Inspection on 01/05/08 for Avenue House Nursing and Residential Home

This inspection was carried out on 1st May 2008.

CSCI found this care home to be providing an Poor service.

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 Nursing and... 31/10/08

Avenue House Nursing and... 10/05/07

Avenue House Nursing and... 23/02/07

Avenue House Nursing and... 25/07/06

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Avenue House Nursing and Residential Home 173 - 175 Avenue Road Rushden Northants NN10 0SN Lead Inspector Kathy Jones Unannounced Inspection 1st May 2008 08:15 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 Nursing and Residential Home DS0000067495.V363894.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. Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avenue House Nursing and Residential Home Address 173 - 175 Avenue Road Rushden Northants NN10 0SN 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) 01933 358455 01933 317671 pam.morris@jasminehealthcare.co.uk Jasmine Healthcare Limited Manager post vacant Care Home 46 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (46) of places Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code (N) To service users of the following gender category: Either Whose primary care needs on admission to the home are within the following categories: Older Persons - Code OP Dementia - Code DE. The maximum number of service users who can be accommodated within the category Dementia (DE) is: 10. The maximum number of service users who can be accommodated is: 46. 10th May 2007 2. 3. Date of last inspection Brief Description of the Service: Avenue House is a 43 bedded home located on the outskirts of Rushden, owned by Jasmine Healthcare Limited. The home provides for elderly people requiring personal care or nursing care. There are up to 10 places for people with dementia and 8 places for people who are terminally ill. The home was formerly two domestic dwellings, which have been connected and extended. Residents’ bedrooms are located on the ground and first floors with a small passenger lift providing access to the first floor. Some of the bedrooms on the ground floor have doors leading out onto the garden. Five of the bedrooms are shared and the remainder are single rooms. Communal areas consist of four lounges, a dining room split in two areas plus one small dining room with one table. The responsible individual, provided the following fees as being current on the 28 February 2007: Fees range between £350 and £650 per week dependent on the assessment of care needs and room provided. (The subject of information about fees is Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 5 covered in the ‘Choice of Home’ section). The fees include personal care and where applicable nursing care, meals and accommodation. Chiropody, hairdressing services, transport and newspapers can be arranged and are charged separately. Other costs would include clothing and toiletries. Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. Standards identified as ‘key’ standards and highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for residents. Inspection of the standards was achieved through review of existing evidence, pre-inspection planning, an unannounced inspection visit to the home, collating information received in surveys received from relatives, people who use the service and staff and drawing together all of the evidence gathered. The pre-inspection planning was carried out over the period of half a day and involved reviewing the service history, which details all contact and correspondence with the home and previous inspection reports. The last full inspection took place in May 2007, however a Pharmacist Inspector carried out an inspection in November 2007, which focussed specifically on the management of peoples prescribed medication. Information from these inspections was taken into account as part of the planning. This unannounced inspection visit covered the morning and afternoon of a weekday. The inspection was carried out by ‘case tracking’, which involves selecting samples of residents’ records and tracking their care and experiences. Observations of the homes routines and care provided were made and views on the care provided were sought from people who use the service, visitors and staff. Additionally questionnaires were sent to a random selection of people to ascertain their views. At the time of completion of the report, responses had been received from four people who use the service, six relatives and six staff. Their views have been considered as part of the inspection and some comments incorporated within the report. The management of residents’ medication was checked through reviewing prescribed medication for a sample of people. A sample of staff files were reviewed to check the adequacy of the recruitment procedures in protecting people who use the service. Communal areas and a sample of bedrooms were viewed and observations were made of people’s general well being, daily routines and interactions between staff and people who use the service. Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 7 Verbal feedback was given to the Acting Manager on the day of the inspection. A brief visit was made following the inspection to collect some staff questionnaires. During this visit some of the findings of the inspection were discussed with the Responsible Individual. What the service does well: What has improved since the last inspection? What they could do better: Information about the fees and the fee structure needs to be included in the service user guide to make sure that arrangements are open and transparent and to help people make informed decisions. A requirement made at the last inspection about the assessment process has not been met. People have continued to be admitted without proper consideration of how their needs are going to be met and this has resulted in people having to move which can be very unsettling. Comments from people who use the service, relatives and staff about the standards of care are quite variable. Some people report that they are happy, others feel it would be better if there were more staff and others are not happy with the care. Examples include “a lot of neglect of basic care happens everyday”; to improve need “more staff”. The majority of people at Avenue House are very dependent on staff for assistance and observations identified that people can be left waiting for long periods for example at the meal table. Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 8 There needs to be better recording of dosage changes for medication to reduce the risk of error. Requirements have been made about staffing arrangements, which include the need to look at staffing levels, organisation, monitoring and supervision of staff to make sure that peoples needs are met and that they are not experiencing a long wait for assistance. Better monitoring and review of unexplained bruising and skin tears needs to be implemented to be able to identify poor practices and abuse. Referral to social services safeguarding needs to be made promptly for all allegations and suspicions of abuse to reduce the risk. Improved standards of cleanliness, staff training in infection control and infection control procedures need to be in place to provide a better environment and to reduce the risk of infection. Staff practice in relation to movement and handling needs to be monitored and all staff trained in safe practices to reduce the risk to staff and people who use the service. 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. Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 9 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 Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 10 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): 1, 3. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The admission process does not provide assurances that the needs of people can be met. EVIDENCE: The annual quality assurance self assessment submitted by the Responsible Individual states that a copy of the Statement of Purpose and Service User guide is available in every service user’s room so that they have a point of reference should this be required. The documents provide information about the services provided. Copies were also available in the hall with a copy of the most recent inspection report produced by the Commission for Social care Inspection. The availability of this information is important in helping people to make ongoing decisions Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 11 about their care. Discussion with the Acting Manager about fees identified that currently all queries about the fees are referred to the Responsible Individual and that details are recorded in individual contracts. The Care Homes Regulations 2001 require that information about fees and how any differences are determined and what the fee includes is detailed within the service user guide. This is to ensure that people can be satisfied that there is openness and transparency and that they are clear what they are paying for. Four surveys were received from residents. Three felt that they had enough information before they moved in to help them decide that it was the right place for them. The third didn’t though acknowledged that the reasons for this were outside the control of Avenue House. Relatives were asked in the surveys if they get enough information to help them make decisions about the care. Two of the respondents said always, one usually and three sometimes. The comments indicate that while information is available ongoing communication could be improved. The annual quality assurance self assessment identifies that an area they feel that has improved over the last twelve months is the admission process. A requirement had been made following the last inspection in May 2007 that people must not be admitted unless their needs can be met. The evidence from this inspection identifies that this requirement has not been met, with the Responsible Individual acknowledging that three people had been inappropriately admitted. This has led to a poor outcome for at least one of these people, the consequences of which placed the person at risk. Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9, 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care planning systems are in place to support peoples care, however the quality of care experienced by people varies with some people not receiving an acceptable standard of care. EVIDENCE: Improvements in the care planning process were identified at the last inspection, however concerns were raised by staff, people who use the service and relatives about the care actually received. A requirement was in place about the need to have arrangements in place to ensure that people receive care according to their assessed needs. This requirement has been met in that discussion with staff identified that there are arrangements in place, as staff are allocated to provide care for people in particular rooms and care plans detail the care needed. However Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 13 the outcomes for some people do not seem to have improved in that they are not always receiving timely and consistent care. Comments received from people who use the service, relatives and staff identify that some are satisfied with the care, others feel improvements are needed and others are not satisfied. Positive comments include “I am very happy with my mum’s care, she always seems happy, clean and well supported.” Other comments indicate that there is an ongoing problem with some people not always getting the basic care that they need which some felt would be improved with more staff. Examples given included people not always shaved and people waiting lengthy periods for assistance. A specific example given was of someone being left in their nightdress all day instead of being changed into their day clothes. A sample check of care plans during this inspection indicated that they are reflective of people’s current needs and provide sufficient information to meet the person’s needs. However discussion with staff and information received through surveys identifies that they are not confident that they are kept informed about changes to peoples needs. This indicates that either the care plans are not kept up to date or are not being used effectively as a working tool for staff. Care plans are important documents required to support peoples care, however unless they are used by staff to guide the care, people are not always going to receive the planned care. Risk assessments have been carried out to identify people’s needs and risks. For example the risk of pressure ulcers and those at risk of falls. A risk assessment for the use of bed rails was also found on one persons file. It is important that proper risk assessments are in place to ensure the use of these does not lead to further unnecessary risks. The actual risk assessment did not