Inspection on 31/10/08 for Avenue House Nursing and Residential Home

This inspection was carried out on 31st October 2008.

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

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... 01/05/08

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 06/02/2009.

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 31st October 2008 06:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Avenue House Nursing and Residential Home DS0000067495.V372997.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.V372997.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.V372997.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. 1st May 2008 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 Service User Guide dated August 2008 contains clear information about charges. The guide states “fees charged range from £350 per week to £700 per week. This range of charges includes costs for personal care towards the lower end of the scale and nursing care towards the higher end of the scale. Service users who receive nursing care will receive a payment of at least £101 per Avenue House Nursing and Residential Home DS0000067495.V372997.R01.S.doc Version 5.2 Page 5 week, which will be collected directly by the care home from the local Primary Care Trust. The fees calculated will also be dependent on the care needs / dependency of the service user as well as the room selected.” The service user guide provides details of what is and what is not included in the fee and gives examples of additional costs. Fees include personal care and where applicable nursing care, meals and accommodation. Chiropody, hairdressing services, transport, escort by staff for appointments and newspapers can be arranged and are charged separately. Other costs would include clothing and toiletries. These are just some examples it is important to read the guide in full. A copy of the key inspection report for May 2008 published by The Commission for Social care Inspection was available on the hall table. Avenue House Nursing and Residential Home DS0000067495.V372997.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 1 star. This means the people who use this service experience adequate 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 and information received since the last inspection and an unannounced inspection visit to the home. The preinspection planning was carried out over the period of half a day and involved drawing all of the information together by 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 2008, however two random inspections took place in August and September 2008. The inspection in August focussed specifically on looking at whether people’s health care needs were being met as we had received a complaint, which was referred to social services through safeguarding adult procedures. The inspection in September again looked at health care needs but also looked at progress in complying with previous requirements. Information from these inspections has been taken into account as part of this inspection. This unannounced inspection visit covered the early morning and late afternoon of a weekday. There was a break from late morning to early afternoon due to a multi-disciplinary safeguarding meeting held at social services regarding Avenue House. The Responsible Individual, Chief Executive of Jasmine Healthcare and the Acting Manager also attended the meeting. 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. Not all of the people we observed during the inspection were able to express their views on the care easily, either due to being very poorly or due to having a dementia type illness. 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. Avenue House Nursing and Residential Home DS0000067495.V372997.R01.S.doc Version 5.2 Page 7 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. Verbal feedback was given to the Responsible Individual, Chief Executive of Jasmine Healthcare and the Acting Manager Acting Manager on the day of the inspection. We have also received some information following the inspection by e-mail, which has been incorporated, into the inspection. What the service does well: What has improved since the last inspection? What they could do better: The history indicates that there has been a continued commitment expressed towards raising standards and at times improvements have been made. One of Avenue House Nursing and Residential Home DS0000067495.V372997.R01.S.doc Version 5.2 Page 8 the key areas for improvement is continuing the progress made and then sustaining the improvements. Efforts need to be made to maintain a consistent management and staff team, which will help with continuing the improvements, and provide consistency of care. Some aspects of the management of medication need to be improved. In particular record keeping in respect of maintaining an effective audit trail and also arrangements for the administration of medication via PEG feed tubes. Some dignity issues were highlighted during the inspection such as the lack of a privacy curtain in a shared room and disposal of continence products. While there was evidence of some staff training taking place records show that a considerable amount of training is still required to ensure that all staff have had appropriate training to meet people’s needs. 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.V372997.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.V372997.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, standard 6 was not inspected as intermediate care is not provided. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Good information is available about the services provided by Avenue House and improved arrangements for helping to ensure people’s needs are properly assessed prior to admission have been implemented. EVIDENCE: A requirement was made following the inspection in May 2008 that clear information about the fees and all charges must be included within the statement of purpose. This information is now included in the revised service user guide which also provides prospective and current people who use the service very good information about Avenue house and the services available. This is very important in helping people to make informed decisions about their care. Avenue House Nursing and Residential Home DS0000067495.V372997.R01.S.doc Version 5.2 Page 11 The service user guide describes a clear admission process whereby a persons needs are assessed to ensure that they can be met prior to admission. The inspection in May 2008 identified concerns about the assessment and admission process, which had led to some inappropriate admissions resulting in needs not being met and people having to be moved. This was also an issue of concern in July 2007. However an improvement plan submitted following the inspection in May 2008 stated that training was going to be given to all staff who undertake these assessments. An update of this plan received on 31st October 2008, confirmed that pre-admission assessments would only be carried out by the manager or deputy manager and that the responsible individual would oversee them. The plan also stated that people with dementia would not be admitted until the responsible individual was satisfied that staff have the knowledge and skills to meet the needs of people with dementia. This is important in helping to ensure that the needs of people admitted can be met. During the inspection in September 2008 records were reviewed for someone who had recently been admitted to Avenue House. The documentation identified that an assessment had been carried out prior to admission, which established the person’s needs enabling a decision to be made about whether their needs could be met. We were informed that there had been no further admissions due to an agreement between Northamptonshire County Council and Avenue House to temporarily suspend admissions to enable them to improve standards of care. The suspension on admissions was lifted during a multi agency safeguarding meeting held on 31st October 2008. Due to the lack of recent admissions it was not possible to confirm ongoing improvement in the assessment and admission process, however appropriate arrangements are in place to help ensure that people’s needs are met. Avenue House Nursing and Residential Home DS0000067495.V372997.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 adequate. This judgement has been made using available evidence including a visit to this service. There has been an improvement in the care plans, which support people’s care, and the care they receive. Aspects of the management of medication require further improvement to ensure people’s medication is safely administered and managed. EVIDENCE: The inspection in May 2008 had identified concerns about the quality of care provided and requirements were made. Further concerns were raised about the care of people in an anonymous complaint early in August. The concerns were referred to social services under safeguarding vulnerable adult procedures. In addition as a result of the concerns raised we carried out random inspections on 7th August and 22nd September 2008. The random inspections continued to identify concerns about the quality of care; however there was evidence that action was being taken to address the Avenue House Nursing and Residential Home DS0000067495.V372997.R01.S.doc Version 5.2 Page 13 problems. The findings of this inspection show that some improvements have been made. We looked at a sample of people’s care records, and spoke with people who use the service and staff. We found that there had been improvements to the care plans, which guide staff in the care to be delivered. Plans for further improvements to care planning documentation and organisation of records were discussed with the Acting manager. Care plans were found to be more reflective of people’s needs with better records of the care delivered and changes to people’s health. One of the areas we had been concerned about previously had been wound care. The records reviewed during this inspection for someone with a pressure ulcer identified that there was a care plan in place, which clearly identified the treatment, required, there were records in place to confirm the treatment the effectiveness of this. There was also evidence that advice had been sought from a Tissue Viability Nurse. Improvements were also found to the instruction to staff and monitoring of someone who is fed through a PEG (Percutaneous Endoscopic Gastrostomy) feeding tube. Records showed that a dietician had recently visited and had given advice on the feeding regime for staff to follow. It is important that the condition of the PEG site is monitored and regular care provided. Records were in place to confirm this. Observations throughput the inspection indicated that the delivery of care was better planned and organised helping to reduce the length of time that people waited for assistance. Discussion with someone who uses the service indicated that waiting times for assistance still vary indicting the need to for ongoing review to ensure that people’s needs are being met. The improvement plan identifies that the Acting Manager has spent time working alongside staff to improve care practices and identify required changes. A staff member confirmed that the manager is working with them to help resolve any practical difficulties in meeting people’s needs. A record showed that referral to relevant health professionals is sought for advice and/or treatment as necessary. A sample check of the management of medication identified that there were some difficulties in checking medication received and administered. In order to do this it was necessary to check back records over several medication cycles. Advice has been given to record on the medication administration record the quantity of medication received and carried forward at the start of each medication cycle to aid a clear audit trail. A requirement made following the inspection in May 2008 has been reworded to make the expectations clearer. Advice was given to seek further clarification from the General Practitioner and advice from the pharmacist about medication to be administered via someone’s PEG feeding tube. Records showed that the General Practitioner Avenue House Nursing and Residential Home DS0000067495.V372997.R01.S.doc Version 5.2 Page 14 had given permission for medication to be crushed prior to administration via the tube, however particular medications were not detailed. As crushing medication can alter the way a medication works it is important that staff seek advice about each medication. Staff were also removing a slow release medication form the capsules. Staff sought some interim advice from the pharmacist on