Inspection on 22/01/08 for Avens Court Nursing Home

This inspection was carried out on 22nd January 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Avens Court Nursing Home 23/04/07

Avens Court Nursing Home 25/05/06

Avens Court Nursing Home 03/05/06

Avens Court Nursing Home 06/02/06

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

CARE HOMES FOR OLDER PEOPLE Avens Court Nursing Home Broomcroft Drive Pyrford Woking Surrey GU22 8NS Lead Inspector Mavis Clahar and Kate Harrison. Unannounced Inspection 22nd January 2008 09:00 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 Avens Court Nursing Home DS0000066356.V358862.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. Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avens Court Nursing Home Address Broomcroft Drive Pyrford Woking Surrey GU22 8NS 01932 346237 01932 336686 sjv_ross@yahoo.co.uk 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) Surrey Rest Homes Ltd To Be Confirmed Care Home 60 Category(ies) of Dementia - over 65 years of age (60), Physical registration, with number disability over 65 years of age (10), Sensory of places Impairment over 65 years of age (5) Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. All service users required to have a dementia disorder as their primary condition. Service users who have a sensory impairment must have these needs fully assessed and provision of specialist aids and equipment provided to ensure needs are met. The minimum number of care staff on duty excluding the manager must be: 3RN and 12HCA in the morning 07.45-13.45 3RN and 10HCA in the afternoon 13.45-19.45 1RN and 6HCA at night 19.45-07.45 RN: Registered Nurse HCA: Healthcare Assistant 23rd April 2007 Date of last inspection Brief Description of the Service: Avens Court is a privately operated care home with nursing providing dementia care for older people. The home is situated in a quite residential area within a short distance of the shops and community amenities. The premises comprise of a large detached house, which has recently been extended. Car parking facilities are available at the front of the building and an enclosed, secure garden is provided at the rear. Single and shared bedroom accommodation, some with en-suite toilet facilities is arranged on three floors accessible by two lifts for service users. Communal lounges and a combined dining area are situated on the ground floor. Fees for this home are in the range of £550 to £571 per week. Additional charges apply for hairdressing, chiropody services, dental and ophthalmic services and all personal newspapers and magazines. Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. This unannounced site visit, which forms part of the key inspection to be undertaken by the Commission for Social Care Inspection, (CSCI) was undertaken by Mrs Mavis Clahar and Ms Kate Harrison on the 22nd January 2008 in the presence of the home manager and lasted for six hours and thirty minutes; commencing at 09:00 hours and concluding at 15:30 hours. The CSCI Inspecting for Better Lives (IBL) involves an Annual Quality Assurance Assessment (AQAA) to be completed by the service, which includes information from a variety of sources. This document initially helps to prioritise the order of the inspection and identify areas that require more attention during the inspection process. This document was received in good time by CSCI. The information contained in this report is gathered from residents’ notes and records kept by the home, from information contained in the AQAA, from relatives and service users’ feedback by way of personal interview and telephone and from discussions with nursing staff and visiting professionals. Information was also gathered from direct observation by the inspectors, along with discussions with care workers A tour of the home was undertaken and it was observed that residents’ bedrooms were kept in good condition, both decorative and clean and tidy. Most of the bedrooms are attractively presented. Generally, the home presents as clean and tidy. However the back gardens need tidying up and the old furniture and washing machine taken away. A number of requirements were made and these can be found at the end of the report in the requirements section with fuller discussions in the text of the report under standards 3; 10; 12; 30 and 33. We (the commission) would like to thank all the service users, visitors and care staff who made the visit so productive and pleasant on the day. The final part of the visit was spent giving feedback to the manager about the findings of the visit. Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The missing persons’ form contained within the assessment folder of the service users must be completed with suitable information about the service user which would aid the Police should the need arise to find a missing person. Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 7 Staff should wear name badges to enable and encourage service users with memory impairment to recognise the member of staff. This would also help relatives and visitors to the home, to know whom they are speaking with. The home must seek out and implement best practice in all aspects of care of people living at the home with dementia, so that their daily lives at the home can be improved. The back garden must be kept clear of unwanted furniture to prevent service users using the garden to have accidents and falls. Care staff must have up-to-date and regular training in dementia care to enable them to give the most up-to-date care to service users living in the home. The Registered Provider must ensure that monthly quality assurance checks are carried out at the home and provide the manager with a copy of the findings, which must be kept at the home available for CSCI inspection. In addition to the above requirements, eight recommendations of good practice were made and these are listed at the end of the report under Recommendation of Good practice. 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. Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users and their relatives have the information needed to choose a home, which will meet their needs and service users are being assessed to ensure the home is capable to meet the needs of the service users prior to being admitted into the home. EVIDENCE: Review of service users documents and identified policies demonstrated the home has a policy and procedure on admission and discharge of service users. Within the admission policy all service users must have an assessment prior to being admitted into the home. Two Registered Nurses who are both trained in the principles of assessment of service users’ needs based on what the care the home says it will provide carries out all pre admission assessments of service users prior to them being admitted into the home. Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 10 Review of a random sample of service user’s files including one recently admitted service user, demonstrated that pre admission assessments are being carried out and relatives were being involved in the assessment process. However, it was noted that people were not adequately identified on paper to aid Police should some one go missing. A requirement was made on this standard. Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good and clear care plan in place for service users and this includes appropriate risks assessments. Which forms the basis for care based on the agreed care needs of the service users and demonstrated that trained staff met service users’ health and personal care needs. The home’s medication policy on receiving, storing and administering of medication was in place and being adhered to thereby ensuring the safety and protection of the service users. Care workers treated service users with respect and maintain their dignity and privacy when delivering personal care. EVIDENCE: The randomly selected care plans were clear and easy to read, identifying potential and actual risks to service users and detailing how these risks would be managed. The daily work sheet along with discussion with service user’s relatives and care workers demonstrated that service users care needs are Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 12 fully met. The service user or relative had not signed the care plans to indicate their involvement in deciding what care they received. However, the member of care staff undertaking the development and monthly review of the care plans had signed and dated them. Information contained in the home’s Annual Quality Assurance Assessment (AQAA) states “ Care plans are developed with the information provided by the Social Care team and/or the service user’s representative and the information obtained at the preadmission assessment which involve the service users”. Telephone surveys to randomly selected relatives of current service users revealed that they were involved in the assessment of their relatives. A requirement was made on this standard to ensure service users/relatives sign the care plans to demonstrate their involvement in the development of the plan of care being delivered. All service users are registered with a local General Practitioner (GP) of their choice and visits are recorded, with access to specialist healthcare professionals through their GP practice as required and these visits are also recorded in the service user’s folder. Service users are offered a three monthly access to chiropody service and weekly access to hairdressing facilities are available at a cost to the service users. In discussion with the registered nurse and care worker they were extremely proud of the high standard of care they provided to all service users in the home. Care staff identified as capable to administer medication (Registered Nurses only) are requested to leave a sample of their signature, which is dated in the medication trolley. All service users have a recent photograph included in their personal folder and medication record to reduce the risk of mistakes happening during medication administration. We were told by care workers no service user on the day of the site visit was assessed as capable to self medicate. This aspect of medication management was supported in discussion with the Senior Nurse. Medication records were checked and found to be correct as documented on the Medication Administration Record (MAR) sheet. Four relatives contacted and two responded to the CSCI telephone survey and all stated they were happy with the care given to the relatives, and that the staff are always polite to them and they were free to visit any part of the home their relative was using. We observed that care workers did not wear name badges to enable visitors and service users with memory impairment to be sure of whom they are speaking with. A recommendation was made on this standard. We observed Service users being treated in a friendly but respectful manner by care workers. It was noted that care workers communicated amongst themselves and with the manager and with the service users in English. In discussion with a number of service users it was evident they were not fully able to answer questions asked and would reply yes to every question asked. In discussion with service users who were able to understand the questions, Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 13 they told us that they are treated with respect and dignity, and that they are able to make their own choice. One service user told us “I am very happy here. Everything is so nice. I have my own room; I can have as much privacy as I want”. Another service user said “We have good staff here; they do not ill treat me. I have help to choose my own clothing every day. Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 14 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 poor. This judgement has been made using available evidence including a visit to this service. The home does not have a clear understanding of what constitutes best dementia care practice, and as a consequence people living in the home are not supported to live their lives in the best way. EVIDENCE: From observations we made during the morning we saw that people spent most of the time sitting in the day rooms. Several had breakfast sitting in armchairs, with individual tables positioned in front, and again took lunch in the same way. At breakfast time one woman tasted the bread and marmite she was given, and said that it was stale and too salty. She shouted out that she hated it, did not want it. She continued to say that the bread was too salty, (‘like a bowl of salt’) and that she had asked for toast and marmalade. Some other people were also eating bread and marmite, and it was not clear that this was through choice or misunderstanding. One individual had dressings on her ankles, but no stockings or tights. She was sitting in an armchair behind a little table and was wearing a dress that was too short to cover her knees. She repeatedly Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 15 tried to cover her knees with the dress while eating breakfast from the little table, but the dress was too short. During breakfast one member of staff came and cleaned surfaces with a cloth and cleaning spray, so that there was a strong smell of cleaning fluid in the air as people had breakfast. These instances of poor practice were discussed with the manager, as they do not show respect for people. It was not clear that people understood that they could walk around the home and use the garden if they choose to, and the arrangements in the communal areas did not encourage them to feel independent, as some were not able to move the small tables away from their chairs independently. New small dining room tables have recently been purchased, though they are not yet generally used, and at lunchtime only four people used the tables. We understood that some individuals prefer to eat sitting in armchairs, but the dining room arrangements at present do not encourage mealtimes to be seen as an enjoyable social event. A recommendation was made on this standard. The hobbies and interests of people living in the home are recorded in the ‘Getting to know you’ document completed by relatives. Some progress is being made to improve the quality of life in the home. One member of staff is spending time at a local day centre for people with dementia, with the expectation that an understanding of what activities will be best suited to people living at the home will be gained. There is a programme of activities provided weekday afternoons, including group activities such as ball games and watching films, and some individual activities like aromatherapy. The manager explained that the activities available at the home were being reviewed, so that new areas would be developed with an emphasis on reminiscence. A recommendation was made on this standard. There is a menu available showing the choices available, and people can request different food if they do not like the food presented. The lunchtime food was wholesome and drinks are provided at different times of the day. Some of the people living in the home preferred to eat the food with their fingers, and it was not clear from the menu that enough finger foods are provided. It is not clear that people have access to drinks as they wish, or that attention is paid to the particular nutritional needs of people with dementia, such as the provision of finger foods and the availability of more frequent smaller meals. Most of the people living at the home wear white plastic aprons at mealtimes to protect clothing, as carers do when they are attending to the personal care needs of individuals. To show respect for people as individuals, other protection, such as individual tabards, should be considered at mealtimes as protection for clothing. As the home is registered with us to provide care for people with dementia, it is expected that there will be expertise within the home about best practice in the dementia area. Currently there is no identified senior staff member with the necessary knowledge and experience to lead and monitor the dementia care improvements, or for staff members to refer to for advice and Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 16 information, and this needs to be addressed. A recommendation was made on this standard. Visitors are welcome to the home, and several people were visiting on the day of the inspection visit. A Relatives Forum is held regularly, so that relatives can meet and discuss issues with the manager. Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made at the home so that people are better protected from harm and complaints will be listened to and responded to. EVIDENCE: The home has a complaints procedure that is displayed in the hallway, and includes all the necessary details. As it is unlikely that individuals living in the home would be able to make a formal complaint the home has information available for relatives about using an advocacy service. Efforts are also made to keep contact with relatives through the Relatives Forum, so that they are aware of the complaints procedure. Visitors said that they could discuss issues easily with the manager, and have confidence that their concerns will be addressed. Staff training includes ‘Effective Communication’ and ‘Needs of the Service User’, so that staff members are becoming aware of their role in responding to the needs of people at the home to have their wishes known. A record of complaints is kept, and relatives of two people living at the home made complaints since the last inspection visit. Both have been managed according to the home’s procedures and within the timescales of the procedure. Relatives spoken to over the telephone said they usually discuss issues with the staff as they arose, so that they had no reason to complain. One relative Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 18 visiting the home told us she had cause to raise a complaint about the care of her relative and this was dealt with immediately. The home’s safeguarding vulnerable adults policy is available at the home, and there is a leaflet for staff members entitled ‘How to contact Safeguarding Adults’ displayed in the hallway. The home also has a copy of the county council’s Safeguarding Adults codes of practice with information about how to manage safeguarding incidents. Since the last inspection visit we received information about three unexplained injuries, and the home has cooperated in the investigations to understand what happened. New procedures have been implemented to improve practice, such as staff members always working in pairs, improved training for staff members on how to move individuals who need help, and the development of a flow chart to improve the management of any incidents of new bruising. Most of the staff members have now received training on safeguarding vulnerable people, and the two remaining staff members are due to attend training. Although there is information available for staff if they need to respond to an allegation, the home needs to develop an easy procedure for staff members to follow in the event of an allegation being made. A recommendation was made on this standard. Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that meets the general needs of the people who live there. The home is becoming more comfortable and has a programme to improve the decoration, fixtures and fittings. Occasionally there is slippage of timescales and maintenance tends to be reactive rather than proactive. EVIDENCE: The manager told us that staff encourages the service users to view the home as their own home. We observed that the home presents as comfortable with some aids to meet the service users’ needs. The AQAA stated that there is an on-going programme to improve the decoration, fixtures and fittings in the home. The requirement issued on this standard at the last key inspection has been met, and gates are fitted to the stairs and ramps. Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 20 The AQAA states that there is a full time maintenance man employed to carry out regular checks and maintain the home in good repair. In discussion with the maintenance man he was able to verify his employment and was also able to show us areas of improvement in the appearance of the home and discuss his programme of work. There is still a lot of work to be done to the home to make it comfortable for service users. We observed that new plain carpets have been laid in the entrance hall, the library has been repainted and new circular dining tables and new chairs have been provided as stated in the AQAA. We observed that service users were reluctant to move from their armchairs in the lounge to the dining room for lunch, when asked by staff even although the tables were laid very nicely. In discussion with the manager she said the tables are relatively new and maybe the staff need to re-consider the placements of the tables in the dining room. She told us this would be discussed at their staff / relatives meeting to be held tomorrow. We observed free standing electric radiators were in some bedrooms even though the radiator from the central heating was on and hot. In discussion with the manager we were told that they have been experiencing problems with the old boiler and they are waiting for delivery and installation of a new boiler. In the mean time freestanding radiators are supplied to any bedroom, which does not meet the required temperature for the safety and comfort of the service users. We noted that each bedroom we visited had a record of room temperature on the back of the door, which was completed twice daily. A tour of the grounds revealed items of old furniture and a washing machine littering the back garden preventing service users safe use of the garden. A requirement was made on this standard. Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some improvements have been made in the training of staff, but better dementia care training is needed, so that the staff team gain a better understanding of how to care for people with dementia. EVIDENCE: The home has a staff rota showing that at least one nurse is available over the twenty-four hours, and that enough carers and domestic staff are available, to care for the 44 people living in the home. There has been a dedicated effort to provide training and supervision for staff on care issues, but the effort has not resulted in effectively trained staff in dementia care. Training about caring for people with dementia was arranged but was cancelled for some of the staff by the contractor, and this training has been rearranged to take place soon. There are some staff members who have never received training on dementia, and the manager has confirmed that the dates for the introductory training have been organised. Other important training has been arranged, such as person centred care and information about the Mental Capacity Act. All staff members attend the necessary training such as moving and handling and fire training, but one individual working in the kitchen has not attended food hygiene training and the manager is arranging for the training to take place soon. Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 22 No training is available to help staff members meet the needs of the individuals who have sight impairment, and this needs to be provided. All care staff members have started supervision sessions and these are expected to take place every two months. Two requirements and one recommendation were made on this standard. The home’s induction programme is to the expected standard, and arrangements are in hand to support more staff members to gain the National Vocational Qualification Level 2 in Care. We looked at the home’s recruitment process, and saw that one staff reference was of a ‘To Whom it May Concern’ type, and the references for another staff member were not available. Although there was some evidence that clearance from the Criminal Record Bureau (CRB) was applied for, there was no evidence to show that enhanced clearance had been obtained. Proof of clearance was forwarded to CSCI within twenty-four hours of the site visit as this key information was held at another premises. Following the inspection visit, the manager confirmed that the references and CRB had been obtained and were appropriate and satisfactory. A recommendation was made on this standard. Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager trains and develops staff who are generally competent and knowledgeable to care for the service users. The service focus on the individual, takes account of equality and diversity issues, and generally works in partnership with relatives or close friends, and professionals as appropriate. The home has a statement of purpose that sets out the aims and objectives of the service. The manager is improving and developing systems that monitor practice and compliance with the care plans and the policies and procedures of the home. More work is needed in this area. EVIDENCE: Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 24 The manager has demonstrated that she has kept herself updated on issues relating to care of the service users and staff in her charge. She is a Registered Mental Health Nurse with many years experience of caring for older people with mental health needs. She is also in possession of the Registered Managers Award, and will be submitting her application for registration as manager of the home next month. In discussion with the manager, it was evident she was knowledgeable about the training needs of the care workers to meet the identified needs of the service users in the home. There are clear lines of accountability within the home, each member of staff spoken to on the day of inspection aware of their role and responsibilities. We were told regular residents meetings are arranged and minutes of the meetings are passed to the owners who will action requests as soon as possible. A copy of minutes of the first meeting was available for review. We were told that regular Regulation 26 monitoring visits were carried out on a monthly basis, but on review of the records no records were available since October 2007. A requirement was issued on this standard The home does not become involved in service users finance. The manager ensures that risk assessments are carried out for all safe working practice topics and that significant findings of risk assessment are recorded. The maintenance man works diligently alongside the manager to rectify risks as soon as they are identified. Review of documented records demonstrated that health and safety checks are routinely carried out at the home. All equipment examined on the day was properly maintained. Records indicated that fire drills, fire alarm, bedroom and water temperature were regularly checked. Random sample of care workers’ training files demonstrated that up to date and relevant training were carried out by care workers to protect service users’ health, welfare and safety. However, it was also evident that more training is needed for care workers in the area of Dementia care. A requirement was made on this standard. In discussion with care workers they were able to discuss their understanding and implementation of appropriate procedures to safeguard service users. Furthermore they spoke about their understanding of promoting safe working practices based on their health and safety training. In discussion with various staff members it was apparent that there is a good understanding of the equality and diversity needs of the individual service users. Care workers are confident in delivering high quality outcomes for service users in the areas of age, sexuality, gender, disability and belief. Although the care workers are knowledgeable about issues relating to race and equality and diversity, they are not able at the moment to put this knowledge into practice with the service users, as the current service users are all Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 25 Caucasians. However, they have a rich and diverse knowledge in dealing with Caucasian people from different cultures apart from the British culture. Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x N/A x x 2 Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 27 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. Standard OP3 Regulation 14 (2) (a) Requirement Ensure that the missing Person’s form in the assessment is completed accurately with up-todate information. The home must seek out and implement best practice in all aspects of the care of people living with dementia, so that the daily lives of people living in the home can be improved. Remove the old furniture and washing machine from the back garden, to allow service users safe use of the garden. The home must provide training for staff so that the needs of people with sight impairment are better met. The home must provide dementia care training for all care staff members at an improved level, such as that recommended by an expert dementia care organisation, so that all the staff care members are equipped with skills to care for the people living at the home. DS0000066356.V358862.R01.S.doc Timescale for action 14/03/08 2. OP12 12 (1) (b) 31/03/08 3. OP20 23 (1) (a) 14/03/08 4. OP30 18 (1)(c) 31/03/08 5 OP30 18(1)(c) 31/03/08 Avens Court Nursing Home Version 5.2 Page 28 5. OP33 26 The manager must ensure that Regulation 26 monthly visits are recorded and that a copy is left in the home for review on a site visit by CSCI. 15/02/08 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 arrangements in the communal rooms should be reviewed, so that people living in the home are encouraged to be more independent and that mealtimes become more of an enjoyable event. More attention should be paid to the importance of information provided in the ‘Getting to know you’ document, so that staff members can use the information to engage with individuals throughout the day. To show respect for people as individuals, other protection instead of the plastic aprons, such as individual tabards should be considered at mealtimes as protection for clothing. Advice should be sought from an expert organisation, such as The Alzheimer’s Society, about how to better meet the nutritional needs of people with dementia living at the home. A senior member of staff should be identified and trained to lead the improvements needed in the care of people with dementia, so that the daily lives of people living in the home are improved. The home should develop a clear procedure for staff members to follow in the event of an allegation of abuse being reported to them. The home should consult with an organisation expert in sight impairment and blindness, with a view to improving life for the people living in the home with these difficulties. The home should make suitable arrangements to show that all the necessary information about people working in the home is available at the home. 2 OP12 3 OP15 4 OP15 5 OP12 6 7 8 OP18 OP14 OP29 Avens Court Nursing Home DS0000066356.V358862.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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