provide enough information to confirm that the risk for the individual had been adequately assessed. For example one of the things it said must be ensured was that “the spacing between the bars is not wide enough to present a hazard”. It did not confirm that this had been checked in relation to the individual. Advice was given to access guidance through the Medicines and Healthcare Products Regulatory on risk assessment for the use of bed rails to ensure that the risk to people is reduced as far as possible. People’s records contained evidence that health care is accessed on behalf of people who use the service, from people such as the General Practitioner and Community Psychiatric Nurse. Daily records showed that people’s health care needs are monitored, however there was no evidence of follow up of recurring issues such as skin tears and bruising. This issue is raised under safeguarding and also health and safety in the management section. The Lead Pharmacist Inspector from the Commission for Social Care Inspection (CSCI) carried out an unannounced inspection on 6th November Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 14 2007, which focussed specifically on medication. The annual quality assurance self assessment states that over the last twelve months “Medication practice has improved following reports from the local pharmacist and also CSCI”. A sample check of people’s prescribed medication was made to see how this was being managed. This confirmed that prescribed medication was in stock and records were in place to confirm receipt and administration of medication. Dates of opening for medication had been recorded where appropriate. Advice was given during the inspection of medication in November 2007 about the need to improve practices and reduce the risk of errors. An example of this was the practice still in place of nurses taking medication from the secure trolley on a tray to other parts of the home creating risks, which include that of the nurse being unable to safely secure the medication in the event of a resident requiring urgent assistance. A check of the quantity of medication received, signed as administered and in stock indicated that in most cases medication is managed properly. However there is evidence that safe medication practices and appropriate recording are not always followed. For example one persons medication administration record identified that they were prescribed warfarin. Regular blood tests are required for people prescribed this drug and the dosage changes dependent on the test results. The recent changes had been recorded on a small scrap of paper separate from the medication record, which could easily have been lost and was not adequately dated. Failure to keep proper records of dosage changes has the potential to put people at risk. Information received through notifications identifies that there are systems in place for reporting drug errors and that appropriate action has been taken, which include seeking medical advice and additional staff training where necessary. Staff spoken with during the inspection without exception expressed a desire to ensure that people who use the service received good care and were treated with respect and dignity. Staff spoke to people in a respectful manner during the inspection. However some of the outcomes observed for people were less than dignified. For example one person was observed having breakfast in her room with the meal left in a position where it was difficult to reach resulting in spillage on her clothes. On the morning of inspection bedroom doors were open unless personal care was being provided. To ensure that people’s privacy and dignity is properly respected it is important that the practice of leaving bedroom doors open through the night is reviewed to ensure that this is based on individual preferences. Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 15 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, 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The quality of people’s daily lives appears to be largely dependent on the level of assistance that they require. EVIDENCE: The annual quality assurance self assessment submitted by the Responsible Individual states: “We allow the service users choices to determine the way they wish to spend their time at the care home” and “We employ an activities co-ordinator five days a week who ensures that all service users have access to recreational facilities”. Of the four surveys received from people who use the service, only two responded to the question about daily life and social activities. One felt there were sometimes suitable activities for them to take part in and the other said that they were aware that activities were available but that they didn’t join in with them. Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 16 Of the six relatives who responded four commented on the area, and all felt that more staff, more entertainment or more outings would enhance service users quality of life. However someone who uses the service spoke about going to the shops and the garden centre with the activity organiser and planting seeds for the garden and being generally satisfied with their daily life. The needs of people at Avenue House are very different, making it difficult for one person to provide activities, which suit the varying needs and interests on an everyday basis, which may explain the different levels of satisfaction. Care staff report that they have little time to spend sitting and talking with people. Observations during the inspection identified that people spend large amounts of their day waiting at the meal table for a meal or waiting to be assisted to the lounge following a meal. This issue was raised at the previous inspection and appears to be a continuing problem. Visiting arrangements are flexible and people are able to have visitors as and when they wish. The level of choice and control that people have over their lives is largely dependent on the level of assistance that they need. For example someone was taken from the dining room to the lounge and then left in the wheelchair in the lounge for another forty minutes at least, before being assisted in to a comfortable chair. This is supported by comments received in surveys. Five of the six relatives who responded to the survey felt that the service only usually met the diverse needs of people who use the service. Of four people who responded about food provision, two were less than fully satisfied. Discussion