the day of inspection and confirmation was received following the inspection that further discussions had taken place with the General Practitioner. Conversations with people who use the service and a relative during the inspection identified that staff treat them with respect. Staff were heard to speak to people in a respectful manner during the inspection. People spoken with said that they had no concerns about how they were treated by staff and that their dignity was respected. One person identified the difficulties when new staff or agency staff are on duty as it is then necessary to tell each individual what assistance they need with personal care. During the inspection we identified that there is no privacy curtain or screen in one of the shared rooms. Neither of the occupants were able to express a view about arrangements to protect their privacy and dignity due to having a dementia related illness. In view of this it is considered to be even more important that arrangements are put in place. Avenue House Nursing and Residential Home DS0000067495.V372997.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 encouraged and made welcome and people who use the service are mostly satisfied with the food provided. There have been some improvements to people’s daily lives, in that they receive more timely assistance. EVIDENCE: In the surveys received in May 2008, people who use the service acknowledged that there were some activities that they could take part in. Relatives responded that more entertainment or more outings would enhance people’s quality of life. There have been some difficulties in retaining a dedicated activity organiser, however there are some regular activities, which have been arranged. These include having an entertainer in once a month, armchair aerobics each Wednesday morning and someone from the ‘Pat’ dog scheme visits with their dog every two weeks. Avenue House Nursing and Residential Home DS0000067495.V372997.R01.S.doc Version 5.2 Page 16 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. It was reported at the last inspection that care staff have little time to spend sitting and talking with people. Someone who uses the service advised that this remains the case. The manager is however confident that staff training and changes to working practices will improve this situation. Visiting arrangements are flexible and people are able to have visitors as and when they wish. A visitor confirmed this, and also that they are made welcome by staff. People were observed to be given appropriate assistance with their meals. Some people eat in the dining room, others prefer to eat in their room and there are some people who are nursed in bed and require assistance in their rooms. To meet all of these varying needs requires sufficient staff and good planning and organisation. Observations indicated an improvement in this area. Those people eating in the dining room were spending less time waiting at the meal table for a meal or waiting to be assisted to the lounge following a meal and staff were assisting people in their rooms appropriately. This was a problem that had been identified at previous inspections. This inspection visit started early in the morning and as people arrived in the dining room they were given drinks quite promptly, those people in their rooms also confirmed that they had received an early morning drink. People were provided with choice of breakfast, which included cereals, toast and various cooked options. People spoken with during the inspection said they were satisfied with the meals provided. Prior to the inspection a copy of a quality assurance audit was forwarded to CSCI for information. The questionnaire asks detailed questions about the meals provided and while the majority of people appeared satisfied with the meals some useful comments were made and an action plan developed to act on the comments made. Avenue House Nursing and Residential Home DS0000067495.V372997.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 adequate. This judgement has been made using available evidence including a visit to this service. There are complaint and safeguarding procedures in place which people are aware of and evidence that complaints are investigated. EVIDENCE: There is a complaint procedure in place and records of complaints are kept. A sample check of these records show that complaints are investigated; shortfalls acknowledged and responded to appropriately. The concern is that a brief review of the complaints identifies continuing concerns about similar issues relating to care needs not being met. A complaint received by the Commission for Social Care Inspection (CSCI) about the care of several people who use the service was referred to Northamptonshire County Council for investigation under safeguarding adult procedures. As a result of the above concerns CSCI carried out a random inspection to look at how people’s care needs were being met. This inspection carried out in August identified that there was a new manager in post and that she was concentrating on improving care practices. Multi-agency meetings have been held to discuss the safeguarding concerns and representatives from Jasmine Healthcare have attended these meetings. They have co-operated with this process and given assurances about Avenue House Nursing and Residential Home DS0000067495.V372997.R01.S.doc Version 5.2 Page 18 improvements. One of the meetings was held on the 31st October 2008, the day of inspection. The outcome of the meeting was that people were satisfied with the plans submitted and that it was not necessary to hold any further meetings unless further concerns arise. A requirement was made at the last inspection about the need for staff to have safeguarding adults training. Records and discussion with staff show that the majority of staff have now undertaken this training. Concerns had been identified at the May inspection about some concerns that had not been reported through safeguarding adult procedures in a timely manner. Managers and staff confirmed through discussions during this inspection their understanding of their responsibilities. Avenue House Nursing and Residential Home DS0000067495.V372997.