Inspection on 23/02/07 for Avenue House Nursing and Residential Home

This inspection was carried out on 23rd February 2007.

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

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

Other inspections for this house

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

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

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

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 Mrs Kathy Jones Key Unannounced Inspection 23rd February 2007 08:50 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.V331302.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.V331302.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.V331302.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 31st October 2006 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.V331302.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 as part of the pre-inspection planning and an unannounced inspection visit to the service. 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 reports from the last key inspection carried out on 25 July 2006 and a random inspection on 31 October 2006, were also reviewed and the findings taken into account when planning this inspection. All inspections were unannounced and the information gathered assisted with planning the particular areas to be inspected during this visit. Information gathered through a pre-inspection questionnaire and questionnaires received from residents, relatives and health professionals were incorporated into the inspection report of 25 July 2006 and therefore have not been included within this report. The unannounced inspection visit covered the morning and afternoon of a weekday and was carried out by two inspectors. 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. Communal areas and a sample of residents’ bedrooms were viewed and observations were made of residents’ general well being, daily routines and interactions between staff and residents. Feedback on the inspection findings was given to a consultant who was representing the management team at the time of the inspection. Some additional discussion has taken place by telephone with the responsible individual following the inspection. What the service does well: Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 6 There are flexible visiting arrangements and staff greeted visitors on arrival. The majority of the residents’ were happy with the meals provided and it was confirmed that there is a choice of meal. On the day of the inspection the main lunch time meal was fish and chips, or scampi or sausage. Residents’ were complimentary about the activities programme and had enjoyed particular activities such as quizzes and armchair exercises. On the morning of the inspection the activity organiser discussed the daily papers with some residents’ individually. Relatives of a recently admitted resident were pleased that they had been able to bring some of the residents own furniture in order to create as homely an environment as possible. They were also pleased with the efforts of staff to help settle the resident. Staff were co-operative with the inspection process. What has improved since the last inspection? What they could do better: Care plans, which are tools to guide staff in the actions they need to take to meet residents’ needs, were not fully reflective of residents needs and in some cases were not followed or contained conflicting information. This puts residents’ at risk of their needs not being met. The extent of the shortfalls was of particular concern as previous requirements have been made. In view of repeated requirements and the risk the inadequate care planning presents to residents a new short timescale for compliance has been given. Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 7 Resident records and information detailed in complaints from relatives identifies concerns about assessment, planning and meeting of residents’ needs including health care needs. Requirements have been made which include assessment, dementia care and catheter care. The use of aids such as pressure mats and pressure pads on chairs which sound an alarm to alert staff if the resident moves, which are in place for some residents without, consent has been queried. Currently there is no evidence of consent or a proper assessment to support the need for this restraint/restriction on residents’ rights. Inspectors also observed that in one case this appeared to be a barrier to maintaining a residents’ mobility. The management of medication was found to be generally poor and put residents at risk through unsafe practice. On arrival at Avenue House, inspectors saw in the treatment room a small tray, which contained thirteen small pots containing various tablets, two beakers which appeared to contain soluble medication. There was no means of identifying which pot of medication was prescribed to which resident and there was a serious risk a resident would be given the wrong medication. Following discussion the medication was destroyed and medication was administered correctly to one resident at a time. Staffing levels, routines and practices of the service do not appear to be based on the needs of residents, with residents having to wait lengthy periods. This was identified in relation to assistance with washing and dressing in the mornings and evenings and also to be assisted to and from the dining table and served with meals. The inspector has been informed that there is a re-decoration and refurbishment programme in place. Some areas of the home were looking quite shabby, however this was exacerbated by the poor standard of cleanliness and the storage of equipment, which was also dirty in the lounge. The findings of the inspection, which have identified deterioration in the standards of care, require the organisation to implement urgent measures to comply with regulations and safeguard residents. 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.V331302.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.V331302.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, standard 6 is not applicable, as Avenue House does not provide intermediate care. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an admission process to establish the ability of the service to meet the needs of people admitted to the home prior to admission, however more care needs to be taken to ensure that the needs fall within the range that the service is able to meet. EVIDENCE: This section of the standards was not assessed in detail during this inspection as the focus for the inspection was considering how the needs of current residents’ were being met. However a sample check of the care records for a recently admitted resident was made to ensure that an assessment of the needs of prospective residents was being carried out prior to admission. It was confirmed that this had been done. Pre-admission assessments are considered Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 10 important in establishing if the service is able to meet the specific needs of the individual. Review of another residents’ care file identified that although staff considered the resident to have dementia, there was no evidence of this diagnosis. The records indicated that in fact the resident might have mental health needs. Mental health is not a category that the service is registered for and there was no evidence of any specific training that staff have undertaken. It was therefore unclear as to how a judgement had been made about meeting the prospective residents’ needs, which puts them at risk of not being met. One of the inspector’s spoke with relatives of a recently admitted resident who felt that staff were doing their best to assist the resident to settle into the home. Avenue House Nursing and Residential Home DS0000067495.V331302.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 poor This judgement has been made using available evidence including a visit to this service. The shortfall in the planning and oversight of residents’ care and health needs and unsafe medication practices puts residents at risk. EVIDENCE: Requirements were made following the inspection on 25 July 2006 regarding the need to ensure that care plans were reflective of residents needs. At the time of a random inspection on 31 October 2006 some work was being carried out on the care plans however shortfalls were again identified and a new timescale for compliance was set for 15 January 2007. Care plans are considered to be important documents in guiding staff in the care and support required to meet residents’ needs. At the time of this inspection there was a consultant who had been employed to work with staff in addressing the shortfalls in care planning, however this work had not yet been completed. Review of a sample of the care plans during Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 12 the inspection identified continuing shortfalls. Some examples of this are detailed below: In some cases care plans contained conflicting information, for example “has no problems with breathing” and then “requires assistance of an inhaler on occasions as ----- is asthmatic”. One resident had a care plan, which stated “regular use of laxatives” but also has a care plan for diarrhoea and vomiting to “try and reduce the number of episodes”. This identified a lack of proper oversight and consideration of residents’ health care needs and there was no evidence of referral to a General Practitioner for review. Review of the care records for a resident with a supra pubic catheter indicated that care plans were not followed and did not contain all of the required information putting residents at risk of inadequate care. The care plan stated that the catheter site should be checked and cleaned daily. A “dressing chart” was in place. These records were difficult to track as the dates were not in all cases consecutive, however in two cases there was not a record of the site being checked for three days and in one case not for four days. There was also no mention within the care plan of the infection, which the professional visit record shows had been diagnosed. Inspectors were informed that some professional advice had been sought regarding the risk of falls. Copies of falls risk assessments provided by the falls adviser were seen on the care file of a resident identified as being at risk of falls however this had not been completed. The resident was observed to be discouraged from walking by staff and there was no plan in place to assist with maintaining mobility, which may increase the risk of falls. Daily notes showed that on one occasion the resident was described as being “wandersome” and had made use of another resident’s zimmer frame to get around. There was no evidence of consideration of any aids to assist this resident with independent mobility. Several residents’ were observed to be wearing no shoes or appropriate footwear which again may increase the risk of falls. A staff member advised that two residents have pressure pads which alert staff that they have moved from the chair, however said that one resident switches theirs off and moves to another chair as she doesn’t like it. There was no evidence on the residents’ care file of consent to this restraint/restriction of rights or evidence of how the need for this had been assessed and agreed. Care plans identified that pressure mats and bed rails were in place in some residents’ rooms. There was no evidence of risk assessments for the use of these. The lack of an adequate assessment for the use of bed rails was identified at the inspection carried out in October 2006 and advice was given to access guidance on the use of bed rails produced by the medical devices agency. Due to the risk of injury if bed rails are not used appropriately it is Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 13 important that a thorough risk assessment has been carried out in respect of the individual resident and that it is reviewed regularly. No care plans were in place to guide staff in meeting a resident’s dementia care needs and disinhibited behaviours. A care plan for one resident stated that their legs should be elevated at all times whilst sitting, there was no evidence of this resident being encouraged to elevate their legs and no stool or any other means available to enable her to do so. Risk assessments to identify nutritional risk and the risk of pressure sores were sample checked. This identified that in some cases they had been incorrectly completed and scored resulting in inaccurate information about