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 10:30 7th August 2008 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.V368474.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 Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Avenue Nursing Home Address Avenue Nursing Home 32 The Avenue Cheam Surrey SM2 7QB 020 8642 3912 F/P 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 Manager post vacant Care Home 20 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (20) of places Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care need on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE (maximum number of places: 20) (of the following age range: 55 years and over) The maximum number of service users who can be accommodated is: 20 11th December 2007 2. Date of last inspection Brief Description of the Service: Avenue Nursing Home is an older style detached property situated in a quiet residential area of Cheam. It is registered with The Commission for Social Care Inspection to provide nursing care for up to twenty older people requiring nursing and who may have dementia. Accommodation is arranged over two floors with toilets and bathrooms on each floor and there is a passenger lift. Since being purchased by the current owners the home has benefited from redecoration and refurbishment, the lounge area has been extended and the garden has been attended to, in order to allow residents to take advantage of any warmer weather. At the time of this inspection fees ranged from £570 - £600 per week with additional costs payable for services such as hairdressing and private chiropody, which would be discussed prior to admission. A copy of the homes Statement of Purpose and the latest inspection report can be obtained from them. The inspection report can also be downloaded from Commission for Social Care Inspection website.
Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 5 Avenue Nursing Home DS0000063984.V368474.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 2 star. This means the people who use this service experience good quality outcomes.
This report has been written following an unannounced visit to the home made as a part of the inspection process for the year 2008/2009. When compiling the report, consideration has also been given to information received since the last inspection including the notification of any incidents and complaints. The report reflects conversations held with residents and members of staff and draws on information supplied in the Annual Quality Assurance Assessment. This is a document is completed by the management team of the home in order to supply The Commission with details about how well they are providing a service for the people that they are supporting. The home is still without a Registered Manager although the acting manager has been in post for around eight months. At the time of the inspection there were twelve elderly people living in the home although one was in hospital. The majority of the residents were spoken with, also the staff that were on duty. A tour of the premises was undertaken, two personnel files of newly appointed staff were seen, a number of care plans were looked at and also the medication procedures and storage. The lunchtime meal was served during the visit. There have not been any complaints received about the service since the last inspection. What the service does well:
Most of the people who live here have done so for some time and they have built up good relationships both with other residents and staff members. The home provides them with a comfortable environment and suits those who prefer to live in a smaller home. The atmosphere within the home is always very friendly and staff are pleasant and welcoming. Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 7 On the day of the visit some of the residents were sitting in the lounge while others preferred to stay in their rooms and watch television or read. They all appeared well cared for and happy. They told us that they liked living in the home, that the people who looked after them were very nice and one lady said, “We never want for anything”. Another resident told us “ I was dreading moving in, as you hear such bad stories but I haven’t regretted it one bit”. She particularly liked the fact that the chef was very accommodating and would always cook her something special if she wanted it. Other people who use this service also agreed that the food that is served in the home suits them and the fact that the home is quite small allows the chef to be a key member of the staff team. He was seen to be frequently in the lounge and had a good relationship with the residents. The care plans that we saw showed us that residents healthcare needs are being addressed appropriately. Any problems that they have are identified and the support that they need is documented so that all staff know how to look after them. They are evaluated regularly so that any changes can be addressed. There is enough specialist equipment available in the home such as pressure relieving cushions and mattresses and there are hoists and equipment to help residents when bathing or using the toilet. The residents are seen regularly by the homes GP and records show that they receive their medication as it has been prescribed. Other healthcare professionals such as dentists, chiropodists and opticians also visit the home. There is now a limited range of activities offered to residents in the home. People told us that they enjoy these and would like to see them increased. They said, “sometimes the day seems very long”. This is something that the manager is aware of and is planning to address. The garden has now been attended to so that people can enjoy sitting out there when the weather is warm. Policies and procedures that are required to be kept as evidence of the homes commitment to the health and safety of the people who use this service were generally in good order now that these are all in line with the other homes in this group. Recruitment policies and procedures ensure that residents are protected from those who have been judges as being unsuitable to work with vulnerable people. What has improved since the last inspection?
