CARE HOMES FOR OLDER PEOPLE
Avenue House 5 Cotham Park North Cotham Bristol BS6 6BH Lead Inspector
Savio Toson Unannounced Inspection 25th March 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 Avenue House DS0000026495.V284076.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. Avenue House DS0000026495.V284076.R01.S.doc Version 5.1 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.V284076.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd November 2005 Brief Description of the Service: Avenue House run by the West of England Friends Housing Society Limited (FHB) is registered with us to provide accommodation and personal care for up to thirty service users (residents), aged sixty-five and over. Since October 2005 the owners have an Agreement with the Methodist Homes Association (MHA) to provide sub-contract management services for all aspects of the Society. The FHB voluntary board retains ownership of the Society, it’s property, employs all staff and provides the registered responsible individual. The motive for making this change is to provide a broad resource of all the professional aspects required by the Society to meet its regulatory and financial responsibilities. The home is an older style detached property, with a recently built large extension to the side of the house. The home has several lifts and all floors are accessible for wheelchair users apart from the basement. The home has mostly single bedrooms except for two, which enable couples to share if they wish to. All of the bedrooms are en-suite 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.V284076.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection consisted of a review of the home’s files held in our office. All correspondence since the November 2005 inspection was viewed, including the fire service report, serious incidence reports and the home’s response to the previous report. The inspection was completed with a site visit to the home and a return visit to look at records that were locked in the manager’s office on the first visit. On the second visit the manager and responsible individual were present and assisted with the inspection. The site visits included talking to 6 staff, 1 visitor and 19 residents individually or in small informal groups. All the residents and visitor spoke well of life in the home. Records were viewed and most of the home was toured to check the environment. What the service does well: What has improved since the last inspection?
The top floor lounge has been made more homely. Staff put on tabards before entering the kitchen to maintain good hygiene standards. Regular staff supervision has now started. Night staff are receiving regular fire training and staff had attended training sessions on protecting vulnerable adults from abuse. The home has recruited a deputy manager who will be able to assist the manager in fulfilling the management duties needed to run the home. Avenue House DS0000026495.V284076.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Avenue House DS0000026495.V284076.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avenue House DS0000026495.V284076.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 5. The residents have their needs assessed before they get admitted into the home. Potential residents and their representative have the opportunity to visit the home before moving in. Residents have their basics rights protected by the use of contracts or terms and conditions. EVIDENCE: The care records contained comprehensive assessments of the residents needs. The information on potential residents was collected before they moved into the home and once in the home the staff continued to add information to the assessment. On the day of inspection a relative had arranged to visit the home to see if it was suitable for a potential resident. The care records contained tenancy contracts that set out the service the residents could expect from the home. Avenue House DS0000026495.V284076.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11. The resident’s care needs are not always set out in the care plan. The medicine administration records were appropriate and met the policy. Residents confirmed they were treated with respect by the staff and their privacy respected. Some of the residents are not given the opportunity to make arrangements for their care at the time of their death. EVIDENCE: All the resident’s had care plans. The care plans viewed did not contain some of the resident’s changing care needs, which staff were recording in the daily care record. The care plans were reviewed monthly. The medicine administration sheets viewed were complete and filled in as required by the medicine procedure. The residents were very positive and able to describe the kindness and care they received from the staff. The staff made the residents feel part of the home and always spoke to the residents respectfully and as individuals. Several of the care plans viewed did not contain the resident’s wishes for the arrangements to be carried out after their death. Avenue House DS0000026495.V284076.R01.S.doc Version 5.1 Page 10 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, 13, 14, 15. The resident’s individual tastes were reflected in the way recreational activities were arranged in the home. Several residents expressed their satisfaction with their lifestyle and maintained contact with their family and friends. Residents exercise choice and control over their lives and have wholesome appealing meals. EVIDENCE: The home has a room set aside for arts and crafts that contained a range of artwork. The home had photographs on display of recently organised activities, one of which was a trip to a nearby arboretum. Residents said that the recreational activities suited their needs. Residents had their own tea and coffee making facilities near the main entrance. Residents gave examples of where they exercised choice and control over their lives. For instance several went out on a regular basis at times that suited them. Avenue House DS0000026495.V284076.R01.S.doc Version 5.1 Page 11 The residents said