the level of risk. Arrangements for the management of diabetics was poor, in that care plans did not contain parameters for blood glucose levels to alert staff as when to take further action. A resident’s daily notes contained an entry that staff were unable to check a diabetics glucose levels, as there were no testing sticks in stock. Records were in place, which recorded quantities of medication held for individual residents. A sample check of records of medication administered confirmed that staff were signing to confirm administration in most cases. However there were no signatures to confirm that some prescribed cream had been applied. The management of medication was found to be generally poor and put residents at risk through unsafe practice. On arrival at Avenue House, inspectors saw in the treatment room a small tray, which contained thirteen small pots containing various tablets, two beakers which appeared to contain soluble medication. There was no means of identifying which pot of medication was prescribed to which resident and there was a serious risk a resident would be given the wrong medication. Following discussion the medication was destroyed and medication was administered correctly to one resident at a time. The tray of medication described above also contained some eye drops, which did not contain the name of the resident they were prescribed for, creating a risk of these being administered to the wrong person. Records showed that antibiotics for a resident were being administered four times a day through the day time period rather than four times a day throughout the twenty four hour period as prescribed. Inadequate spacing of the doses of antibiotics will adversely affect their effectiveness in treating the diagnosed condition. Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 14 The organisation and storage of medication was poor. There were two medication trolleys, however staff advised that there was insufficient space to accommodate medication for all of the residents. Medication for some of the residents’ was stored in a metal cupboard fixed to the wall in the treatment room. This medication appeared disorganised with various boxes of medication piled up in no particular order creating a risk of error. The new supply of medication, which had been delivered, was found on one occasion to be left in the unlocked treatment room. Staff were observed to speak to and treat residents with respect during the inspection and residents spoken with were happy with how they were treated. The night care plan for a resident stated that they wore pads but still got up to the toilet. There was no evidence of any continence assessment to establish if there was a need for incontinence pads. There was also no record of any consultation with the resident around the management of continence or evidence of consideration of their dignity. Avenue House Nursing and Residential Home DS0000067495.V331302.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 adequate. This judgement has been made using available evidence including a visit to this service. Visitors are welcomed into the home and residents’ were on the whole satisfied with the food provided, however the daily routines are not based on the needs and preferences of residents’. EVIDENCE: The routines and practices do not support individual choices for those resident’s reliant on staff assistance. For example in discussion with one resident it was identified that times for getting up and going to bed vary considerably and are not based on choice. The resident identified that sometimes they will be assisted to bed about 7-45pm and another time it might be 11pm. On the day of the inspection discussion identified that the fact that some residents were not washed and dressed until almost lunch time was again not based on personal preference. A new activities organiser started work in the home just before Christmas. Discussion with her and review of the February activity programme identified that there are organised activities such as crafts, reminiscence, quizzes, games Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 16 and current affairs. There is also recognition that some residents are not able to or would wish to join in some of the organised activities and some one to one time is organised. On the morning of the inspection the activities organiser was taking copies of newspapers to residents and discussing the news with them. Observations and discussions with residents’ indicated that the approach to activities had made a positive contribution to residents’ daily lives. One of the residents spoken with said that they had some armchair exercises the day before the inspection and also enjoyed the quizzes. A monthly newsletter started in January, which includes birthdays and information about the activities with some colour photographs of some of the crafts that were made such as trinket boxes and name plates for bedroom doors. On the day of the inspection some of the residents were enjoying having their hair done by the hairdresser who said she visits the home twice a week. Visiting arrangements are flexible and during the inspection staff were greeting visitors in a friendly manner. The majority of residents spoken with were happy with the food provided. Lunch on the day of inspection was a choice of fish and chips and peas, or scampi or sausages. There is also a choice at tea time of sandwiches or something hot on toast. Special diets are catered for and the cook was aware of these. Observations during the lunch time period identified that the majority of residents’ eat their meals in the dining room at the same time. Residents were observed to have to wait for lengthy periods at the dining table either for their meal or for assistance in moving away from the table. Some residents waited up to one hour before their meal was served. Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 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 responded to appropriately with shortfalls being acknowledged, however this has not in all cases resulted in improved outcomes for residents’. EVIDENCE: There were indications at the time of the inspection in July 2006 that complaints may not have been recorded in all cases. A recommendation was made that records should be kept of all complaints/concerns/grumbles and the action taken to address them. Following the key inspection in July 2006, concerns have been raised from some relatives about the standards of care in the home. Due to the level of concerns, social services have held meetings under safeguarding adults’ procedures to consider appropriate actions to protect residents. The meetings have involved social services as the agency responsible for protecting vulnerable adults; health, police and the commission for social care inspection. The responsible individual and a director of the organisation co-operated with social services and other agencies and have attended the meetings and supplied information within detailed action plans of the actions taken to Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 18 address the concerns that have been raised. The action plans have identified appropriate actions have been taken. However the complaint record held at Avenue House at the time of the inspection identified that there has been a recent increase in the level of complaints with eight complaints received since the middle of January 2007. Six of the complaints related to concerns about resident care. An improvement in the way complaints are managed was identified in that the complaints had all been appropriately investigated and responded to, with an acknowledgment of shortfalls where these had been identified. Thorough investigation of complaints and acknowledgement of shortfalls is considered to be an important step in improving standards of care for residents. However, while the management of complaints appears to have significantly improved and is considered to be good, it is of concern that a sample check of a resident’s care records identifies that acknowledged shortfalls have not in all cases resulted in an improvement in practice. While these shortfalls link to the management of complaints they have been addressed through making specific requirements relating to health and personal care. A copy of a report received about the conduct of the home identified that staff training was booked for January 2007 in protection of vulnerable adults. The responsible individual advised following the inspection that a training package has been purchased however staff have not to date completed the training. This training is considered to be important in ensuring staff fully understand what constitutes abusive practice and are aware of their responsibilities in protecting vulnerable people in their care from abuse. There is evidence that the organisation is aware of their responsibilities in acting to protect residents from abuse. Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The poor standard of cleanliness and attention to the environment does not provide a safe and comfortable place for residents’ to live. EVIDENCE: A brief tour of the environment was carried out during the inspection, which consisted of a sample check of communal areas and residents’ rooms and bathrooms. The kitchen was also viewed during the inspection. Findings were as follows: The communal areas of the home were observed to be in need of a thorough clean and re-decoration. For example walls and paintwork were scuffed and shabby and carpets were dirty and stained, and in some areas worn. A report submitted to the Commission for Social Care Inspection from the organisation Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 20 identifies that there are plans in place for the re-decoration and refurbishment of the home. Timescales for this were not detailed in the report. The home caters for people with a wide range of needs including people who need wheelchairs and hoists for assistance with movement and handling. It was noted at the inspection in July 2006 that there were no storage facilities for this type of equipment and it is stored in bathrooms and lounges. This remains the case and areas of the home appear cluttered. A bathroom, a cloakroom and a shower room were found to have no locks impacting on the privacy and dignity of residents. A stick deodorant, shaving foam and some dipobase cream were found in the shower room. These items did not contain the names of residents indicating that more than one resident may use these. As well as this being a dignity issue it creates an infection control risk. A communal nailbrush in the staff toilet was also considered to be an infection control risk. Paper towels, soap and disposable gloves were available for use by staff in residents’ rooms to reduce the risk of infection. A member of staff informed inspectors that infection control procedures have recently been tightened up, due to some residents having infections. The standard of cleanliness was poor, carpets and some chairs were dirty and stained, tablecloths in the dining room were stained with dried food even when re-set ready for lunch. Movement and handling equipment such as the hoists were dirty and contained what appeared to be food debris. The utility area of the kitchen was very dirty and a bed base in a residents’ bedroom contained brown stains. Following the inspection the responsible individual has informed the inspector that arrangements have been made for contract cleaners to carry out a thorough clean in all rooms. Relatives of a recently admitted resident said that the resident had been able to bring some of their own furniture and personal belongings and had a nice room. Lights were switched off in the corridor on the first floor, on two occasions during the day, even though there were residents on that floor. As there was no natural light it was quite dark and posed a risk of falls. Observations during the inspection identified that there were delays in responses to resident call bells. Further exploration of this identified that there was a limited number of displays to identify the number of the room requiring a response in the home. Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 levels and staff training do not provide adequate care and protection for residents. EVIDENCE: Concerns about staffing levels and deployment of staff were identified in the report of the inspection carried out in July 2006. A random inspection in October 2006 identified that improvements had been made to how residents’ needs were met. A report of visits undertaken in December 2006 and January 2007 produced by Jasmine Healthcare states that staffing levels continue to be well in excess of those recommended. The report refers to the dependency levels of residents in relation to staffing levels. Given that this inspection has highlighted serious shortfalls in the level of care received by residents the process for determining staffing levels clearly needs to be reviewed. At the time of the inspection there were forty residents with a variety of different needs including nursing needs. Discussion with staff during the inspection and review of the staff rota, identified that there had been a reduction to one nurse on duty on some days, which made it very difficult for them to carry out the duties expected of them and to meet residents nursing needs. The staff rota also showed that at night there was only a nurse and two Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 22 care assistants on duty, which given the number and needs of residents and the layout of the building was considered to be insufficient. Following the inspection the responsible individual has advised that some staffing increases have been made in response to verbal feedback on the inspection findings about meeting residents’ needs. This includes increasing the nursing staff to two each morning and an extra carer on night duty. It is of concern that as detailed in the daily life and social activities section of this report, residents’ needs and preferences were not being met at the time of this inspection. While the increase in staffing levels should improve outcomes for residents’ to some extent, it will be necessary to carry out a full review of staffing levels and deployment throughout the twenty four hour period and to review regularly to ensure residents’ needs are fully met. A sample check of the staff rota was made, this identified that it was difficult to evidence the adequacy of staffing arrangements from the rota. The role of staff was not consistently recorded or the times of shifts, and rotas for domestic staff could not be located during the inspection to evidence staffing levels. At a random inspection carried out in October 2006, the responsible individual informed the inspector that she had audited staff files as the previous owner and/or the registered manager who has now left had employed many of the staff. Concerns were identified about the recruitment processes that had been carried out in respect of some of the staff and discussion indicated that appropriate action has now been taken to protect residents. A sample check of the files for recently recruited staff confirmed that two references and a criminal record bureau clearance were obtained prior to staff starting work. Advice was given to ensure that the adequacy of the references is explored, as it was identified through review of one member of staff’s references that there was nothing to indicate their suitability in carrying out the role they had applied for. There was no evidence of any induction training or an assessment of training needs being carried out on the files of two recently recruited staff. One of the directors of the organisation has been carrying out interviews with staff during his visit, and as part of this some training needs have been identified. The director’s report says that some training has been carried out and a significant amount has been identified and booked. A sample check of staff files confirmed that some training had been carried out, however it was not clear to what extent the shortfalls had been addressed. Following the inspection a training matrix has been requested with an overview of staff training. Staff training is considered to be crucial in helping to ensure that residents specific needs can be met. Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although there are improvements in some of the management systems, overall management arrangements are not protecting the health, safety and welfare of 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.V331302.R01.S.doc Version 5.2 Page 24 Since the registered manager in post at the time of the last inspection left, the responsible individual has been carrying out the management role with the support of a director of Jasmine Healthcare. At the time of the inspection a consultant was assisting with the development of the care plans, and following the inspection the responsible individual has advised that the consultant will be project managing general improvements in standards for a short period. A recruitment process for a new manager is also underway. There is evidence that Jasmine Healthcare have carried out a considerable amount of work in developing action plans to address shortfalls identified through complaints and safeguarding concerns. They have also co-operated with other agencies through multi-disciplinary safeguarding meetings and provided requested information. One of the directors has carried out regular visits to the home and submitted copies of the reports to the Commission for Social Care Inspection. These reports have been quite thorough and have included in depth interviews with staff. Given the detailed action plans and reports which indicate a commitment to identifying and addressing shortfalls it is very disappointing and of concern that this does not seem to have resulted in improvements in standards of care. In fact the findings of this inspection indicate that there has been deterioration in standards of care received by residents’. It is also of concern that shortfalls in staffing levels had not been addressed before they were prompted by the inspection findings. The management of residents’ monies was not reviewed during this inspection, however a sample check was carried out during the inspection in July 2006. This confirmed that there was a clear system for recording any money held on residents’ behalf and there was evidence that the money was stored securely. No concerns have been received about the management of residents’ monies since that time. It was identified that a monthly audit on accident records was being carried out and the findings evaluated. This record has shown a reduction in the number of falls and skin tears. As detailed in the staffing section an overview of staff training was not available at the time of the inspection and has been requested. It was therefore not clear if all staff have received up to date training in safe working practices. Records on two staff files checked identified that they had received recent movement and handling and first aid training. However there was no evidence of one receiving any fire safety training and the other had not since 2003. Some of the systems and practices observed indicate a need to consider training and practice for staff in relation to their particular roles. For example Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 25 a cleaning trolley was left unattended with a range of cleaning products accessible posing a particular risk to residents with dementia. Steradent tablets were noted to be left in bathrooms and there was no evidence of a risk assessment for this or similar products. Such products pose a particular risk to residents’ with dementia who may swallow the tablet with serious consequences. Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 X X X 1 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/A X 2 X X X X 2 Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 27 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 12 (1) (a &b), 15 Requirement Care plans must be reflective of residents’ current needs and sufficiently detailed to guide staff in providing consistent care. (This requirement is outstanding from a previous inspection and the timescale for compliance of 15/01/07 has not been met.) Care plans for residents with dementia must provide clear detail about how their dementia care needs are to be met. Care plans must include the presence of infections where present, and details of any additional treatment or specific infection control procedures. Arrangements must be in place to ensure that residents receive assistance according to their assessed needs. (This requirement is outstanding from a previous inspection and the timescale for compliance of 20/11/06 has not been met.) Arrangements must be in place to monitor residents’ health DS0000067495.V331302.R01.S.doc Timescale for action 06/04/07 2. OP4 OP7 OP7 OP8 12 (1) (a &b), 15 12 (1) (a &b), 13 (3), 15 14 (1), 12 (1) (a, b) 30/03/07 3. 30/03/07 4. OP4 OP8 30/03/07 5. OP8 12 (1) (a, b), 13 (b) 30/03/07 Avenue House Nursing and Residential Home Version 5.2 Page 28 6. OP8 7. OP8 8. OP8 9. OP8 OP14 10. OP9 11. OP9 needs and ensure any necessary care is provided, with referral to healthcare services where necessary. This would include catheter care and the management of diabetes. 12 (1) Assessments including pressure (b), 14 sore and nutritional risk assessments must be completed by a suitably qualified and trained person and be accurate to reduce the risk to residents. 12 (1) a, A risk assessment must be b), 13 (4) carried out, prior to the use of (c), 14 bed rails to reduce the risk of injury. A suitably qualified and trained person must do this. 12 (1) a, A risk assessment must be b), 13 (4) completed for residents (c), 14 identified as being at risk of falls. A suitably qualified and trained person must do this and arrangements for appropriate physical exercise must be included and facilitated. 12 (1) a, There must be evidence through b), 12 (2), detailed assessments, 13 (7) consultation with residents, their families and health professionals that there is full agreement that the use of pressure mats, pressure cushions (with an alarm) and bed rails are the only practicable means of securing the resident’s welfare. 12 (1) (a, Prescribed medication must not b), 13 (2), be administered to residents 13 (4) (c) unless it contains their name and the prescriber’s instructions. (This requirement is outstanding from a previous inspection and the timescale for compliance of 20/11/06 has not been met.) 12 (1) (a, Medication administration b), 13 (2) records must confirm that prescribed medication including creams have been administered in accordance with the DS0000067495.V331302.R01.S.doc 30/03/07 30/03/07 30/03/07 30/03/07 12/03/07 12/03/07 Avenue House Nursing and Residential Home Version 5.2 Page 29 12. 13. OP9 OP9 14. 15. OP9 OP12 OP27 16. OP26 OP27 OP28 OP30 17. 18. OP38 prescriber’s instructions. Resident’s medication must not be pre-dispensed due to the high risk of error. Residents’ must receive medication at intervals determined by the prescriber, which includes antibiotics. 13 (2), 13 Medication must be stored and (4) (c) organised securely and safely and enable safe administration. 18 (1) (a) There must be sufficient staff on duty to meet residents needs at all times and ensure that they do not have to wait long periods for assistance such as with washing and dressing, meals and medication and handling and can exercise choice in their daily routines. 18 (1) (a) There must be sufficient staff on duty and adequate arrangements 16 (2) (j) to ensure that a good standard of cleanliness is maintained. 18 (1) (c) Staff must receive training, (i) which includes induction training and training to meet the specific identified needs of residents’ living at Avenue House. 13 (4) (c ) Arrangements must be in place to ensure that residents are not put at unnecessary risk to their health and safety through unattended cleaning products and products such as ‘steradent’. 12 (1) (a, b), 13 (2), 13 (4) ( c) 12 (1) (a, b), 13 (2), 12/03/07 12/03/07 30/03/07 30/03/07 30/03/07 30/04/07 12/03/07 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. Refer to Standard OP22 Good Practice Recommendations A review of the adequacy of the call bell displays should be DS0000067495.V331302.R01.S.doc Version 5.2 Page 30 Avenue House Nursing and Residential Home 2. 3. 4. OP19 OP19 OP10 OP8 carried out to ensure this is not increasing response times to residents. Alternative storage arrangements for equipment such as wheelchairs and hoists should be found to reduce the cluttered appearance of lounges. Timescales for re-decoration should be identified. A review of the use of toiletries should be carried out to ensure that residents do not have the indignity or risk of infection from communal use of products. Avenue House Nursing and Residential Home DS0000067495.V331302.R01.S.doc Version 5.2 Page 31 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.V331302.R01.S.doc Version 5.2 Page 32 - 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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