CARE HOMES FOR OLDER PEOPLE
Avenue Nursing Home Avenue Nursing Home 32 The Avenue Cheam Surrey SM2 7QB Lead Inspector
Alison Ford Unannounced Inspection 20th October 2005 10:00 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.V254781.R01.S.doc Version 5.0 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.V254781.R01.S.doc Version 5.0 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.V254781.R01.S.doc Version 5.0 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. 5th and 11th October 2004 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 earlier this 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 will be brought into line with other homes owned by this provider. This will provide a much more pleasant environment for both its residents and staff which complies with current health and safety legislation. Avenue Nursing Home DS0000063984.V254781.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes first inspection for the year 2005/2006 although three visits had already been made throughout that time, since the home was sold to its new owner, Mr J Patel. These had been to check on the progress of the work being undertaken. This unannounced visit took place over six and a half hours and included a tour of the premises, with the fire safety officer to check compliance with a number of issues that had previously been raised and a meeting with a care manager of one resident to investigate an alleged incident. All of the residents were spoken to during the visit and one relative who was visiting. In view of the extensive renovation and refurbishment under way in the home this visit concentrated on talking to residents to ensure that they feel that their safety and wellbeing is being protected throughout this time. Recruitment procedures and health and safety policies are also being updated in line with the owners other homes. As no new staff members have been recruited, staff files will be assessed at a separate visit and certificates of worthiness, for equipment, at the next inspection. The home currently has no registered manager although it is hoped that the current acting manager will be applying for registration in the near future. Management issues are currently being overseen by Mrs P Reid who is the registered manager in one of the owners other homes. Since the original new registration, a further six months was granted to the providers in order to finish the building work. Consideration was given to the vast amount of work being undertaken and all of the key standards will be assessed at the next inspection. What the service does well:
Despite all the problems experienced in this home the majority of care staff have continued to provide good quality care to its residents. Comments made by residents that were spoken to included “staff were mostly very kind and willing to help” and “they know how I like things done”. They enjoyed the activities that took place and agreed that the food served was very good. All of the residents were enjoying seeing all the renovation work that was being done and agreed how good it was looking. Several felt involved in the process, knew exactly what was going to happen next and were able to explain how it was going to look in the end. The management team has also tried to involve relatives so that they were kept informed as to what was happening. Avenue Nursing Home DS0000063984.V254781.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: 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.V254781.R01.S.doc Version 5.0 Page 7 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.V254781.R01.S.doc Version 5.0 Page 8 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): 3,6 Potential residents in this home have a comprehensive pre-admission assessment undertaken, so that they can be sure that the home can meet their assessed healthcare needs. This home does not offer intermediate care. EVIDENCE: Two new residents had been admitted since the last inspection and their care plans were seen. The home is now using a commercially produced care plan, The Standex System. There was evidence that the resident’s healthcare needs had been assessed and a relative of one of them confirmed this. This assessment then forms the basis for individual care planning and is subject to regular review. As this format is new to the home it will be assessed in more depth at the next inspection. Avenue Nursing Home DS0000063984.V254781.R01.S.doc Version 5.0 Page 9 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): 10 Residents are always treated with respect so that their dignity and privacy are maintained. EVIDENCE: Staff were observed treating the residents respectfully during the inspection and those residents that were able to express an opinion confirmed that they were always kind and caring. Personal care is delivered in resident’s own rooms. The home has just introduced a new care planning system and so this will be assessed at the next inspection. Avenue Nursing Home DS0000063984.V254781.R01.S.doc Version 5.0 Page 10 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): 12,13,15 The range of activities in the home are suitable for the residents living there, adding interest to their daily lives and visitors are always welcome so that family contacts and friendships can be maintained. Residents receive a nutritious balanced diet, which maintains their health and wellbeing. EVIDENCE: A range of activities is offered in the home, mainly by staff, and residents are able to choose whether or not they wish to participate. On the afternoon of the inspection a chair based exercise session was being enjoyed by many of them. Visitors are always encouraged and one that was spoken to confirmed that she was always made to feel welcome. They could, if they wished, be received in resident’s bedrooms but there are currently no private areas that could be used. Residents were generally happy with the food that is served in the home and the lunchtime meal that was served looked appetising. 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. Comments were received about the way that supper had been heated the evening before and the manager must ensure that all staff
Avenue Nursing Home DS0000063984.V254781.R01.S.doc Version 5.0 Page 11 preparing food have an up to date food hygiene certificate. A requirement is issued in relation to this under standard 30 Avenue Nursing Home DS0000063984.V254781.R01.S.doc Version 5.0 Page 12 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): 18 Residents and their families can feel confident that any concerns will be treated seriously and acted upon promptly so that they can feel safeguarded from abuse. EVIDENCE: During the inspection, the care manager of one resident arrived in response to concerns that had been raised by their relatives. There was evidence that this had been dealt with promptly and sensitively. The issues had not at that time been reported to The Commission for Social Care Inspection. An outcome is awaited from the investigation. Avenue Nursing Home DS0000063984.V254781.R01.S.doc Version 5.0 Page 13 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): 19,20,22,24,26 Residents are confident that the extensive improvements being made to the home will result in a clean, safe well maintained environment for them to live in. EVIDENCE: An extensive refurbishment plan is in progress throughout the home. Both communal areas and resident’s bedrooms are being redecorated. Carpets and furniture are being replaced and washbasins are being put into all the bedrooms. The laundry and sluice facilities have been re sited and a new shower room has been made. Following the requirements of the fire safety officer, bedroom doors have been replaced and magnetic door catches have been put onto them to ensure the safety of residents in the event of a fire. Decking has been laid in the garden to provide a seating area and an extra wide door leads out onto it to facilitate acres for wheelchair users. New storage areas have been made for linen and food and a new office has been created for staff use. Planning permission is still awaited for further improvements. The residents have watched all the work with interest and commented on how good it was all looking now and staff said that they appreciate the new environment. The management team have tried to involve relatives in the process; explaining the progress of the work as it happens.