they enjoyed the meals and if there was something they did not like an alternative was provided. A lifetime vegetarian described how the staff put thought into preparing her meals. The standard for providing residents with a choice of meals was discussed because the menus only contained the main meal at lunchtime without any written alternatives. However the home demonstrated it had made arrangements to ensure residents had meaningful alternatives to the main meal. The evening meals offered soup and hot snacks. The dining room was well set out and the notice board displayed the meal of the day. Avenue House DS0000026495.V284076.R01.S.doc Version 5.1 Page 12 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. The resident’s have their complaints taken seriously and are protected from abuse. EVIDENCE: The home has a complaints book and a recent concern of abuse was well managed by the home with a positive outcome for the home and residents. The majority of the staff had now received their training on the protection of vulnerable adults from abuse. Avenue House DS0000026495.V284076.R01.S.doc Version 5.1 Page 13 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 well-maintained environment. The communal areas were suitable and the home had the specialist equipment required for the handling and moving residents. The bathrooms and toilets were in good order and catered for people with disabilities. The resident’s bedrooms were comfortable and reflected their individual tastes. Most of the home was safe and comfortable. And the home was found to be warm, clean and tidy. EVIDENCE: The home was found to be warm, clean and tidy. The carpet outside the lift on the middle floor was badly stained and needed to be deep cleaned or changed. One of the residents using the lift remarked that she wanted something to be done about the stains. The home had a range of lifting hoists, assisted baths and toilets. Avenue House DS0000026495.V284076.R01.S.doc Version 5.1 Page 14 The bedrooms were in good decorative order, individualised and homely. All the bedrooms viewed had their own en suites. There was concern for one of the bedrooms which had three steps going into the room and the three windows which had very low sills. The windows were discussed as a health and safety issue and was going to be dealt with by the home manager. Avenue House DS0000026495.V284076.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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, 30. Residents’ needs were met by the skill mix of the staff. Residents’ benefit from care staff who are being kept up to date. EVIDENCE: On the day of inspection there was a range of staff on duty and the residents were very satisfied with the service. Staff were able to discuss the training they had received over the last few months and were aware of the need to keep up to date. The home collates the documents used in the recruitment process. The Criminal Records Bureau (CRB) disclosure for the most recently recruited employee was missing but the manager could demonstrate that she did follow the CRB procedure. Avenue House DS0000026495.V284076.R01.S.doc Version 5.1 Page 16 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): 32, 22, 37,38. Residents receive a service from a team that works on the ethos that everyone was valued and needed to be cared for as an individual. The resident’s best interests are not always safeguarded because as already stated in this report not all the records are up to date. The health and safety procedure in place for the protection of residents needs to improve. EVIDENCE: The staff’s interaction with the residents was observed to be to a good standard. Staff were polite, worked in friendly manner with residents and appeared committed to being helpful. Residents described staff as kind and doing extra things for them. As one resident said” this home has a spirit”. The incomplete care records meant that the written guidance on care which staff had to provide to residents was not always up to date. Avenue House DS0000026495.V284076.R01.S.doc Version 5.1 Page 17 The home did not inform (using a Regulation 37 form) us of a serious incident to a resident. It was agreed that some of the mail between the home and our local office must be getting lost in the post. The electrical appliances tests (PAT testing) had not been carried out for over a year. As previously reported, there was concern for the low windows sills in one of the bedrooms and one of the bathrooms which had a notice saying it was out of order, had bath water which was over the advised 43 degrees C. The senior carer locked the bathroom door to ensure that bathroom remained out of use. Generic Health and Safety risk assessments need to be carried out as soon as possible. Avenue House DS0000026495.V284076.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X X 3 2 2 Avenue House DS0000026495.V284076.R01.S.doc Version 5.1 Page 19 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. Standard OP7 Regulation 15(2)(b) Requirement Actions needed to meet shortterm health problems should be detailed. (As requested at the last inspection) The middle floor corridor carpet outside the lift needs to have the dark marks removed. (As requested at the last inspection) The work place Health and Safety risk assessments must be carried out. (As requested at the last inspection) The three windows below 1 metre must be risk assessed and action taken to reduce the risk of falling (As requested at the last inspection) The electrical equipment used in the home needs to have its annual test (personal appliance test) Timescale for action 30/06/06 2. OP26 23(2)(d) 30/06/06 3. OP38 13(4)(c) 30/08/06 4. OP38 13(4) (a) 30/06/05 5 OP38 23(2)(c) 30/05/06 Avenue House DS0000026495.V284076.R01.S.doc Version 5.1 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations For end of life plans to be recorded for all residents (As requested at the last inspection) Avenue House DS0000026495.V284076.R01.S.doc Version 5.1 Page 21 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
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