At the last inspection the acting manager had only just joined the home. Since that time she has been working hard to implement new policies and procedures and improve the outcomes for the people who live in this home
Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 8 and all of the requirements that were issued have been addressed. Documentation that is available to people who are choosing a home has been improved. It is well organised and complies with the regulations. It would give anyone considering moving into the home, or their relatives, all of the information that they would need to help them decide if the home will suit them. A new brochure is being developed and there is also web-based information available. The manager has recognised shortfalls in the care plans that were being used and has implemented new ones which are much more person centred in their approach. They ensure that all staff are aware of how to support residents and care for them. The provision of organised activities has improved and a coordinator visits twice weekly. People say that they enjoy these sessions although some of them would still like more to do and this is being addressed. The chef has become more involved with residents and has become an integral part of the staff team. All of the residents that we spoke with were very complimentary about the food that is served in the home and they liked the fact that he came and talked to them and asked for their views. Medication practices have improved in the home and we were particularly pleased to see a policy for “covert administration” to be used, in exceptional circumstances, when residents are unwilling to take their prescribed medication. What they could do better:
We have asked the homes Registered Provider to consider the problems caused by a lack of storage facilities in the home. In particular the storage of a hoist, which poses a health and safety hazard. Also, we found a security keypad at the top of some stairs that was not working. These devices have been put in place to stop people from being able to get onto the stairs on their own and possibly falling, so it is important that they are always fully functioning. The Commission for Social Care Inspection should be notified of any incidents that affect the health or welfare of residents and we have noted that this was not being done. This information helps us to monitor the safety of the service and we have issued a requirement that this must be done in the future. There is a conservatory in the home, which is not being used. We have suggested that consideration should be given to utilising this as additional communal space or as a dining room. Apparently there are some problems with the temperature in there that will need to be addressed first. Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 9 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 Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 10 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.V368474.R01.S.doc Version 5.2 Page 11 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): Standards 1,3,6 People using the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Anyone who is considering moving into the home would be able to get all of the information that they might need to help them to make their choice. Someone from the home usually undertakes a pre-admission assessment to make sure that they are able to meet the needs of that person. This home does not offer intermediate care therefore Standard 6 does not apply. EVIDENCE: After the last inspection we asked the home to improve the standard of the information that was available to any one considering moving in. At this visit we looked at the revised Statement of Purpose and Service User Guide that have been produced. Copies of these have been given to all the residents and are kept in their rooms. There is also a copy in the front entrance hall.
Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 12 The documentation is well organised and complies with the regulations. It would give anyone considering moving into the home, or their relatives, all of the information that they would need to help them decide if the home will suit them. However, given the remaining abilities of those people who use this service, it is recommended that some thought should be given to producing it in a format that would be easier for them to read, perhaps with photographs. The Annual Quality Assurance Assessment tells us that web based information is also available about the home and a new brochure is being developed. The care plan of a resident, who had been admitted since the last inspection, was seen and it appeared that a pre-admission assessment had not been undertaken. Apparently, a Care Manager had given information verbally and an assessment had then been carried out when the resident arrived. Usually a senior member of staff would visit the person prior to them moving in so that they would avoid a situation where the home finds that is not suitable for them or cannot meet their needs. It is understood that for this resident the placement had been needed quickly. A discussion was held with the manager about the importance of obtaining as much information as possible prior to admission. The resident was spoken with during the inspection and told us that they were very happy living in the home. Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 13 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): Standards 7,8,9,10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have an individual care plan, which is reviewed regularly, to make sure that their healthcare needs are always met and any changes are identified. There are medication policies and procedures in place to protect them. They are always treated in a way, which respects their dignity, and privacy. EVIDENCE: All of the people in the home on the day of the inspection looked clean and well cared for. People who were being nursed in bed looked comfortable and free from pain. Each resident has an individual care plan, which sets out the action that staff need to take in order to ensure that all of their healthcare needs are being met.
Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 14 The acting manager has identified shortfalls in the format of the care plans that were in use and has developed new ones, which are being gradually introduced for each resident. The new plans are well organised, easy to read and identify resident’s individual problems and the support that is needed. They are evaluated regularly so that any changes are addressed. They include risk assessments, nutritional assessments and the monitoring of factors that could indicate deterioration in general health and a predisposition to pressure sores. There are assessments of resident’s memory, orientation and communication abilities and visits from the doctor and other healthcare professionals are recorded. Moving and handling plans are included and it is intended that these will also be put into people’s rooms so that any temporary staff that do not know them well will know how to help them. Throughout the home there was evidence that equipment to promote tissue viability such as pressure relieving mattresses and cushions, was in place and currently no resident has pressure sores. Some areas for improvement were noted in the care plans. These were discussed with the manager and will be monitored at future visits. It is acknowledged that the people who live in this home are very frail and many have limited capabilities however, they or their relatives should be offered the opportunity to influence the care that they receive. Therefore, the care plans should provide evidence that they have been consulted and their views have been considered. There should also be information available to indicate how they wish to be cared for in the event of them becoming more unwell or their death. The manager said that although staff were trying to collect this information it was difficult and we noted that it was documented in some care plans that residents and relatives had been unwilling to discuss it. Medication policies and procedures are in place to ensure the safety of residents. The home has recently started to use a monitored dosage scheme and this was all in order. The records showed that people are receiving their medication as it has been prescribed by the doctor. There are currently some problems being experienced with storage however, a new medicine trolley has been purchased and is waiting to be fitted into the clinical room. This will resolve the problems. The medication policy has recently been updated and we were particularly pleased to see a very good policy for the covert administration of medication for one resident. There is evidence to show that both the doctor and the resident’s relatives were involved in discussions about this and are aware of the situation. Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 15 All of the people that we spoke with agreed that staff are always kind to them and talk to them politely. All personal care is delivered in their own rooms and they could receive their visitors there or in the lounge, as they prefer. Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 16 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): Standard 12,13,14,15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home say that they are free to decide how they spend their days and that generally the lifestyle meets their needs. However, some of them would appreciate more organised activities. They all enjoy the meals that are served to them. EVIDENCE: Residents in this home are free to choose how they spend their days. Some of them sit together in the lounge while others prefer to sit in their room and watch television or read. There are some organised activities however, these are limited and some residents told us that they would like more. One lady told us “sometimes the day seems very long when there’s nothing to do” Another lady suggested “could any children visit to do a little song or play? Its nice to see some new faces sometimes” It is recommended that some consideration should be given to finding out what residents would like to do and providing activities, which will suit their interests. The Annual Quality Assurance Assessment tells us that the manager is aware that this is an area, which needs to be improved, and has some ideas about how to do it.
Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 17 Visitors are always welcome in the home and some residents are able to go out. Two residents go to the local church and one to a stroke club. It is recognised that the frailty of some of the residents limits their opportunities to go out of the home. All of the people that we spoke with said that the food served in the home is very good. Lunch was served during the visit, it was well presented and looked appetising. The mealtime seemed to be a pleasurable experience for the residents with the food served on small tables in the lounge, which, we were told, was their choice. Staff were available to help those residents who needed it. There is a small conservatory, which we thought would make a pleasant dining area however; we were told that it is very hot in there in summer and cold in the winter. The chef serves the meal to residents from a hot trolley and choices were available. Apparently he comes and talks with the residents in the morning to explain what he is going to be cooking and to give them the opportunity to ask for an alternative if they want one. One resident told us “he is always very accommodating, nothing is ever a problem”. Individual diets can be catered for and birthdays and themed days are recognised with cakes or special meals. Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 18 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): Standards 16,18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an appropriate procedure in place to ensure that any concerns and complaints that might be raised are taken seriously and acted upon appropriately. There are procedures and training in place to help protect people living in the home from abuse. EVIDENCE: There is a complaints procedure in place in the home. A copy is displayed in the entrance hall and there is a book there for people to write in. No entries had been made since the last inspection. Residents told us that they would tell the staff if they had any worries or concerns and they felt sure it would be sorted out. The complaints procedure is also in the Statement Of Purpose and The Service User Guide that are in all of the residents bedrooms. Policies regarding abuse and adult protection are in place in the home and all staff have received training. They were able to explain what they would do if they suspected abuse and they knew what was meant by the term “whistle blowing”. Robust recruitment procedures ensure that residents are protected from those who have been judged as being unsuitable to work with vulnerable adults. No one is employed without all of the necessary checks being carried out.
Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 19 The Commission has not received any complaints about this service since the last inspection. Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 20 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): Standards 19,26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home find that it generally meets their needs. It is safe, clean, pleasant and hygienic. EVIDENCE: We undertook a tour of the premises. We know that the Registered Providers are still hoping to get approval to extend the home however; there are some issue, which need to be addressed meanwhile. The home provides a clean and generally well-maintained environment for the residents who live there. It was refurbished during the last two years but in some areas paintwork is now scuffed and marked and repairs are needed to the plaster on the walls. An ongoing redecoration and refurbishment programme needs to be put in place to ensure that it remains a pleasant place for people to live in. The Annual Quality Assurance Assessment states that this
Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 21 is in hand and residents have been consulted about colour schemes. Therefore a requirement has not been given at this time and we will consider the issues at future inspections. Some concerns were raised about the lack of storage facilities, which have meant that a hoist is stored in a linen cupboard. This means that the door to the cupboard is wedged open, it restricts access to the linen, which could be a health, and safety risk for staff and also it has resulted in a trailing flex, as it has to be kept plugged in to remain charged. An alternative storage solution for this must be found as soon as possible. Unfortunately, the conservatory too, seems purely to be used as a storage area for wheelchairs, hoists and cushions. It is considered that this could provide an alternative communal area for residents if the problems relating to the temperature in there could be solved and it is recommended that some consideration should be given to this. Resident’s bedrooms are all pleasantly decorated and furnished and people have been encouraged to bring in their own possessions to personalise them and make them more homely. The people that we spoke with said that they thought that the home was a nice place to live in and that their bedrooms were comfortable. The home is now able to care for people who have dementia and, to ensure their safety, security keypads have been fitted on doors at the top of the stairs and those leading out of the home. On the day of the inspection one of these on the first floor was not working. It is unlikely that anyone would be able to go out of the door unnoticed however, the acting manager was asked to ensure that it was repaired as soon as possible. These keypads must be checked regularly to ensure that they function properly The home was warm, very clean and free from malodour on the day of the visit. Appropriate hand washing facilities and protective clothing such as aprons and gloves are available to help in the control of infection. The kitchen area has recently been retiled and upgraded in response to a visit from the environmental health officer. Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 22 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): Standards27, 28,29,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are always enough staff on duty to meet the needs of the people who live in the home. Recruitment procedures are in place to ensure their protection and there is an ongoing staff training programme. EVIDENCE: We looked at the rotas and there are always enough staff on duty to meet the needs of the residents however, there is still some reliance on staff from other homes in the group. The acting manager is actively trying to recruit more permanent staff. Few care staff have achieved an NVQ qualification and arrangements must be put in place to ensure that all staff who have not achieved this are enrolled on to a course. It is acknowledged that this will be an ongoing issue as more permanent staff are recruited to the home. Recruitment practices in the home ensure that people who have been judged as being unsuitable to work with vulnerable adults are prevented from doing so. We looked at the files of two new members of staff and all of the necessary checks had been done prior to them starting work. The acting manager has developed an induction programme for new staff and this was seen.
Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 23 There is an in-house training programme in place. The group of homes has its own trainer and sessions are held on a weekly basis. Staff confirmed that they have attended these although it is difficult to evidence this from records. It is recommended that a training matrix is produced and the manager will be doing this. Avenue Nursing Home DS0000063984.V368474.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): Standards 31,33,35,36,38 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service This service is run in the best interests of the people who live here although they are given limited opportunities to contribute their views. There is an acting manager in post who has many years experience of working with this client group. Working practices in the home generally show due regard for the health and safety of those people who use the service. EVIDENCE: The home is without a registered manager although there is an acting manager in place. The general running of the home, relationships between staff and residents and the quality of care are always influenced by person in charge and it is recommended that an application for registration should be made, to The Commission, in order to assess her experience, capabilities and suitability.
Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 25 There are now some opportunities for residents and their families to comment on the running of the home and contribute their views. Resident / relatives meetings are held regularly and visits are made by a member of the organisation in line with Regulation 26 to monitor the situation within the home. This is an area, which will still need to be expanded upon. The views of the people that use the service should be the basis for the annual development plan, which will ensure that the service remains responsive to their needs and preferences. Therefore more ways of gaining these such as questionnaires and surveys should be explored. It would also be useful to gain the views of healthcare professional such as community nurses and the GP who visit the home regularly. Maintenance records for equipment and services in the home were in place although the Fire Risk Assessment was compiled some time ago. This must be updated and it is recommended that professional advice should be obtained to help with this. It has been noted that there has been a failure to notify The Commission of incidents that have occurred in accordance with Regulation 37. These notifications help us to monitor the health and safety of those people who use this service. To make sure that there were no concerns we looked at documentation in the home and it would seem that there have been five deaths since the last inspection but no untoward incidents. All of the accidents that have occurred have been relatively minor with no resident requiring hospital admission following an accident. There were not any complaints recorded in the book and we have not been made aware of any issues from relatives or staff members. We have therefore judged this to be a safe service although the manager has been made aware of the importance of providing this information. Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 27 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 OP19 Regulation 13(4)(a) Requirement There must be improved storage facilities so that the hoist that is stored in the linen cupboard does not pose a health and safety risk to residents or staff. Security keypads in the home must always be fully functioning to minimise the risk to the people living in the home. The Commission for Social Care Inspection must be informed of any incident that affects the health or welfare of any resident in the home in order to help monitor their safety. Timescale for action 30/09/08 2. OP19 13(4)(c) 30/08/08 3 OP38 37 30/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations It is recommended that the Service User Guide and Statement of Purpose could be developed to make it easier
DS0000063984.V368474.R01.S.doc Version 5.2 Page 28 Avenue Nursing Home 2. 3. 4 OP12 OP19 OP31 for the people who use this service to understand. It is recommended that more activities should be provided which suit the interests and capabilities of those people who use the service. It is recommended that consideration should be given to developing additional communal space in the conservatory. It is recommended that an application, from a suitable person, should be put to the Commission for Social Care Inspection for consideration to be the Registered Manager for the service. Avenue Nursing Home DS0000063984.V368474.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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
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