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, 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; and there have been improvements in the standard of cleanliness. EVIDENCE: We looked at lounges and dining rooms and a sample of people’s bedrooms during the inspection. We found that the programme of re-decoration and refurbishment was continuing. Monthly reports submitted to CSCI have confirmed the decoration of communal areas has been identified as a priority and then re-decoration of individual rooms will follow. 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. Avenue House Nursing and Residential Home DS0000067495.V372997.R01.S.doc Version 5.2 Page 20 We found that there had been an improvement in the standard of cleanliness, which had helped to reduce the odour. There continued to be a slight odour in some places, however it was felt that this would be addressed by the planned replacement of some carpets. Following the inspection we received written confirmation that deep cleaning of all communal areas, bathrooms and bedrooms was to commence which would include all carpets. We were concerned that in May 2008 the annual quality assurance self assessment identified that a total of forty three staff are employed, however only sixteen of these have received infection control training. A record of staff training submitted after this inspection indicates that there is little change to this. We have however been informed that a training manager has been recruited by Jasmine Healthcare and that training at Avenue House will be a priority. Staff were observed to use disposable gloves and aprons when involved with personal care and laundry. We did observe that staff were leaving single wrapped used pads outside bedrooms for later collection rather than disposing of these in the appropriate bag immediately. This creates a risk of infection and impacts on people’s dignity. We did note that where someone had an infection such as MRSA that very clear guidance was provided to staff about the procedures they must follow to reduce the risk of infection. 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.V372997.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 adequate. This judgement has been made using available evidence including a visit to this service. Improved staffing levels and work routines mean that people’s needs are being met in a more timely way. More staff training is required to ensure that all staff have the knowledge and skills to meet people’s needs. 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. Observations and comments received during the May 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. An improvement plan submitted following the inspection in May 2008 stated that a total review of staffing levels, work flow and the skills and competency of the staff team would be carried out. Staffing levels were increased at key times 7am to 2pm and 7pm to 10pm. Avenue House Nursing and Residential Home DS0000067495.V372997.R01.S.doc Version 5.2 Page 22 The improvement plan also stated that the Acting Manager would be working alongside staff to improve practices and identify the need for changes. During our inspection in September 2008 and this inspection in October 2008, the Acting Manager and staff confirmed that this had been happening. Observations and discussion with people who use the service during the inspection indicated that there has been an improvement in this area. People were receiving assistance in a timelier manner and a staff member talked about better working routines. One example of this was that people were being assisted to the toilet more regularly. Meal times were also more organised, which improved the level of assistance that people, were getting. The inspection in May 2008 highlighted that none of the staff who responded in the surveys felt that felt that their induction covered everything that they needed to know. We spoke with someone who had been employed since the last inspection who confirmed that they had received induction training, which helped them in meeting people’s needs indicating some improvement in this area. Someone who uses the service identified that the main problem was when they were reliant on new or agency staff who did not know their individual needs. Staff rotas show that the time when agency staff are mostly used is at a weekend. The manager advised that where it is necessary to use agency staff they try to use the same people to help with consistency. There continue to be shortfalls in staff training as shown in the staff training matrix submitted by the responsible individual following the inspection. We have been informed that a training manager has been employed ant that they will focus on the provision of staff training at Avenue House as their first priority. A requirement was made following the inspection in May 2008 about identifying and planning staff training. We spoke with staff who told us that training needs had been identified, some training had taken place and that more was planned. A member of the ancillary staff was very pleased to have been included in some dementia awareness training which they felt gave them a better understand of the people cared for and their needs. It is important to people’s daily lives and well being that all staff working with them understand their needs. There have been problems in the past whereby training has been offered but not always taken up by staff. Discussion with the manager confirmed that there is now a more pro-active approach to training and that staff will be supported and expected to attend training to give them the knowledge and skills they need. A new requirement has been made about staff training. Avenue House Nursing and Residential Home DS0000067495.V372997.R01.S.doc Version 5.2 Page 23 During the inspection in May 2008 we identified that the staff recruitment process in terms of obtaining references was not as rigorous as it should be. We still had some concerns about this at our inspection in September 2008, when we were unable to find a reference and found that information in an application had not been checked properly. Staff files were better organised this time and we found that for a recently recruited member of staff all of the necessary checks and references had been made and obtained. We have received written confirmation within the improvement plan that all files for existing staff have been checked and where necessary additional information obtained and placed on file. Avenue House Nursing and Residential Home DS0000067495.V372997.