CARE HOMES FOR OLDER PEOPLE
Avarest 35 Chambres Road Southport Merseyside PR8 6JG Lead Inspector
Daniel Hamilton Unannounced Inspection 5th January 2006 09:30 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 Avarest DS0000005393.V276675.R01.S.doc Version 5.1 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. Avarest DS0000005393.V276675.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Avarest Address 35 Chambres Road Southport Merseyside PR8 6JG 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) 01704 544646 01704 530551 Mr Keith Wright Mrs Patricia Wright Mrs Patricia Wright Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Avarest DS0000005393.V276675.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 15 OP Date of last inspection 21/07/05 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 reach 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 DS0000005393.V276675.R01.S.doc Version 5.1 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 July 2005. 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, manager, two staff members, 8 of the 12 residents and two relatives were spoken with during the visit and their views obtained of the home. Comment 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?
Avarest DS0000005393.V276675.R01.S.doc Version 5.1 Page 6 A new pre-admission assessment form had been introduced by the manager, which enabled the home to undertake a comprehensive assessment of prospective residents’ needs. Staff had signed medication administration records, to confirm the administration of all medication. Furthermore, a list of staff designated with responsibility for the administration of medication had been established, together with sample signatures. Protection of Vulnerable Adult checks and two satisfactory references had been obtained for new staff, prior to staff starting work in the home. Likewise, a new application form had been introduced, to enable applicants to record their full employment history. Records of induction and training completed by staff had been introduced and systems had been established to ensure staff received safe working practice and refresher training. The home’s training matrix had also been updated, to detail the date that staff had completed training. A qualified person had serviced the fire alarm system and emergency lighting and rotas had been updated to detail the capacity of staff. What they could do better:
The administration of controlled drugs and medication entering the home had not been correctly recorded and some medication was being secondary dispensed. These practices are not safe and must stop. Furthermore, some medication records did not provide a complete audit trail and there was no system in place to verify the identity of residents prior to administering medication. These issues should be addressed and a copy of guidance issued by the Royal Pharmaceutical of Great Britain should be obtained to ensure best practice. The home provided activities for residents, however a few residents had requested additional activities via the home’s quality assurance process. In order to satisfy the recreational needs and interests of all the people living in the home, the range and frequency of activities should be reviewed in consultation with residents. Likewise, a record of activities provided should be maintained. Recruitment practice had significantly improved since the last visit however health information required under the Care Home Regulations was missing from staff files. This matter must be addressed. The home circulated quality assurance questionnaires to residents and their representatives each year, however the results had not been summarised for interested parties to view. This issue should be addressed to improve the quality assurance process.
Avarest DS0000005393.V276675.R01.S.doc Version 5.1 Page 7 Written records were available for money handled on behalf of a resident however receipts had not been obtained for all expenditure. Receipts must be obtained for all money handled, to protect the interests of the residents and the registered provider. A service record could not be located for hoisting equipment used in the home. This must be obtained and the fire alarm system should be tested on a weekly basis, to ensure the health and safety of residents and staff. 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 DS0000005393.V276675.R01.S.doc Version 5.1 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 Avarest DS0000005393.V276675.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home had established an assessment system, to ensure the needs of prospective residents were identified, prior to moving in to the home. EVIDENCE: Assessment documentation was viewed for two residents who had recently moved into the home. Each file contained a “Resident Assessment Prior to Admission” form, which had been developed by the manager since the last inspection. The assessment form contained the necessary assessment criteria to enable the home to undertake a full assessment of a prospective resident’s needs, however there was limited space to record information. Functional assessments had also been completed. An assessment completed by a Social Service’s Care Manager was also available for one of the residents. Information gained from the assessment process had been used by the home to devise a plan of care for each resident. Avarest DS0000005393.V276675.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9 A care plan system had been established, to provide staff with key information on the support requirements of residents. Some medication practice was poor, which has the potential to place residents at risk. EVIDENCE: Two files were viewed for residents that had moved into the home since the last visit. Each file contained a care plan that detailed the support required by staff to ensure that the needs of residents were met. Care plans had been kept under monthly review and supporting documentation including risk assessments, medical records, daily report sheets and weight and personal care records were in place. Personal profiles were also in the process of being completed for each resident, to ensure the home had key information on 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. Staff spoken to during the visit confirmed that they referred to the home’s care plans on a regular basis, to ensure they were aware of the needs and support requirements of residents.
