Inspection on 10/05/07 for Avenue House Nursing and Residential Home

This inspection was carried out on 10th May 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Avenue House Nursing and... 31/10/08

Avenue House Nursing and... 01/05/08

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 Key Unannounced Inspection 10th May 2007 08:40 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.V338888.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.V338888.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 Position Vacant Care Home 43 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (43), of places Physical disability (1) Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That Avenue House is permitted to accommodate one named service user in the category of PD No one falling within the category of OP may be admitted into Avenue House where there are 43 Service Users who fall within the category of OP already accommodated within the home. No one falling within the category of DE(E) may be admitted into Avenue House where there are 10 Service Users who fall within the category of DE(E) already accommodated within the home 23rd February 2007 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 following fees were provided by the responsible individual 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 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.V338888.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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 the information held by the Commission for Social Care Inspection, two unannounced inspection visits to the service and review of comments received from relatives in questionnaires and telephone calls. The pre-inspection planning was carried out over the period of half a day and involved reviewing the service history, which details all contact with the home including notifications of events reported by the home, telephone calls, letters, action plans, reports on the conduct of the service, and details of complaints and concerns received. The report from the last key inspection carried out on 23 February 2007 was reviewed and the findings taken into account when planning this inspection. The information gathered assisted with planning the particular areas to be inspected during the unannounced inspection visits. A meeting was held with the responsible individual and a director from Jasmine Healthcare following the inspection carried out in February 2007 to discuss how compliance with regulations was to be achieved and standards of care improved. Due to the level of concern and the number of requirements made at the previous inspection, two inspection visits were carried out. These covered the morning and afternoon of weekdays. The inspection was carried out by ‘case tracking’ which involves selecting residents’ and tracking their care and experiences through review of their records, discussion with them, the care staff and observation of care practices. Inspectors’ also spoke with other residents’ who were not part of the case tracking process, some relatives who were visiting and staff. A sample of staff files were reviewed to check the adequacy of the recruitment procedures. Observations were made throughout the inspection of residents’ general well being, daily routines and interactions between staff and residents. Feedback on the inspection findings was given throughout the inspection process to a consultant who was representing the management team for part of the inspection, a director and on the final visit the responsible individual. Questionnaires were received from seventeen relatives following the inspection visits, these contained quite detailed information, which was reviewed and Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 6 taken into account as part of the inspection process. Additional information was received during telephone calls with some relatives. What the service does well: What has improved since the last inspection? What they could do better: More care needs to be taken to consider the range of needs that Avenue House can meet and to ensure that the needs of people admitted can be fully met. The needs of existing residents must also be taken into account to ensure that their needs are not compromised. Staff must have appropriate qualifications and experience to meet the needs of residents. Particular issues were identified in relation to dementia care, where it was identified that staff felt they could not meet the needs of some residents. Improved arrangements for the application of prescribed creams need to be made as there was no evidence that they were applied to residents as prescribed. Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 7 The consistency of care needs to be improved and monitored to ensure that residents receive the care they need and as identified within their care plan. This may mean keeping under review staffing levels and organisation to ensure there are sufficient staff at all times to meet residents’ needs. Staff practice in relation to movement and handling needs to be monitored to ensure that safe practices are adhered to and that residents’ are not put at risk. 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.V338888.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, Standard 6 is not applicable, as intermediate care is not provided. 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 residents’ will be met. EVIDENCE: The statement of purpose and the service user guide which give information about the services provided were not available on the day of inspection and therefore not reviewed. The responsible individual has advised that they are in the process of being revised and updated and a copy will be placed in residents’ rooms for residents’ and their families to read. A copy of the report of the inspection carried out by The Commission for Social Care Inspection in July 2006 was available in the hallway at the time of this inspection. Information received from some residents confirmed that the findings of the inspection had been discussed at a relatives meeting. Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 10 Records for a resident who had been admitted within the last few months were reviewed to check the adequacy of the assessment process in ensuring that the needs of residents admitted to Avenue House can be met. Review of the records, discussion with staff and information received following the inspection indicate that sufficient regard had not been taken of the qualifications and skills of staff to ensure the residents needs could be fully met. For example records for one resident indicated that they required dementia nursing care, however at the time of the inspection there were no suitably qualified nurses employed. Some relatives have raised concerns about the effect of the behaviours of residents’ with advanced dementia on the quality of life of other residents. The need to review the admission process to ensure that the needs of all residents’ are considered when making a decision about admitting a new resident have been acknowledged by the organisation in discussions following the inspection. Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ do not consistently receive the care that they need. EVIDENCE: At the time of the last inspection in February 2007, a consultant had just been employed to assist with the care planning and improving the care provided. Improvements were identified within residents’ care plans, which are much more reflective of residents’ individual care needs and the actions required of staff to meet them. Care plans are considered to be important documents in guiding staff in the care and support required to meet residents’ needs. While the improvements in the care planning are very positive, additional work is required to ensure that residents actually receive the care which is detailed in their care plan. Information received through review of complaints and comments made by relatives indicate that the care received by residents’ is variable and that staff Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 12 are not always aware of/or are meeting the needs of residents’. Some relatives felt that residents receive very good care, while others have noted that personal care is often rushed and in some cases residents’ are not receiving basic care. One relative identified frustration for a resident due to staff not knowing about her particular needs. Since the last inspection the number of nurses on the morning shift was increased to two, which appears to have improved the quality of the nursing care. However records still indicated that healthcare needs are not monitored as regularly as the care plan identifies they should be in order to meet residents’ assessed needs. A requirement was made following the last inspection about the need to carry out risk assessments prior to the use of bed rails. Review of a resident’s records confirmed that assessments have been carried out and that these determine the risks in relation to the individual. The assessments also indicate that guidance from the medical devices agency has been utilised reducing the risk to residents. Requirements in relation to assessments for the risk of pressure sores, falls and a nutritional risk assessment have also been met. Review of accident records for a resident identify several incidences where bruising has occurred. Discussion with staff indicates that the resident has dementia and can be resistive to care. However there is no evidence of a referral being made, or advice being sought from the Community Psychiatric Nurse about how best to meet this resident’s needs. Concerns were raised at the last inspection about the risk of prescribed medication being given to the wrong resident, as it was being pre-dispensed into small pots for several residents’ at a time. Since the last inspection additional medication training has been given to staff involved in this practice and additional medication trolleys have been purchased to assist with safe storage and administration of the medication. Observations of staff practice confirmed that nurses were administering medication correctly to one resident reducing the risk of error. The additional nurse on duty on the morning shift enabled medication to be administered more promptly to residents’. The consultant employed by the organisation was at the time of inspection in the process of carrying out a medication audit and had involved the pharmacy to reduce problems of overstocking. Advice was given as part of the audit to review practice in relation to the application of prescribed creams, as there was no evidence to confirm that this was being applied. Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 13 Observations during the inspection indicated that staff were mindful of protecting residents dignity, for example when using the hoist to transfer them from a wheelchair to a lounge chair. Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Visitors are welcomed into the home, the quality of the meals provided is good, however the daily routines are not based on the needs and preferences of residents’. EVIDENCE: On the two days of these unannounced inspection visits there appeared to be an improvement in the day to day organisation. However discussion with staff during the inspection and feedback from relatives identifies that there continues to be a problem with residents not being assisted to wash and dress in some cases until 11-30am. Staff advise that sometimes everyone will be washed by 10-30am but that this varies from day to day dependent on whether agency staff are used and which staff are on duty. Residents’ choices in relation to their preferred routines therefore continue to be limited. During the inspection the activity organiser was observed to spend time with individual residents. Choices in relation to music in one of the lounges were discussed and agreed with a group of residents. A resident with dementia who Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 15 had been a keen knitter was involved with winding balls of wool. Residents said that there are also some music and movement sessions. Comments from some relatives and observations during the inspection indicate that the daily lives of some residents without dementia are affected by the behaviours of some residents with advanced dementia. The comments identify the need to review how dementia care is provided to ensure that the needs of all residents living at Avenue House can be met. Discussion with relatives during the inspection and comments received in questionnaires confirm that the visiting arrangements are flexible and that they are able to visit as and when they choose. Residents spoken with were happy with the meals provided. On the day of inspection, there was a choice of home made Quiche Lorraine or celery bake for lunch. The meal was well presented and looked appetising. A sample confirmed that the meal was tasty. All feedback received from relatives in questionnaires about the food has been positive and two have particularly commented on the good management of diabetic diets. Discussion with the cook confirmed that staff are mindful of the need to check dietary needs when new residents are admitted and aim to meet individual needs and preferences. For example, although there are currently no vegetarians the cook has found that several residents often prefer a vegetarian alternative. Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and action is taken to safeguard residents’. EVIDENCE: The Commission for Social care Inspection received two complaints between the inspection carried out in February 2007 and the inspection visits in May 2007. One of the complaints was referred to social services for investigation under safeguarding adults’ procedures and related to the care of a specific resident. A meeting had been arranged with social services and relatives to review the issues and the care needs of the resident. The issues raised in the other complaint which was anonymous were taken into account as part of the inspection process and included: - limitations on residents choices such as times for getting up, staffing levels, high use of agency staff, staff turnover, difficulty in meeting the needs of some residents with dementia and owners not listening to staff concerns. The record of complaints at Avenue House identifies that they received two complaints during the same period, one from a relative and another from a resident. Records show that both had been responded to appropriately. Discussion with relatives identifies that they feel that their concerns are taken seriously. Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 17 Review of the training matrix identifies that the majority of staff attended protection of vulnerable adults training in March 2007 and discussion with staff confirmed that they are aware of their responsibilities in relation to reporting any concerns about how residents are treated. Records show that management take prompt action to safeguard residents and investigate any concerns raised with them. However it was identified in one case that an incident had not been notified to social services prior to investigation as required by safeguarding adults procedures. Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 18 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. The programme of re-decoration and refurbishment is gradually improving the environment that residents’ live in. EVIDENCE: Discussion with one of the directors identified that a full review of the redecoration and refurbishment needs had been carried out and progress was being made in bringing it up to an acceptable standard. For example some carpets that had been worn and stained at the time of the last inspection had been replaced and some areas had been re-decorated. One of the lounges that was just being completed was much brighter and improved lighting had been installed. Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 19 Some new furniture was also being delivered during the inspection and new storage areas have been identified for wheelchairs and hoists to reduce the ‘cluttered’ appearance of lounges. Equipment such as the hoist were cleaner and there was an improvement in the general cleanliness. A relative described the bedrooms as being “very clean”. A resident said they were not able to use the garden. The garden area had become overgrown and required a general tidy up in order to make it accessible to residents’. It was confirmed that a landscape gardener had been employed to carry out this work and enable residents to access it. Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing arrangements do not fully meet the needs of residents’. EVIDENCE: Following the inspection in February 2007 the responsible individual advised that some staffing increases had been made in response to verbal feedback on the inspection findings about meeting residents’ needs. This included increasing the nursing staff to two each morning and having an extra carer on night duty. On the day of inspection there were two nurses on duty in the morning and staff rotas indicate that this is being maintained. Observations during the inspection indicated that the increases in staffing had resulted in better organisation to meet residents’ needs. However discussion with staff, residents and relatives identified that this varies from day to day and is very dependent on the staff on duty. Comments from relatives include “there are occasions when staffing levels are inadequate leading to rushed care.” “Understaffed”, “need more staff to give a better service”, “always short staffed, particularly at weekends”. During discussions with the directors they have acknowledged the need to continue to monitor staffing arrangements and levels in relation to the needs of residents. Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 21 Staff with varying roles and responsibilities were spoken with during the inspection and all presented as being caring and anxious to work to improve standards of care to residents. This is supported by conversations with some relatives who feel that the majority of staff are very caring. Several relatives have also commented on the need for more permanent staff to provide consistency of care. At the time of inspection several prospective staff had been interviewed and references and criminal record bureau checks applied for. Two staff files were reviewed to check the adequacy of the recruitment process. This identified that references and criminal record bureau clearances were obtained prior to staff starting work, which provides some protection to residents. Advice was given to request employment references from the business address rather than a private address and to where possible verify the source of references in order to protect residents. Review of the training matrix and discussion with staff