during the inspection identified that people felt the quality of the meals varied considerably, according to who was doing the cooking. However people spoken with on the day of the inspection confirmed that they had enjoyed their lunch. There have been some shortages of staff in the kitchen, which has resulted in care, and sometimes maintenance staff doing the cooking. Staff advised that some of these have the necessary experience to enable them to do this, however for the majority, cooking for forty plus people is outside their experience. The Acting Manager advised that a new cook had been recruited, which it was hoped, would improve the quality and consistency of the meals. Some people have some or all of their meals in their room. A breakfast tray was seen to be nicely laid out with cereal, toast and a small pot of tea. It was therefore a pity that this had been left in a position where the person was having difficulty reaching it. Issues were raised by people who use the service; their relatives and staff about the lack of time staff appeared to have to assist people with their meals. There are a lot of people at Avenue House who need assistance of varying degrees with their meals, therefore it is Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 17 important that this is taken into account when considering staffing levels to ensure that people’s nutritional needs are met. Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 18 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): 16, 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are effective complaint procedures in place which people are aware of, however failure to operate rigorous safeguarding procedures and sustain improvements following complaints puts people at risk. EVIDENCE: There is a complaint procedure in place and records of complaints are kept. These records show that complaints are investigated, shortfalls acknowledged and responded to appropriately with actions to address the shortfall identified. People who responded to the survey felt confident about how to make a complaint, or in the case of staff, how to respond to a complaint being made. However there was less than full satisfaction with the way complaints are responded to. For example there was a comment about the quality of response being satisfactory initially, and then the issue quickly lapsing into an unsatisfactory status again. This was supported by concerns raised by staff in their surveys, which indicated this was due to problems in maintaining sufficient committed staff or having time to ensure standards were consistently met. There was evidence that improvements are required to procedures for protecting people from abuse. The annual quality assurance self-assessment Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 19 identifies that there have been no referrals made to safeguarding adults within the last twelve months. However the findings of the inspection indicate a possible lack of understanding of the responsibilities for reporting allegations or concerns. For example a recent notification to the Commission for Social Care Inspection identified that there had been delays in reporting an allegation of financial abuse and that the referral to safeguarding adults was prompted by the Commission for Social Care Inspection. Review of one person’s care file identified that there were sufficient concerns for photographs to be taken of some injuries, however no referral had been made to safeguarding adults and there was no evidence of any investigation of the cause. Review of people’s care records and discussion with staff also identified the need for better reporting and review of unexplained bruising and skin tears. Staff spoken with understood their responsibility for reporting any concerns, which include unexplained bruising and marks and confirmed that they have reported these. However there are no records to confirm who the concern was reported to, how it was reviewed and any action taken. This leaves managers and staff in a vulnerable position and does not provide adequate protection for people who use the service. Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 20 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): 19, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People confirm that they are comfortable in their environment; however the standard of cleanliness is poor, which is unpleasant and also increases the risk of infection. EVIDENCE: There is a programme for re-decoration in place and the Acting Manager confirmed that decoration of the corridors, some of which were in particular need of attention is due to be completed shortly. The annual quality assurance self assessment acknowledges that an area for improvement is to carry out redecoration more quickly. Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 21 Review of the information supplied in the annual quality assurance self assessment confirms that equipment including the lift is serviced regularly, helping to maintain a safe environment for people who use the service. Improvements have been made to the garden since the last inspection, which now provides a pleasant area for people who use the service, and visitors. Observations and discussion with people who use the service confirmed that they are comfortable in their rooms and are encouraged to personalise them with ornaments, pictures and plants. Three of the four residents who responded in surveys about the cleanliness were satisfied. However the other raised concerns about stained and dirty carpeting and prolonged delays in replacing carpeting. Concerns were also raised about malodours due to bins not being emptied promptly. The concerns were supported by a sample check of the premises during the inspection, which included some bedrooms. This identified that there was a poor standard of cleanliness and some areas, including one of the lounges had an unpleasant odour. Staff spoken with were very aware that the poor standards of cleanliness provide a less than pleasant environment for people living at Avenue House, give a poor “first impression” and also increase the risk of infection. Discussion with staff identified that there are no cleaning schedules in place and that staff from all departments have expressed concerns about the standards of cleanliness to managers. The annual quality assurance self assessment identifies that a total of forty three staff are employed, however only sixteen of these have received infection control training. Staff spoken with appeared aware of good practice in relation to handling soiled laundry and of the need to use disposable gloves and aprons when involved with personal care and laundry. However a member of staff spoken with was not aware of there being any infection control procedures in place. This is of particular concern given that there was an outbreak of infection just two months prior to the inspection. Rigorous infection control procedures and practices are extremely important in helping to control and reduce the risk of infection for people who use the service. Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29, 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing arrangements do not adequately meet people’s needs and protect them. EVIDENCE: Concerns about staffing levels have been identified in previous inspection reports and requirements made. Information received in copies of monthly reports compiled by the Responsible Individual identifies that a recognised tool is used, as a guide to assess the number of staffing hours required based on the dependency levels of people who use the service. The information indicates that the hours provided exceed what has been assessed as required. However observations and comments received during the inspection and in surveys identify that some people’s needs are not always being met and that they feel that this is due to a lack of staff. For example three of the six relatives who responded to the survey raised queries relating to whether there were enough staff at the home. Comments included: “They have some very caring staff who excel but at times there seems to be a shortage of staff”, “a lot of neglect of basic care happens everyday”, to improve need “more staff”. Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 23 Concerns about staffing were supported by people who use the service, with three of the four raising concerns about staff availability to support them. Discussion with staff and responses in staff surveys also include concerns about the adequacy of staffing to ensure that standards and people’s needs are consistently met. As detailed earlier in the report people were observed during the inspection to be left at the dining table and in wheelchairs for long periods waiting for staff to assist them. Records of staff training and discussion with staff identified shortfalls in staff training to meet the needs of people who use the service. An area for improvement identified by staff and also by the Responsible Individual in the annual quality assurance programme is the induction training for new staff. Records for the induction of recently recruited staff could not be found to confirm that this had been carried out. Induction training is important in ensuring that staff have basic knowledge of the service and people who use it to be able to meet their needs appropriately and safely. None of the staff who responded in the surveys felt that felt that their induction covered everything that they needed to know. The annual quality assurance self assessment shows that less than half of the care staff hold a basic qualification such as a National Vocational Qualification (NVQ) in the care of older people. Surveys identified that most staff felt that the training at the home was good but there were comments that more training and updates were needed; that some staff didn’t attend sufficient training and that more training was needed in specific areas such as basic care, infection control and health and safety. Training records confirm that some staff have not received basic training putting people at risk of their needs not being appropriately and safely met. Information about planned training starting on 6th May 2008 states “as many carers as possible to attend please”, indicating that staff are choosing whether to attend rather than there being a programme of training based on staff training needs. It is also of concern that training is being planned for staff actually on shift, as this is likely to lead to either staff training needs, or the needs of people who use the service not being fully met. A training schedule for April/May 2008 states, “staff are expected to attend these training sessions, but resident’s needs will always take priority”. Staff surveys identified that appropriate checks and references are carried out as part of the recruitment process, which is important in helping to protect people who use the service. Review of files for two newly recruited staff confirmed that criminal record bureau clearances had been undertaken and references obtained. However only one rather than the required two references was found on one of the files indicating the need to be more rigorous. Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 24 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): 31, 33, 35, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of residents has not been properly protected by the management arrangements and quality assurance systems. EVIDENCE: Standard 31 relates specifically to the registered manager and their experience and qualifications. There has been no registered manager in post since the end of 2006. However this standard is considered from the perspective of the adequacy of the management arrangements, as this is considered a key aspect of ensuring that residents receive appropriate care. Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 25 Following the last inspection an Acting Manager was appointed and has recently left, however during the period of her employment an application for registration was not submitted to the Commission for Social Care Inspection. At the time of the inspection there was a new Acting Manager who had been in post for just a few weeks. As it is an offence under the Care Standards Act 2000 to carry on or manage a care home without registration it is important that an application for registration is prioritised. The findings of this inspection identify that some people are satisfied with the care that they receive, however shortfalls have been identified in many areas, which reflect on the management and organisation of Avenue House. Information received in surveys from relatives and staff and discussion with staff indicate that issues have been raised with ‘management’ and that there is some frustration about recurring issues. Systems are in place to check the quality of the service provided. For example the Responsible Individual produces a monthly report, which is quite detailed and