CARE HOMES FOR OLDER PEOPLE
Avarest 35 Chambres Road Southport Merseyside PR8 6JG Lead Inspector
Daniel Hamilton Unannounced 21st July 2005 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. Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Avarest Address 35 Chambres Road Southport Merseyside PR8 6JG 01704 544646 01704 530551 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) Mr Keith Wright Mrs Patricia Wright Care Home 15 Category(ies) of (OP) Old Age 15 registration, with number of places Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 15 (OP) Old Age. Date of last inspection 7th December 2004 Brief Description of the Service: Avarest is a residential care home providing accommodation for up to fifteen older people. The home is situated in a quiet residential area not too far from the centre of Southport and all its amenities and is within easy of public transport. The home is a large detached 3-storey building with 14 single bedrooms and 1 double room. There is a large, well-kept garden to the rear of the property and a small sitting area at the front. The communal areas in the home consist of a dining room and a lounge. Toileting and bathing facilities are located throughout. The home is well maintained internally and externally with good quality furniture and fittings. There is a passenger lift servicing all floors and a call bell system is fitted in the home. Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 8 hours. It was an unannounced visit and conducted as part of the regulatory requirement for care homes to be inspected at least twice a year. There had been no cause for any visits to the home since the last routine inspection in December 2004. A partial tour of the premises took place and observations were made. A selection of care, staff and service records were also viewed. The owner and manager, 2 staff members, 7 of the 13 residents and 3 relatives were spoken with during the visit and their views obtained of the home. Comments cards were also left in the home to enable residents and others to comment on the service provided. What the service does well: What has improved since the last inspection?
Information and documentation relating to the employment of a member of staff was made available during the inspection. The documents could not be located at the last inspection.
Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 Page 6 Some areas of the home had been redecorated including a corridor, en-suite and kitchen. This had enhanced the appearance of the home for the benefit of residents. 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. Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Basic assessments of need were completed prior to admission, to ensure the needs of residents were identified. EVIDENCE: Two files were viewed for residents that had moved into the home since the last inspection. Both files contained a “resident assessment prior to admission” form. This functional assessment used a score system and provided basic information on the dependency levels and needs of prospective residents. Some areas of assessment were missing from the form and both assessments viewed were not dated or signed. Personal profiles were also completed for each resident upon admission to the home. The profiles covered a range of areas including; personal needs, life history, spiritual needs, diet and food, activities and hobbies, friends and neighbours, getting on with people, outings, getting out and about, sight, hearing and teeth, personal hygiene, my bedroom, a healthy older age and medical history.
Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 Page 9 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 and 10 Care plans were in place that detailed residents’ individual needs and the support required to meet them. Medication records were not always completed. This shortfall has the potential to place residents at risk. Residents had access to health care services as required and care was provided in accordance with the expectations and needs of residents. EVIDENCE: Two care plans were viewed for residents that had moved into the home since the last inspection. Care plans were generated from an assessment of need and clearly detailed the action required by staff to ensure that all aspects of each resident’s health, personal and social care needs were met. Overall, care plans were reviewed on a monthly basis and were signed by residents and staff. Additional documentation including; risk assessments, weight records and personal care records were maintained. Medical appointments were recorded and records viewed confirmed that residents had access to general practitioners and chiropodists. Residents spoken with reported that they had access to health care practitioners as required. One resident said; “You only have to tell them and they would look after your needs.” Another reported; “they take a genuine interest in how you feel”.
Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 Page 10 The home had a medication policy in place and staff designated with responsibility for administering medication had completed external training. Some medication administration records viewed had not always been signed to record the administration of medication. Furthermore, there was no resident identification system in place or a record of sample signatures for staff designated with responsibility for administering medication. Staff spoken with demonstrated a thorough understanding of how to respect the rights of the people living in the home and residents complimented the overall care provided. Comments included: “I feel very well cared for indeed, nothing is too much trouble for the staff”; “I like living here and the care is very good. On the whole I am treated with privacy and dignity” and; “In this home you are well looked after. The staff are very attentive to your needs.” Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 Page 11 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) 13, 14, and 15 Residents were encouraged to take control of their daily lives in order to maintain their independence, relationships and preferred lifestyles. Meals were well managed and provided in comfort, to ensure residents received a nutritious and appealing diet. EVIDENCE: Residents confirmed that they were able to maintain contact with family and friends both inside and outside of the home and that there were no restrictions on visiting times. One resident spoken with said; “I can have visitors whenever I want” and another stated; “You can have visitors morning, noon or night.” A relative reported; “I am always made to feel welcome. They offer me a drink no sooner than I have entered the home.” Residents were able to determine what they wanted to do each day and could choose how to lead their lives. Comments from three residents included; “There are no routines in the home. I am not restricted in how I wish to lead my life”; “No-one tells you what to do, you can please yourself” and; “I am able to lead my life and I am not told what to do and when”. The home had a four-week menu, which showed residents received a choice of meals and a balanced and nutritious diet. Meals were served in the home’s dining room, which was pleasant and equipped with table-cloths, flowers and
Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 Page 12 condiments. Although meals were served at set times, arrangements were flexible to accommodate individual needs. All residents spoken with were satisfied with their meals. Four residents’ views included; “The cook is excellent and so is keith [owner]”; “Servings are more than sufficient”; “The food is lovely and it’s served on china” and; “You could not get better food if you went away on holiday to a five star hotel. The food is excellent. You have a choice for every meal.” Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 Page 13 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 and 18 Complaints were handled promptly and fairly and residents were confident that if they needed to make a complaint, their concerns would be listened to and acted upon. Safeguards were in place to ensure a proper response to any suspicion or evidence of abuse. EVIDENCE: The home had a complaints procedure and maintained a record of all complaints received. Records showed that two complaints had been received since the last inspection. Both complaints concerned an incident between a staff member and a resident and had been fully investigated and recorded by the manager. Residents spoken to had no complaints about the service and were confident that if they had a complaint they would be listened to and the complaint would be acted upon. Comments from two residents included; “I have never needed to make a complaint but I am sure they would listen to me” and; “I would complain to the owners if I was unhappy. Pat [owner / manager] would sort it for me.” Policies and procedures were in place, to protect the people living in the home from abuse and to provide guidance to staff on how to respond to suspicion or evidence of abuse. Staff spoken to demonstrated a basic awareness of the concept of abuse and their duty of care to protect vulnerable people. Records showed that ten staff had completed “Abuse and Restraint” training. A resident spoken to said “I feel safe here”. Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 Page 14 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 and 26 The home was suitable for the needs of residents and maintained to a good standard. Residents benefited from safe, clean and comfortable surroundings. EVIDENCE: All areas viewed during the visit appeared to be free from hazards and were well-maintained. The fabric and decoration was in good order and this provided residents with a pleasant and comfortable home. A maintenance plan was not in place as the owners lived on-site and ensured the environment received ongoing investment and maintenance as required. Since the last inspection a corridor, en-suite and the kitchen had been redecorated. Furthermore, a new fridge, cooker and water boiler had been purchased. A maintenance book was in place, to record work in need of attention. The home employed a domestic and areas viewed during the visit were clean and tidy. One resident stated; “the home is always clean.” Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 Page 15 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 and 30 Sufficient numbers of staff were deployed to meet the needs of residents. Recruitment practice was poor and did not adequately safeguard the people living in the home. Training records were not up-to-date and showed that some staff had not received all the necessary training, to ensure competency in their role. EVIDENCE: Direct observation, discussion with staff and inspection of the staffing rota confirmed that two care staff and the manager / owner were on duty during the day. During the night, the home was staffed with one waking night staff and the owner / manager provided a sleep-in service. At the time of the visit, the home had no staff vacancies. Residents spoke highly of the staff team and felt there were sufficient staff on duty to meet their needs. Comments included: “Everyone of the staff is marvellous, you can’t fault them” and; “There are enough staff around to offer help and support.” No new staff had commenced employment since the last inspection. A personnel file was viewed for a member of staff which could not be located at the last inspection. Records showed that the member of staff had commenced employment without a Protection Of Vulnerable Adult (POVA) check and two written references. Furthermore, application forms did not provide sufficient space for applicants to record their full employment history. All other documentation required under the Care Home Regulations was in place. Discussion with staff and inspection of personnel files and individual training certificates verified that staff had received induction training and had access to ongoing training. The home’s “training review” form showed that a number of
Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 Page 16 staff had not completed all safe practice training and that some staff required refresher training. Staff did not have an individual record of all training completed. The majority of the staff team had attained a National Vocational Qualification. Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 Page 17 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) 38 There was no maintenance service arrangement in place for the fire alarm system, to safeguard the health, safety and welfare of residents. EVIDENCE: Inspection of records indicated that the fire alarm system was tested on a weekly basis and that emergency lights were visually inspected every month. Fire drills were conducted every six months. The service certificate for the fire extinguishers had recently expired and the fire alarm system was not under a service / maintenance contract. Other service and insurance certificates were available within the home. A fire risk assessment was in place and monthly checklists were completed to monitor food hygiene, equipment safety and cleaning schedules. Water outlet temperatures were monitored on a monthly basis. The home had received an Environmental Health Inspection during January 2005. All areas viewed during the visit appeared to be well-maintained and free from hazards.
Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 2 Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 Page 19 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. 2. Standard 9 29 Regulation 13 19 Requirement Staff signatures must be recorded following administration of all medication. Staff must only be confirmed in post if full and satisfactory information has been obtained via a POVA check, a CRB has been applied for, two satisfactory references have been received and the new employee is supervised by an experienced staff member for who the home has received full and satisfactory information / checks. Each member of staff must have an up-to-date record of induction and training completed. Safe practice training must be completed by all staff and refresher training must be completed periodically. The fire alarm system must be periodically serviced by a suitably qualified person and a service certificate produced. Timescale for action 21/08/05 21/08/05 3. 4. 30 30 19 18 21/09/05 21/09/05 5. 38 23 C 21/09/05 Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 3 9 Good Practice Recommendations The pre-admission assessment should be updated to include all the criteria detailed in standard 3 Sample signatures of staff designated with responsibility for adminstering medication should be maintained. Furthermore, a system should be introduced to assist staff in checking the identification of residents.. Rotas should specify the capacity of staff on duty.. The application form for the home should be updated to enable applicants to record their full employment history. The training review form should detail the date that staff attended training. Night staff should receive fire instruction refresher training every three months. 3. 4. 5. 6. 27 29 30 38 Avarest 20050719 Avarest X100015 UN Stage 4 S5393 V230618 F53.doc Version 1.30 Page 21 Commission for Social Care Inspection Burlington House South Wing, 2nd Floor Crosby Road North Waterloo, Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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