Avarest DS0000005393.V276675.R01.S.doc Version 5.1 Page 11 Residents complimented the standard of care. One resident said; “The staff are marvellous and really care about each and everyone of us”. Likewise, a relative complimented the care provided in the home and said; “The owners and staff are very caring people. They go out of their way to keep us updated on care issues”. A medication policy was in place. Staff responsible for administering medication had completed external training. Since the last visit, the home had developed a checklist to identify the staff responsible for administering medication, together with sample signatures. A resident identification system had not yet been established. Medication records viewed had been completed to record the administration of medication, however the date that medication had been received into the home had not been recorded and some medication balances could not be checked, as there was no audit trail. Furthermore, the seals had been broken on a Nomad cassette in order to add medication that was not originally dispensed into the cassette. This practice is not safe and is known as secondary dispensing. A controlled drug was being administered to a resident and the details were not being recorded in a controlled drugs register. Avarest DS0000005393.V276675.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Daily life within the home was flexible, however the range and frequency of activities provided was in need of review, in order to satisfy the recreational interests and expectations of some residents. EVIDENCE: Residents were satisfied with the lifestyle experienced in the home. Comments from five residents included: “The home is a warm and relaxed place to live”; “The food is excellent and we get a choice”; “The owners and staff always welcome visitors. They are very approachable”; “I like everything about this home” and “I’m really happy living here”. The home was able to support residents to access local churches / representatives, subject to their individual religious beliefs. The home did not have a set activities programme or a record of activities completed. The manager reported that a range of activities was facilitated for the residents by the activities coordinator, who worked on a Thursday morning from 9.00 am to 12.00 pm and on a Friday afternoon, from 2.00 pm to 4.00 pm. Some of the residents interviewed were able to confirm that the home provided activities. For example, feedback from two residents included: “Someone comes and does exercises on a Friday” and “We have arm chair exercises, sing-a-longs, games and reminiscence activities.”
Avarest DS0000005393.V276675.R01.S.doc Version 5.1 Page 13 Residents spoken to were generally satisfied with the range and frequency of activities provided in the home. However, one resident and a relative requested more activities. Furthermore, the results of a quality assurance questionnaire indicated that four residents had requested additional activities. Some residents reported that they preferred not to participate in any. For example one resident said; “I am quite content with my own company. I choose not to participate in activities”. Avarest DS0000005393.V276675.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 A complaints system had been established and residents were confident that their views would be listened to and acted upon. EVIDENCE: A complaints procedure was in place and a record of all complaints was maintained. No complaints had been received by the home or the Commission for Social Care Inspection since the last visit. None of the residents or relatives spoken to had any complaints about the service and residents were confident that the home would address any issues of concern. Comments from three of the people living in the home included: “I can’t think of any complaints. I would be happy to speak to Keith [Owner] or Pat [Manager]. They would listen to me”; “I have no complaints. I am very happy” and “I should think they would listen to me if I had a problem. I would speak to Keith” [Owner]. A relative said; “I would not complain. It’s a wonderful home.” Avarest DS0000005393.V276675.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The standard of the environment within this home is good, providing residents with an attractive, clean and homely place to live. EVIDENCE: Overall, areas viewed during the inspection appeared to be free from hazards and were well maintained. Some carpet seems on the upper floor landing were in need of attention, as they were starting to show signs of wear. The home had established a maintenance / health and safety book to record work in need of attention. A maintenance plan was not in place, as the owner / manager lived on the premises and ensured the home received ongoing investment and maintenance as required. The owners reported that no additional work had been completed since the last visit. The home had developed infection control procedures and cleaning schedules for the home and kitchen. A domestic was employed and areas viewed were clean. Residents considered the home to be clean and well maintained. The views of three residents included: “My room is cleaned every day”; “I think the home is clean and well-maintained” and “The home is spotless”.
