CARE HOMES FOR OLDER PEOPLE
Avenue Nursing Home Avenue Nursing Home 32 The Avenue Cheam Surrey SM2 7QB Lead Inspector
Alison Ford Key Unannounced Inspection 11th May 2006 11:10 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 Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Avenue Nursing Home Address Avenue Nursing Home 32 The Avenue Cheam Surrey SM2 7QB 020 8642 3912 020 8642 3912 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) Avenue Nursing Home Ltd *** Post Vacant *** Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. One service user may be aged 55 plus years. A registered manager must be in post within 6 months. The building works as per plans submitted must be completed within six months. 12th January 2006 Date of last inspection Brief Description of the Service: Avenue Nursing Home is an older style detached property situated in an attractive residential area of Cheam. It is registered with The Commission for Social Care Inspection to provide nursing care for up to twenty people over the age of sixty-five although there is currently a variation in place to allow one younger resident to live there. Accommodation is arranged over two floors with toilets and bathrooms on each floor and there is a passenger lift. Historically the home had been the subject of many concerns and repeated requirements, due to a significant lack of investment. However it was sold last year and is currently undergoing major structural modifications and complete refurbishment and redecoration. Recruitment procedures, staffing issues and policies and procedures designed to protect the safety of residents and staff are being brought into line with other homes owned by this provider. This is beginning to provide a much more pleasant environment for both its residents and staff which complies with current health and safety legislation. At the time of the inspection on 11th May 2006 fees ranged from £453-£537 per week with additional costs for personal items which would be discussed prior to admission. A copy of the last inspection report is included in the Service User Guide that is issued to each resident. Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes first inspection for the year 2006/2007 and was an unannounced visit. It was conducted over five hours during which time a tour of the premises was undertaken, there was inspection of staff files, an assessment of a number of care plans and of the medication procedures and storage. This home was acquired by a new owner last year following considerable problems due to a significant lack of investment. Although renovation work started, problems obtaining planning permission have hindered the refurbishment of the home and the agreed timescale has not been met. The responsible person will now need to decide on a course of action for the home to ensure the comfort and wellbeing of the residents. During this time the home has restricted admissions to the first floor so that there would be room available to enable residents to be accommodated during the work. At the time of the inspection there were thirteen elderly people living in the home. During this inspection all of those standards, considered by The Commission to be key to the inspection process, have been assessed. The majority of the residents were spoken with during the visit and six members of staff and two relatives that were visiting the home. There is still one ongoing concern being addressed under the local authority Protection of Vulnerable Adults Procedure; no further complaints have been received about the service. The acting manager is awaiting an interview date from The Commission to be assessed for registration. What the service does well:
Despite all the problems being experienced during this time of new management and refurbishment staff have continued to provide good quality care to the residents all of whom looked well cared for and happy. Staffing levels allow carers to spend time with the residents and this is much appreciated. Comments made by residents that were spoken with included “staff are mostly very kind and willing to help” and “they know how I like things done”.
Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 6 Those spoken with said that they enjoyed the range of activities that took place although some discussion was held about increasing these. They agreed that the food served in the home was very good and they were enjoying seeing all the renovation work that is being done. What has improved since the last inspection? What they could do better:
When the present owner purchased the home there were comprehensive plans to extend and upgrade it and this would have improved the environment for residents and staff. Unfortunately although this work began and the home is already a brighter and safer place it has not been completed despite the allocated timescale being exceeded. Communal space especailly remains very limited. The Registered Provider is now required to produce an action plan outlining how the original plan will be achieved or an alternative one submitted. In the interim work will need to be undertaken to ensure that the home remains in a good state of repair. Cracks in the walls and broken tiles must be
Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 7 repaired and carpets and windows will need to be cleaned. The downstairs bathroom, which is the one most in use, needs to be upgraded and decorated. To ensure the safety of residents in the event of a fire, self-closing mechanisms must be fitted to bedroom doors if residents wish them to be kept open. The garden will also need some attention to make it a pleasant area for residents to sit in during the summer. The management team are actively trying to recruit more trained nurses and at the moment staff from another home in the group are providing cover. Continuity is maintained by the fact that the same staff often provide this. Hopefully, once more staff are recruited consideration can be given to introducing a quality assurance monitoring tool. Currently residents do not have the opportunity to influence the running of the home and comment on the care that they receive in any formal way. Staff supervision and performance appraisal must also be undertaken as a part of the management process to monitor practice and to identify the learning needs of staff. Currently much of the evidence to show that safe working practices are adopted in the home is held elsewhere and copies of relevant documentation must be made available for future inspections. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 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 Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents can be sure that a pre-admission assessment will ensure that their needs can be met and that they are given appropriate information to help them decide if the home will suit them. This home does not offer intermediate care, this standard does not apply. EVIDENCE: A new Statement of Purpose and Service User Guide have been produced for the home, and were seen at the inspection, and these are compliant with the standard. Copies have been distributed to all the residents and are kept in their rooms. Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 10 Pre-admission assessments are undertaken by the acting manager to ensure that residents healthcare needs can be met prior to their moving in to the home. At the time of this inspection there were no residents who had been admitted since the last inspection Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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 from evidence gathered both during and before the visit to this service. All residents have an individual care plan which details the support that they require and provides evidence that advice is sought from other health care professionals to ensure that care meets their assessed needs. Residents can be sure that they will always be treated in a way, which respects their dignity, and privacy and that they are protected by the homes medication procedures. EVIDENCE: All residents have an individual care plan which details the support that they require and provides evidence that advice is sought from other health care professionals to ensure that care meets their assessed needs. There was limited evidence however, that any of them or their relatives are consulted about their care and that this must be undertaken. Some care plans must be reviewed to ensure that they remain up to date and reflect the care and
Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 12 support currently required and it was recommended that care staff should be encouraged to make entries about the personal care that they deliver. All of the current residents have lived in the home for some time however for many of them information about their past lives was limited. It was recommended that staff spend some time undertaking some life history work to gain an insight into their residents needs. Medication stores and records were seen and were orderly except for one omission in recording. It is recommended that a regular audit should be undertaken of MAR sheets to ensure that any mistakes are monitored and rectified. Residents can be sure that they will always be cared for in a way, which respects their dignity, and privacy and staff were observed to be treating them kindly. Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Although limited, the range of activities in the home is suitable for the residents living there, and visitors are made welcome so that family contacts and friendships can be continued. Residents are encouraged to make choices where possible in order to retain their independence and they enjoy a nutritious balanced diet, which maintains their health and wellbeing EVIDENCE: Some activities are offered in the home, and residents are able to choose whether or not they wish to participate. Recently these have become less frequent and it is recommended that these should be improved to offer interest and stimulation to residents. One resident is able to go to a nearby church and another will be attending a skills centre in the future. Residents have been encouraged to bring personal possessions into the home to make their bedrooms more homely however none of them are currently able to look after their own financial affairs.
Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 14 Residents were generally happy with the food that is served in the home and comments were received that “meals are generally very good” and “there is always plenty to eat“ A hot snack supper is prepared by the cook and available for those who would like it. Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents and their relatives can be confident that their concerns and complaints will be taken seriously and acted upon appropriately and procedures are in place, which will protect them from abuse. EVIDENCE: There is a complaints procedure, which clearly sets out the procedures to be followed and this is detailed in the service User Guide3 that everyone has in their room. A recommendation is made that it should also be clearly displayed in the home for residents and their relatives to see. Policies concerned with adult abuse are in place and recruitment checks contain evidence that appropriate clearance has been gained for new members of staff prior to employment. All current staff now have this clearance. One incident, that occurred some while ago, is still being investigated under the Vulnerable Adults Procedure Training in issues around abuse and the protection of vulnerable adults has been undertaken since the last inspection.
Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home is clean although improvements are still required in order to provide a more pleasant environment for residents to live in and ensure their safety. EVIDENCE: An extensive refurbishment plan is still intended for the home however, apparently planning permission has still not been granted. This has resulted in the renovation work stopping and several areas still requiring attention to make this a more pleasant home for the resident who live there. Following the requirements of the fire safety officer, bedroom doors were replaced however; magnetic door catches, which would close them automatically in the event of a fire, have still not been put onto all of them to ensure the safety of residents. Carpets in the corridors and sitting room need
Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 17 replacing, there are broken tiles in the shower room, and cracks in the walls that need to be repaired. Windows need to be cleaned and the garden requires attention. Communal space in the home is very limited even with the current reduced occupancy and the bathroom downstairs needs to be decorated and fitted with more modern equipment to assist residents who prefer a bath rather than shower. The original timescale for the work in the home to be completed has now been exceeded and the Registered Provider is required to supply the Commission for Social Care Inspection with an updated plan of his intentions. The home was clean and free from malodour on the day of inspection Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents can be sure that there are sufficient staff on duty to ensure their needs will be met and training and recruitment procedures are in place to ensure their protection EVIDENCE: Off duty rotas were seen and showed evidence that there are always sufficient staff on duty to care for residents. The home is experiencing difficulties in recruiting trained nurses and is currently being supported by staff from another home in the group although to maintain continuity of care they are usually the same ones. A training plan has been implemented and all staff are being encouraged to attend. Recent sessions have included manual handling, POVA, food hygiene, infection control and COSHH. 3 carers are enrolled on an NVQ level 2 course. One new member of staff has been employed since the last inspection and records showed evidence of a robust recruitment procedure.
Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 19 Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is poor3. This judgement has been made from evidence gathered both during and before the visit to this service. Management arrangements are in the process of being improved to ensure that a suitably qualified person runs the home. Residents are still not given the opportunity to influence the care and services that are provided however; they can be assured that their financial interests are always protected. There is no evidence that all equipment has been maintained to a standard that will ensure the protection of residents and arrangements are still not in place to provide appropriate supervision to staff. Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 21 EVIDENCE: The home is still without a Registered Manager however the acting manager has completed her application and is awaiting a date for interview with The Commission. Until she is supported by additional trained nurses many of the administrative processes that need to be in place cannot be introduced. There is currently no way for residents to influence or comment on the care and services that they receive in the home. A quality assurance tool is available and is already used in other homes in the group and it is intended to introduce it shortly. Residents will also complete satisfaction surveys every six months. This will be monitored at future visits. Staff currently do not receive formal supervision or appraisal. It is intended that this should start in the home, once more trained nurses are in post however, the Registered Provider must provide an action plan outlining how it will be dealt with in the interim. Training in health and safety issues has started in the home and fire drills occur regularly. Although there are trained nurses on duty sufficient staff must be trained in first aid so that there is always an appropriately qualified person on duty. Certificates of worthiness for all the equipment used in the home were not available for inspection as they are kept at another site. Copies of these as listed in Standard 38 must be forwarded to the office of The Commission for Social Care Inspection and must be kept in the home for future visits. An appropriate insurance certificate is displayed in the hall; the home does not currently take responsibility for the financial affairs of any resident. There was no evidence that hot water temperatures are monitored regularly this must be undertaken weekly and records made available for inspections. Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 22 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X x 2 X 2 Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement The Acting Manager of the home must ensure that there is evidence that residents and their relatives have had the opportunity to contribute to their care plans. The Acting Manager of the home must ensure that all care plans are reviewed regularly to ensure that they reflect the care and support that is currently required. The Registered Provider must ensure that, where resident wish their doors to remain open, they are fitted with a closing device, which operates in the event of a fire. (Previous timescale 30/4/06 not met) 4 OP19 23 The Registered Provider must supply The Commission for Social Care Inspection with an action plan detailing how and when the outstanding work to improve the home and increase living space will be completed.
DS0000063984.V293344.R01.S.doc Timescale for action 30/08/06 2 OP7 15(2)(b) 30/08/06 3 OP19 13(4)(c) 30/08/06 30/08/06 Avenue Nursing Home Version 5.1 Page 24 5 6 7 8 9 OP19 OP19 OP19 OP19 OP19 23(2)(b) 23(2)(b) 23(2)(b) 23(2)(b) 23(2)(b) 10 OP33 24(1)(A)( b) The Registered Provider must ensure that carpets are cleaned or replaced. The Registered Provider must ensure that tiles in the shower room are replaced. The Registered Provider must ensure that windows of the home are cleaned. The Registered Provider must ensure that the garden of the home is maintained. The Registered Provider must ensure that the downstairs bathroom is upgraded and refurbished. The Registered Provider must ensure that a quality assurance monitoring tool is introduced into the home. (Previous timescale 30/04/06 not met) 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 30/08/06 11 OP36 18(2) The Registered Provider must ensure that staff supervision is introduced into the home for all staff and for care staff at least six times a year. (Previous timescale 30/04/06 not met) 30/08/06 12 OP38 13(4)(c) The Registered Provider must ensure that copies of certificates of worthiness for electricity and electrical safety, gas, PAT, call bells and bacterial water analysis are sent to the office of The Commission for Social Care Inspection (Previous timescale 30/04/06 not met) 30/08/06 13 OP38 13(4)(c) The Registered Provider must ensure that there is evidence that the temperature of water
DS0000063984.V293344.R01.S.doc 30/08/06 Avenue Nursing Home Version 5.1 Page 25 intended for total body immersion is tested weekly. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP7 OP7 OP9 OP12 OP16 Good Practice Recommendations It is recommended that care staff should be encouraged to contribute to residents care plans. It is recommended that care staff should be encouraged to undertake some life history work with the residents in the home. It is recommended that Medication Record sheets should be audited regularly to monitor any errors. It is recommended that an increased programme of activities should be introduced into the home. It is recommended that a copy of the complaints procedure should be displayed in the hall. Avenue Nursing Home DS0000063984.V293344.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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