Inspection on 02/11/05 for Avenue House

This inspection was carried out on 2nd November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Avenue House 26/04/07

Avenue House 18/12/06

Avenue House 25/03/06

Avenue House 14/03/05

Avenue House 15/09/04

Avenue House 11/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Avenue House 5 Cotham Park North Cotham Bristol BS6 6BH Lead Inspector Kathy Marshalsea Unannounced Inspection 2nd November 2005 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 Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 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. Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Avenue House Address 5 Cotham Park North Cotham Bristol BS6 6BH 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) 0117 9892020 0117 9892059 West of England Friends Housing Society Limited Mrs Pauline Ann Harvey Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th March 2005 Brief Description of the Service: Avenue House is operated by the West of England Housing Society Ltd and is registered with the Commission for Social Care Inspection to provide board, accommodation and personal care for up to thirty service users (residents), aged sixty five years and over, male and female. Avenue House is built over four floors with two lifts in situ. The home is a large mature detached house that has had an extension added. It is accessible for wheelchair users apart from the basement. All of the bedrooms are single except for two, which enable couples to share if they wish to. All of the bedrooms are now ensuite following a major refurbishment programme. Avenue House is situated near the centre of the city in an established residential area. Public transport is available within a short distance of the home. Local shops and community facilities are within half a mile of the home. Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and conducted as part of the annual inspection programme. The inspector met with residents and staff and also gathered evidence by reading documents, such as care plans and records relating to residents care. The inspector case tracked four residents. The manager was not present at the home but the staff on duty were able to ably assist the inspector. The Chairperson for the WOEFHSL popped in and was given some feedback from the findings of the inspection. The inspector also toured the whole building unaccompanied. What the service does well: During this inspection it was noted that there were obvious friendly, humorous yet professional relationships between the staff and residents. There were also obvious friendships between residents themselves. Residents spoken with talked about the kindness of the staff where “nothing is too much trouble” and “we have lots of fun”. Prospective residents have their needs assessed so that they can be sure that the home can meet their needs. They are also able to visit the home to assess its suitability before deciding to move there. Residents can be assured that the staff will promote their health and take steps according to changing needs. The care plans approach problems based upon the resident’s abilities and what the staff can do to assist where necessary. This is commended. Life histories are taken to enhance the staff’s knowledge of the person. Residents can be assured that the staff care for the whole person. There is a very active social and activities programme which is displayed throughout the home, including resident’s bedrooms. One resident who is partially sighted told the inspector “staff come every day and tell me what is going on as I can’t read now. They do this even though I usually choose not to join in, but it’s nice to feel included”. This ensures that those residents who enjoy going out and participating in group activities have an active life. Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 Page 6 Medication practices follow the home’s Policies and Procedures ensuring that safe practice is observed. Every effort is made to ensure that the residents influence the home way the home is run. They are able to choose the way they spend their day, what they eat, when they rise and retire. The house is kept clean and tidy and there are many homely touches. The bedrooms are very personalised. Residents are able to make their room their own. The manager has enabled there to be a relaxed and friendly atmosphere, which permeates throughout the house making it a happy home to live in. Senior staff have been empowered to extend their role and take on certain responsibilities, leading to a more accountable senior team. The manager communicates a clear sense of direction so that staff are confident in their practice. Training is offered to all staff in all mandatory topics so that the residents can be sure that staff are up to date in care practices. Actions are taken to solve moans and grumbles so that there are few actual complaints and residents and relatives can be sure that their views are taken seriously. Health & Safety issues are generally dealt with promptly and efforts made to make the house safe and comfortable. What has improved since the last inspection? What they could do better: There were some concerns in regard to Health & Safety issues. To ensure that safety deficits are responded to quickly, Immediate Requirement notices were left for the following: Ensure that after each accident/fall the risk to each resident is reviewed and action taken to reduce any identified risk. Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 Page 7 It was not possible to determine if all night staff are receiving their 3 monthly update in fire safety. This must be offered to staff at the stipulated intervals. Staff may be starting their employment before a satisfactory Criminal Records Bureau check has been received by the home. This contravenes the current regulations. Dates to action these deficits were agreed with the senior carer on duty and the home’s administrator. Other things identified during the inspection, which need to be improved, were: Not all resident files contained end of life plans. Residents cannot be sure that staff are aware of their wishes. These should be discussed with each resident or their representative and recorded to ensure that their wishes are carried out. The top floor lounge does not provide the same standard of décor and comfort that the other communal rooms do. Staff are not receiving regular formal supervision. This was a requirement at the last inspection and needs to be done as a matter of priority. To reduce any risk from windows above ground floor level the home must ensure that all windows 2 metres or above are risk assessed and steps taken to reduce any risk. The house itself needs to be risk assessed to make it a safe place to live and work in. Care plans should be done for short-term health problems so that residents can be assured that all staff are aware of this need. 