENCE: A maintenance person is employed to do routine maintenance of the home and was redecorating one of the bedrooms at the time of the inspection. Bedrooms were seen to be carpeted and comfortably furnished. Many of them had been personalised by the service users and their families with possessions brought in from home. A total of 82 hours per week is allocated for domestic staff so that they are on duty seven days a week. At the start of the inspection, two carpets were seen to be stained, awaiting cleaning. The carpet shampoo machine was repaired during the course of the inspection and both carpets were then cleaned. Avandale Lodge Nursing Home F51 F01 S18754 Avandale Lodge V220373 140405 Stage 4.doc Version 1.20 Page 12 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Appropriate numbers of staff were on duty to meet the needs of the service users, and the homes procedures for the recruitment of staff were thorough to ensure that residents were protected at all times. Although staff training is provided, steps need to be taken to increase the number of staff with qualifications which would provide a more skilled workforce in the delivery of care to the service users. EVIDENCE: The staff rotas showed the following staffing levels were being provided: two trained nurses and seven care assistants during the morning; two nurses and six care assistants in the afternoon; one nurse and four care assistants at night. The personnel files seen of new staff employed at the home contained completed application forms, two satisfactory written references, job descriptions, statements of terms and conditions of employment, health declarations, and satisfactory enhanced Criminal Records Bureau disclosures. Staff have received training in safe moving and handling practices and food hygiene, and training in incontinence has been identified to take place at the end of April. Ten members of the care staff have attained an NVQ level 2 in care award, and two other care staff are currently undertaking this training. One of the care staff employed with an NVQ level 2 is also undertaking training leading to an NVQ level 3. At least 50 of the care staff should hold an NVQ Level 2 in care. Avandale Lodge Nursing Home F51 F01 S18754 Avandale Lodge V220373 140405 Stage 4.doc Version 1.20 Page 13 A training session was held for the domestic, maintenance and catering staff on the day of inspection in relation to the Control of Substances Hazardous to Health legislation. Avandale Lodge Nursing Home F51 F01 S18754 Avandale Lodge V220373 140405 Stage 4.doc Version 1.20 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 36 & 38 Residents’ views are taken into account in the way the home is run and care is provided, and there are systems in place to protect and safeguard the residents’ interests. In general the health, safety and welfare of service users and staff are promoted and protected,but there were some minor improvements needed to make sure that residents’ health is protected at all times. EVIDENCE: Service users said that their opinions were sought and taken into account by the staff. Relatives present at the time of inspection said that the standard of care was good, and that they were kept informed about the health and welfare of their family member. One visitor went on to say that his wife’s condition had so improved that he was contemplating taking her home. Avandale Lodge Nursing Home F51 F01 S18754 Avandale Lodge V220373 140405 Stage 4.doc Version 1.20 Page 15 As part of the home’s quality assurance, a survey is sent to the families of service users, and to various care professionals such as nurses and doctors who visit the home, to find out their views. Money held on behalf of the service users is well managed and safely stored. In some instances small amounts of money were held for residents to pay for personal items. Receipts are kept for all purchases and the balances were found to be correct. The fire alarm and emergency lighting systems are tested weekly, and records were seen of all the staff having received fire safety awareness training within the past six months. The fire officer from the local brigade visited the home in December 2004 and identified work needing to be carried out. Records showed that this work had been done. The home manager carries out a monthly check of all accidents sustained by service users. The majority of the accidents over the past three months were attributed to falls or of service users being found on the floor. Falls risk assessments had been undertaken for all the residents. Where bed rails were fitted to a service user’s bed, an appropriate risk assessment regarding their use was contained in their care records. Formal staff supervision is not carried out on a regular basis, and thus deprives staff of the opportunity to meet with their manager/senior to discuss and develop their career development needs. Two machines intended for use by service users with specific breathing problems were found to be in need of a thorough cleaning, as was a suction machine. There were no records available to verify that the suction machine had been tested with regards to its electrical safety since 2002. Avandale Lodge Nursing Home F51 F01 S18754 Avandale Lodge V220373 140405 Stage 4.doc Version 1.20 Page 16 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 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 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 3 x 3 2 x 2 Avandale Lodge Nursing Home F51 F01 S18754 Avandale Lodge V220373 140405 Stage 4.doc Version 1.20 Page 17 no 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 12 Regulation 16 Requirement Timescale for action 08/05/05 2. 18 13 3. 38 23 Arrangements must be made to enable all of the service users to engage in social and community activities. All staff employed at the home 30/05/05 must receive training with regard to the prevention of abuse. This requirement was made at the previous inspection, and requires further action to ensure that staff have fully understood the training and that they are aware of the procedures to follow. All equipment used by service 08/05/05 users must be maintained in a clean and safe condition. 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 28 Good Practice Recommendations Action should be taken so that least 50 of the care staff employed at the home have an NVQ Level 2 in care. Avandale Lodge Nursing Home F51 F01 S18754 Avandale Lodge V220373 140405 Stage 4.doc Version 1.20 Page 18 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich Cheshire CW9 7LT National Enquiry Line: 0845 015 0120 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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