confirms that various training courses have been provided since the last inspection. The training has been specific to meeting the needs of residents and includes: medication, infection control, protection of vulnerable adults, dementia and tissue viability. Discussion with staff about the care of residents with dementia indicated that although they had attended the dementia care training it did not appear to resolve the difficulties that they were having in meeting the needs of residents’ with dementia. This is also reflected in comments received from relatives one of which says that although staff are caring, it would be an advantage if some staff could have more in depth training in dementia care. As detailed in the choice of home section of this report, records for one resident indicated that they required dementia nursing care, however at the time of the inspection there were no suitably qualified nurses employed to meet these nursing needs. Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 22 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): 33, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality of care received by residents’ still requires improvement; however the appointment of a permanent manager and additional management support provides a better opportunity improve the care and safeguard residents’. EVIDENCE: Standard 31 has not been assessed as such as this relates specifically to a registered manager and there is no registered manager in post. However management arrangements have been considered and are reported on as they have a direct effect on standards of care provided to residents. Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 23 At the time of the inspection the responsible individual was managing the home with the support of a director of Jasmine Healthcare. A consultant had been employed to assist with the development of the care plans and other management duties. A new manager had been recruited and was due to start work shortly after the inspection. There is evidence that Jasmine Healthcare have put a lot of time and effort in to making improvements, such as additional training for staff and improved care planning processes, improvements to the environment are also being made. Records also show that poor staff practices have been dealt with where appropriate. Compliance with the majority of statutory requirements has also been achieved. The efforts seem to be acknowledged by relatives with comments such as “trying hard to improve” and “think they are moving in the right direction”. Given the efforts that have been made it is disappointing that higher standards of care for residents’ have not yet been reached. Confirmation of the new manager starting has been received following the inspection and she has advised that the management team are working alongside staff to raise the quality of care provided to residents. A management rota has been implemented to ensure that managers are not just working 9am to 5pm and are able to assess and monitor standards of care at weekends and overnight. One of the directors has continued to carry out regular visits to the home to support the responsible individual with the management role and also to identify areas for continued improvement. While records show that staff have received up to date movement and handling training, incidences of poor practice have been identified through discussion with staff and also relatives. These practices have included a resident who was assessed as requiring a hoist being physically lifted by staff putting staff and the resident at risk. Incorrect size slings for hoists have been used causing a resident to slip out of it putting them at risk of injury. Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 24 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 1 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X 2 Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 (1),18 (1) (a) Requirement Timescale for action 15/07/07 2. OP4 OP8 14 (1), 12 (1) (a, b) Residents’ must not be admitted to Avenue House unless their needs can be met, which includes staff being appropriately qualified and experienced. Arrangements must be in place 15/07/07 to ensure that residents receive assistance and care according to their assessed needs. (This requirement is outstanding from previous inspections with timescales for compliance of 20/11/06 and 30/03/07 have not been met.) Medication administration records must confirm that prescribed medication including creams have been administered in accordance with the prescriber’s instructions. (This requirement is outstanding from a previous inspection with a timescale for compliance of 12/03/07, which has not been met.) Residents’ must be supported to exercise choice in their daily DS0000067495.V338888.R01.S.doc 3. OP9 12 (1) (a, b), 13 (2) 15/07/07 4. OP12 12 (3) 15/07/07 Avenue House Nursing and Residential Home Version 5.2 Page 26 5. OP14 OP12 18 (1) (a) routines. Staffing arrangements and staffing levels must adequately meet the needs and preferences of residents’ at all times. ( A similarly worded requirement with a timescale for compliance of 30/03/07 has not been met.) Movement and handling practices must be monitored to ensure safe practices are adhered to and residents are not put at risk. 15/07/07 6. OP38 13 (5) 15/07/07 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. 4. 5. Refer to Standard OP3 OP4 OP4 OP19 OP30 OP33 Good Practice Recommendations The admission criteria should be reviewed to ensure that the needs of people admitted can be met. A review of the way dementia care is provided should be carried out taking account of current research and good practice. The planned re-decoration and refurbishment programme should be completed as soon as practicable to provide a pleasant environment for residents. The adequacy of training including dementia care training in equipping staff to meet residents’ needs should be reviewed. Methods of ascertaining the consistency and adequacy of care including personal care should be developed. Avenue House Nursing and Residential Home DS0000067495.V338888.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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.V338888.R01.S.doc Version 5.2 Page 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!