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): 32, 33, 35, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of residents has suffered from a lack of consistent management. However a stronger management team is in place with evidence of improvements to outcomes for people who use the service. EVIDENCE: Standard 31 relates specifically to the registered manager and their experience and qualifications. There was no registered manager in post at the time of this inspection in October 2008. 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.V372997.R01.S.doc Version 5.2 Page 25 There had been no registered manager in post since the end of 2006. Since that time there have been three managers, the most recent having started work at Avenue house at the end of July 2008. Applications for registration had not been submitted for the previous managers, however the Commission for Social Care Inspection at the time of inspection was processing an application for registration for the current manager. Previous inspection findings and the safeguarding concerns have raised concerns about the management and oversight of Avenue House and the ability to improve and maintain standards of care. Positive feedback was received from staff about the new manager. One member of staff said that there had been improvements since the manager and the deputy manager had taken up post, they said that they listen to staff and that problems are resolved as a team. They felt that staff now know what they are supposed to be doing resulting in better care for people. Similar comments were received from other people and staff seemed to be supportive of the new manager, for example one person commented “manager needs encouragement, works on the floor, never seen that before”. A decision had been taken by the new manager and the responsible individual that the manager would spend a large proportion of their time working with people who use the service, alongside staff. As most of the previous concerns have been around the provision of care this should help to identify any problems and to improve working practices and the care provided. We were critical in our inspection report following the inspection in May 2008 about the management and organisation of Avenue House. We were particularly concerned that following a period towards the end of 2006 and 2007 where standards had started to improve these were found in May 2008 to have slipped back. Following the May inspection we met with the responsible individual to discuss our concerns and confirm that enforcement action would be taken if improvements were not made and regulations were not met. Advice was given in the report of the inspection in May that there was a need to concentrate on reviewing the causes of problems and implementing more rigorous ongoing monitoring as part of the quality assurance process. The random inspections and this recent inspection identify that improvements are being made and that there appears to be a stronger management team in place, which should help in continuing and sustaining improvements. Systems continue to be 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. Avenue House Nursing and Residential Home DS0000067495.V372997.R01.S.doc Version 5.2 Page 26 In addition other specific quality audits have been undertaken. For example a dietary audit referred to previously in the report appeared quite detailed and produced some helpful suggestions for improvement. A service user satisfactions survey has also been sent out, however responses had not been collated at the time of inspection. Information received about meetings with relatives indicates that there are opportunities for open discussion about strengths and areas for improvement. Information gathered from these different sources provides a good basis for identifying improvements required. 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. Staff training continues to be required in safe working practices in areas such as fire safety, food hygiene, movement and handling training and infection control. Avenue House Nursing and Residential Home DS0000067495.V372997.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 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 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 2 17 X 18 2 2 X X X X X X 2 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 N/A 3 2 X 3 X X 2 Avenue House Nursing and Residential Home DS0000067495.V372997.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? 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 OP9 Regulation 13 (2) Requirement The quantity of medication received and carried forward at the start of each medication cycle must be recorded to aid a clear audit trail. This helps to confirm the safe administration of medication. Advice must be sought from the pharmacist and written confirmation received from the prescriber of the method of administration in respect of each and any medication that is crushed or removed from capsules for administration via a PEG feed tube. Staff must receive training appropriate to their role to ensure that they have the necessary knowledge and skills to fulfil their responsibilities and meet people’s needs. This must include induction training and training in safe working practices. Timescale for action 15/01/09 2. OP9 13 (2) 05/01/09 3. OP30 18 (c) (i) 15/03/09 Avenue House Nursing and Residential Home DS0000067495.V372997.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP10 OP12 Good Practice Recommendations Improvements to the care planning system should continue in order to support people’s care. People’s privacy and dignity should be protected in shared rooms by the use of privacy curtains/screens. Additional arrangements should be made to increase the activities and stimulation provided based on individual needs and preferences. The findings of complaints and safeguarding investigations should be used to identify areas for improvement and then monitored to ensure improvements are sustained. Staff practice in relation to disposal of used pads should be monitored to ensure that rigorous infection control procedures are followed and people’s dignity respected. 4. 5. OP16 OP18 OP26 Avenue House Nursing and Residential Home DS0000067495.V372997.R01.S.doc Version 5.2 Page 30 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. 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