Avarest DS0000005393.V276675.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Sufficient numbers of trained staff were deployed to meet the needs of residents. Recruitment practice had improved, but further information is still required, to ensure the welfare of residents is fully safeguarded. EVIDENCE: Examination of the staffing rota and discussion with staff, residents and relatives confirmed that staffing levels were sufficient to meet the needs of residents. Staffing levels remained the same as at the last inspection. Two care staff and the manager / owner were on duty through the day. At night, the home was staffed with one waking night staff and the owner / manager provided a sleepin service. Since the last visit, the rotas had been updated, to identify the staff roles. The manager reported that there were no staff vacancies. All residents spoken with complimented the staff team. Comments included: “The care provided is brilliant”; “The staff are very helpful and try to please you in any way”; “The staff are wonderful. They are reliable and always there for you” and “You only have to press your buzzer and they are there.” Two staff had commenced employment at the home since the last visit. The recruitment files were viewed. Since the last inspection the manager had introduced a new application form, to enable applicants to record their full employment history. Avarest DS0000005393.V276675.R01.S.doc Version 5.1 Page 17 All records required under the Care Home Regulations had been obtained, with the exception of evidence that the individual staff were physically and mentally fit to undertake their roles. The manager reported that the home employed 12 care staff. Records showed that eight staff (75 ) had completed a National vocational Qualification at level 2 or above. All senior staff had also completed the D32/D33 NVQ assessor’s award. Staff interviewed confirmed they had received inductions and records viewed confirmed that the new employees had completed a ‘Staff induction to Work and Workplace’ prior to starting work. Likewise, the new staff had attended the ‘Working in Care Induction Standards’ course. Since the last visit, the manager had updated the home’s ‘Training Review Form’ to include the dates of training. Likewise, a record of induction and training completed had been established. Good progress had been made with staff training and a number of staff had completed; Moving and Handling, First Aid, Food Hygiene and Health and Safety Training during 2005. The manager had systems in place to monitor the outstanding learning needs of staff and confirmed that Infection Control training was due to be coordinated for staff during 2006. Avarest DS0000005393.V276675.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Some administration / records within the home need further attention, to ensure the welfare of residents is safeguarded. EVIDENCE: The Registered Manager (Pat Wright) was registered with the Commission and had managed the home since approximately 1989. The manager had attained the Registered Managers Award and was an accredited assessor and internal and external verifier for National Vocational Qualifications. During her career, the manager had completed a range of additional training that was relevant to the management of a residential care home for older people. Staff and residents interviewed spoke highly of the manager / owner. A staff member said; “Pat is an approachable and supportive manager who is there to help staff”. Likewise, a resident reported; “The people who own and run this place are lovely”. The home commissioned an external quality assurance system each year and had developed quality assurance questionnaires, to forward to residents and
Avarest DS0000005393.V276675.R01.S.doc Version 5.1 Page 19 relatives every year. The results (summary of scores) was viewed for May 2005, which showed that generally service users and relatives were satisfied with the service provided, however four residents had requested more activities. At the time of the visit, the results of the surveys were not published. The manager reported that residents meetings were not coordinated due to the wishes of residents. This was documented on a quality control / assurance audit record. Discussion with residents confirmed that many of the people living in the home did not wish to participate in meetings and were happy to have individual discussions with the manager, owner and staff. The home had developed a procedure for the management of residents’ personal monies. The owner and manager did not act as an appointee for any of the people living in the home. Residents looked after their financial affairs independently or with support from family members / solicitors. Systems had been established to collect fees. The owner supported four residents to manage their social security benefits and maintained a record of personal allowances paid to each of the residents. Likewise, the owner was responsible for the distribution of personal money to one resident. The financial record was up-to-date and the balance correct however receipts for expenditure had not been maintained. Since the last visit, the home had arranged to have the fire alarm system and emergency lighting serviced and the owner had established a system to ensure staff received fire refresher training at the recommended intervals. At the time of the visit, the fire records showed that the fire alarm system had not always been tested on a weekly basis. Furthermore, an up-to-date service record for the hoisting equipment was not in place. All other service certificates and records were checked at the last inspection. A number of staff had completed Safe Working Practice Training as identified in Standard 30. Avarest DS0000005393.V276675.R01.S.doc Version 5.1 Page 20 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 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Avarest DS0000005393.V276675.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2 3 4 Standard OP9 OP9 OP9 OP29 Regulation 13 13 13 19 (4) Schedule 2 17 (2) Schedule 4 23 (2) Requirement The receipt, administration and disposal of controlled drugs must be recorded in a register. All medication entering the home must be dated on the Medication Administration Record. Medication must not be secondary dispensed. Evidence must be obtained, to confirm that staff are physically and mentally fit for the purposes of the work they perform at the home. Receipts must be obtained for all money handled on behalf of residents. A service record / certificate must be obtained for all hoisting equipment. Timescale for action 05/02/06 05/02/06 05/01/06 05/02/06 5 6 OP35 OP38 05/02/06 05/02/06 Avarest DS0000005393.V276675.R01.S.doc Version 5.1 Page 22 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 OP9 OP9 Good Practice Recommendations Medication records should provide a complete audit trail for all medication. A copy of ‘The Administration and Control of Medicines in Care Homes and Children Services’ (issued by the Royal Pharmaceutical Society of Great Britain) should be obtained for reference. A system should be introduced to assist staff in checking the identification of residents. A record of all activities provided for residents should be maintained at the home. The range and frequency of activities provided should be reviewed in consultation with residents and their representatives. A summary of the results of quality assurance questionnaires should be produced and made available to current and prospective users, their representatives and other interested parties. The fire alarm system should be tested on a weekly basis. 3 4 5 6 OP9 OP12 OP12 OP33 7 OP38 Avarest DS0000005393.V276675.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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