Avenue Nursing Home DS0000063984.V254781.R01.S.doc Version 5.0 Page 14 Despite all the work taking place, the areas being used by residents and staff were all clean and free from odour on the day of inspection. In view of the ongoing work in the home no requirements were issued regarding these standards however they will all be assessed at the next inspection. Avenue Nursing Home DS0000063984.V254781.R01.S.doc Version 5.0 Page 15 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): 27,30 There are sufficient staff on duty to ensure that residents can be confident that their needs will be met however, they cannot be sure that they are always appropriately trained. EVIDENCE: On the day of inspection there were sufficient numbers of staff on duty and the rotas confirmed that this was always the case. Staff were seen to be free to sit in the lounge with residents and help them in their activity session. Staff training is an area that will need to be addressed when the refurbishment programme is complete and this will be assessed at the next inspection. However, the acting manager must ensure that any member of staff who is involved in preparing or serving food has an up to date Food Hygiene Certificate. The manager of the home explained that staff files are in the process of being reviewed to ensure that all the necessary documentation was included however, confirmed that all staff had received clearance from the Criminal Records Bureau. These files will be checked during an additional visit. Avenue Nursing Home DS0000063984.V254781.R01.S.doc Version 5.0 Page 16 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): 38 Residents cannot be sure that working practices are sufficiently appropriate to ensure their health and safety. EVIDENCE: Serious concerns were previously raised about fire safety in the home and this visit included a tour of the premises with the fire safety officer to check compliance with requirements that were made. He was impressed to note that the majority of these had all been complied with. Re-siting of the laundry means that fireproof glass is now required in the window, it must remain shut and a ventilation fan installed. He also recommended that the emergency plan should be reviewed and all staff updated on its contents. Kitchen records were seen and fridge and freezer temperatures had been recorded as being out of the acceptable range. In order to minimise risks to residents the Registered Provider must provide evidence that temperatures remain within the required range. His representative agreed to replace the fridge promptly and monitor the freezer temperatures and ensure that staff
Avenue Nursing Home DS0000063984.V254781.R01.S.doc Version 5.0 Page 17 knew how to record them correctly. In addition the dishwasher was not working and he agreed to get this repaired. These issues will be checked at an additional visit. The remaining standards and other maintenance issues were not assessed at this inspection. A registered manager has still to be appointed. Avenue Nursing Home DS0000063984.V254781.R01.S.doc Version 5.0 Page 18 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 X 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 3 X 3 X 3 X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 Avenue Nursing Home DS0000063984.V254781.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP30 Regulation 13(4)(c) Requirement The Registered Provider must ensure that any member of staff involved in preparing or serving food has a valid food hygiene certificate. The Registered Provider must ensure that there is evidence that the fridge and freezer temperatures remain within an acceptable range. The Registered Provider must ensure that the dishwasher is working. The Registered Provider must fit safety glass into the laundry window as specified by the fire safety officer. The Registered Provider must ensure that the homes emergency fire plan is updated and all staff are made aware of its contents. Timescale for action 30/01/06 2 OP38 13(4)(c) 29/10/05 3 4 OP38 OP38 13(4)(c) 13(4)(c) 29/10/05 30/11/05 5 OP38 13(4)(c) 30/11/05 Avenue Nursing Home DS0000063984.V254781.R01.S.doc Version 5.0 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Avenue Nursing Home DS0000063984.V254781.R01.S.doc Version 5.0 Page 21 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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