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. Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 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 Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 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): NONE MADE EVIDENCE: These standards were not fully assessed. However, the inspector met a prospective resident and their family during the inspection. They stayed and had lunch at the home. The inspector heard them being shown around the building and being told useful information about how the home runs, and what they could expect. Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 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, 8, 9 Residents’ long-term health, personal, social needs are set out in an individual plan, but end of life plans need to be completed. Residents can be assured that the home or relevant specialist will meet their needs. Accident after care must be improved so that any risks are assessed to promote resident’s safety. Residents are protected by the home’s Policies and Procedures for medication. EVIDENCE: Care plans seen by the inspector concentrate on each person’s abilities. Detail is then given of any assistance they need from staff to meet that need and the resident’s preferred routine. The detail and emphasis on abilities instead of disabilities is commended. Some regular reviews were seen giving up to date information about any changing conditions. Some of these should have been extended to be shortterm care plans. Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 Page 11 Some assessments were present for example Manual Handling profiles, which were up to date. It was noted that one fairly new resident had three accidents since moving into the home. There had not been a review of their care plan or a risk assessment for the prevention of accidents. This must be done to ensure that the home is taking all possible steps to minimise the risk of any more incidents. There were only 3 risk assessments present in the files. None of these related to any accidents seen in the accident book. The manager must audit the recording of accidents. Of the four care plans viewed only one end of life plan was present. This must be addressed so that residents can be assured that their wishes when they die are carried out. Another resident who has an increased problem of confusion did not have this recorded in their care plan. This should be done to help staff maintain a consistent approach to this problem. Medication records checked showed that safe practices are adhered to. A risk assessment was done for a risk of one resident storing their medication. This is good practice. Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 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 The routines of daily living and activities are flexible and varied to meet to residents’ social, cultural, religious and recreational needs. EVIDENCE: Residents are invited to attend monthly activities planning meetings. They are then able to make choices about events and trips. At the last meeting held 19 attended. The administrator works very hard to arrange the trips, entertainers and daily social activity. An impressive daily sheet is posted in the main reception area with varied events. The home is to be commended for the effort made to this important aspect of life for their residents. The inspector was told about the Halloween party by a resident who was delighted as the staff had dressed up and said, ”I don’t usually like things like that, but it was such fun, and the staff made such an effort for us”. There were photographs displayed of recent trips to Harry Ramsden’s Restaurant and Bristol Zoo. Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 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 the following standard(s): 16, 18 Residents and their relatives can be assured that their views are taken seriously and actions taken to resolve issues when necessary. Residents are protected from abuse but not all staff are aware of local policies and procedures. EVIDENCE: The complaints procedure was revised following the last inspection. It is now clear and in a larger font making it more accessible. For example one resident who is partially sighted, spoke of knowing that they could have a grumble safe in the knowledge that some action would be taken. They also were aware of the process if they were not satisfied with the outcome. Staff spoken with had attended recent training session in abuse. They were aware of the different types of abuse but unsure of the local procedures, such as contacting Care Direct, the local Social Services department responsible for dealing with abuse, or the No Secrets (Department of health) document used for best practice. Staff need to be confident about how to deal with this issue particularly the seniors who are in charge of their shift. Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Residents live in a clean, well-maintained and generally comfortable environment. There is a choice of sitting space plus a room for activities. One sitting room needs to be updated and one corridor carpet must be replaced to provide a consistent standard of environment. EVIDENCE: The home is generally comfortable, homely and was very clean on the day of the inspection. The grounds are well maintained. Attention is given to maximising independence by the use of aids such as grab rails and bath chairs. The home also has appropriate hoists. Radiators are covered so reducing any risk of scalding. Hot water outlets have their temperatures tested monthly, to ensure that the temperature regulators are effective. Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 Page 15 The downstairs lounge and dining room are comfortable and homely. However, the top floor lounge was not of the same standard. Also the carpet on the top floor has some black stains and needs to be replaced. Toilets and bathrooms had locks therefore promoting privacy. The entrance hall is welcoming and has facilities for residents to make their own drinks. The notice board is informative. There is also a pay phone for residents use. Large print books are available and the home has a visiting library service. There is also a communal room mostly used for craft and also the weekly shop. There is a CD player, jigsaws and books in the downstairs lounge and no television. It was refreshing to be in a home without the TV being used as a form of activity. Resident’s rooms seen were very personalised and reflected the interest of that person. Small items of furniture were also in some rooms. Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 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, 29 The numbers and skills of the staff meet residents’ needs. The recruitment procedure must follow the regulation for not allowing staff to start their employment before receiving a satisfactory CRB clearance, which promotes the residents safety. EVIDENCE: Rotas confirmed that the home operates a safe level of staffing. On the day of the inspection there was a senior carer plus an agency carer, and the home’s own carer. By the time the inspector was touring the building all those who needed assistance to get up had done so. It was noted that few call bells rang during the inspection. Recruitment records were checked. It was not possible to confirm that satisfactory CRB checks are completed before employment commences. Staff contracts were also not present. The inspector was told that staff contracts are in the process of being re-done and was shown a sample copy. Supervision notes were also not available to evidence that this had been taking place. This had been a requirement at the last inspection and so this will be repeated with a short timescale. Senior staff spoken with stated that they were due to start these but had been trained first before doing them. Some individual training records were seen. This will be looked at in detail at the next inspection. Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 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 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, 32, 33, 35, 36,38 The home is run in the best interest of the residents whose views are sought before decisions are made. Residents’ valuables and monies are safeguarded. Staff are supported in their roles but this could be enhanced by the formal supervision process. Generally Health & Safety procedures protect staff and residents, but some staff are not attending their fire safety updates at the stipulated intervals. Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 Page 18 EVIDENCE: Mrs Harvey has completed her fit persons process with the CSCI so is now the registered manager of the home. The organisation have employed Methodist Homes association to provide subcontract management of all the staff, and to provide in depth professional expertise in running the home which was not available to the voluntary committee. This does not include the Regulation 26 visits. Their responsibilities have just been detailed and finalised. They will supply line management for Mrs Harvey. Staff and residents spoke positively about Mrs Harvey’s management style, which is described as being “inclusive, open, fair and professional as well as being very dedicated.” She has worked hard to address the challenge of taking over as the manager of the home last year. There has been an improvement in the documentation and the way staff issues are dealt with. She is to be commended for rising to the challenge. The inspector was informed that there had been a recent residents and staff meeting but the minutes were not available. The records of the monies held on behalf of the residents were checked. They were easy to audit. Receipts kept tallied with the entries and cash held tallied with the balance sheet. This should assure residents that their financial interests are safeguarded. Health & Safety records were checked. The Fire log showed that safety tests were being conducted at the stipulated intervals. Fire safety training is provided for staff. An external trainer had done a session in July 2005 but records seen showed that not all staff attended. There is a training sheet identifying when staff need to be updated according to whether they work days or nights. Two night staff tracked have not been updated since February 2005. They should be updated 3 monthly. This must be addressed. There are clear Policies and Procedures for fire safety. The Workplace risk assessment was dated 2000. Staff were unclear if this had been reviewed. This will be checked with the manager, as it was a requirement at the last inspection. Generic risk assessments for safe practices in the home need to be completed no later than 14th December 2005 to comply with the requirement made at the last inspection. It was noticed during the inspection that there were lots of staff using the kitchen and his was particularly noticeable during the lunchtime. It is best practice for there to be as few people as possible using the kitchen and there is a drinks machine in the main lobby that staff could use. Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 Page 19 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 2 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 1 X 2 Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard OP7 OP38 OP29 Regulation 13(4)(c) Requirement Timescale for action 02/11/05 30/11/05 02/11/05 4 5 6 7 8 9 OP7 OP18 OP26 OP36 OP38 OP38 Accidents/falls must be audited and risks assessed to evidence the reduction of risk 23(4)(d) All staff must be given fire safety training at the stipulated intervals 19(4) Staff must not start their employment until a satisfactory POVA First check or CRB is received 15(1) Actions needed to meet short term health problems should be detailed 13(6) Staff must be aware of the local policies and procedures for the prevention of abuse 16(2)(c) The top floor corridor carpet must be replaced 18(2) Staff must be formally supervised 23(4)(c)(v The work place risk assessment ) must be reviewed 13 Windows above 2 metres must be risk assessed and any risk of falling reduced 31/12/05 31/12/05 30/04/06 31/12/05 31/12/05 31/12/05 Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 Page 21 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 3 Refer to Standard OP19 OP7 OP38 Good Practice Recommendations For the upstairs lounge to be made homely and comfortable For end of life plans to be recorded for all residents For staff not to have free access to the kitchen Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Avenue House DS0000026495.V272956.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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