includes information gathered during visits to Avenue House. The report identifies a significant amount of time is spent at Avenue House each month. Part of the visits by the Responsible Individual are spent talking with staff, relatives and people who use the service, and who appear to be honest about the strengths and weaknesses of the care provided and to have ideas about the cause of the problems. Overall the feedback is that when concerns are identified there is a willingness to acknowledge any shortfalls and commitment to addressing the concern. However improvements are not always sustained which indicates the need to concentrate on reviewing the causes and implementing more rigorous ongoing monitoring as part of the quality assurance process. A sample check of the systems in place for managing money held on behalf of people who use the service was carried out. This generally involves small amounts of money, which help people pay for services such as hairdressing and chiropody. Records are in place to confirm transactions and balances checked were correct. As detailed earlier in the report, equipment is serviced regularly helping to protect the health and safety of people who use the service. It was identified that some staff have not received important training in areas such as fire safety, food hygiene, movement and handling training and infection control. Some of the staff who had received training in moving and handling have not had any recent refresher training which is important in helping to ensure that safe practice is followed. An incident of unsafe movement and handling was witnessed during the inspection by someone who said they had received up to date training, identifying the need for practice to be monitored to reduce the Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 26 risk of injury to people who use the service and to staff. Discussion with staff and a sample check of peoples care records indicated a need for closer monitoring and review of the cause of skin tears and bruising. This issue has been raised under safeguarding, however discussion with staff indicated that some of these may be due to poor movement and handling practice. Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 27 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 2 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 1 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 3 X X 1 Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 5. Requirement The Service User Guide must contain all information detailed in Regulation 5, including clear information about all charges. This would help prospective and current people who use the service and their families make informed decisions. The assessment and admission process must be sufficiently thorough to ensure that the needs of people admitted can be met. A similarly worded requirement with a timescale for compliance of 15/07/07 has not been met. People must receive care based on their assessed needs in a timely manner. Changes of dosage for medication must be recorded on appropriate records such as the medication administration record and the care plan and be signed by the person making the alteration. This is to reduce the risk of staff administering the DS0000067495.V363894.R01.S.doc Timescale for action 30/06/08 2. OP3 14. 30/06/08 3. OP7 12 (1) (a), 14. 17 (1) (a) 30/06/08 4. OP9 30/06/08 Avenue House Nursing and Residential Home Version 5.2 Page 29 wrong dose. A previous requirement relating medication records with a timescale for compliance of 27/02/08 has not been met. 5. OP12 OP14 12 (3) Residents’ must be supported to exercise choice in their daily routines. This must include ensuring that they are not left sitting at the table for long periods before and after meals. (A similarly worded requirement with a timescale for compliance of 06/11/07 has not been met.) 6. OP15 12 (1) (a) People must receive assistance with their meals according to their assessed needs. This must include ensuring that meals are placed within easy reach of people. All allegations of abuse or suspected abuse and any unexplained injuries must be referred without delay through safeguarding vulnerable adults procedures to social services and reported to the Commission for Social Care Inspection. All parts of the premises must be cleaned and standards of cleanliness monitored to reduce the odour, improve the environment and reduce the risk of infection. 30/06/08 30/06/08 7. OP18 13 (6) 30/06/08 8. OP26 23 (2) (d) 30/06/08 9. OP27 18 (1) (a) (c). 07/07/08 The organisation of staff and staffing levels must be monitored throughout the twenty four hour period to ensure the needs and preferences of people who use the service are met in a timely manner. (A similarly worded requirement with a DS0000067495.V363894.R01.S.doc Version 5.2 Page 30 Avenue House Nursing and Residential Home timescale for compliance of 06/11/07 has not been met.) 10. OP28 OP30 18 (c) (i) Individual staff training needs must be identified and training planned to ensure that they all have the necessary knowledge and skills to fulfil their responsibilities and meet people’s needs. This must include induction training. As part of the recruitment process and checks, two references must be obtained to help determine an applicant’s suitability to work with vulnerable people. Effective quality assurance systems need to be implemented to improve the quality of care. All staff involved with assisting people with movement and handling must be trained and practices must be monitored to ensure safe practices are adhered to and residents are not put at risk. A requirement about safe practices with a timescale for action of 06/11/07 has not been met. 30/07/08 11. OP29 19 30/06/08 12. 13. OP33 OP38 24 (1) (b) 13 (5) 30/07/08 07/07/08 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 OP8 Good Practice Recommendations Risk assessments should demonstrate clearly that risks have been properly assessed. Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 31 2. OP10 People’s preferences in relation to whether their bedroom door is open or closed should be checked to ensure that their right to privacy is protected. Meals should be monitored to ensure that they are of a consistent good quality. 3. OP15 Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Avenue House Nursing and Residential Home DS0000067495.V363894.R01.S.doc Version 5.2 Page 33 - 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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