CARE HOMES FOR OLDER PEOPLE
Averill House Averill Street Newton Heath Manchester M40 1PD Lead Inspector
Geraldine Blow Unannounced Inspection 17th January 2006 09:30 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 Averill House DS0000021631.V278621.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. Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Averill House Address Averill Street Newton Heath Manchester M40 1PD 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) 0161 688 6690 0161 688 6602 Southern Cross Healthcare Services Limited Ian Parker Care Home 48 Category(ies) of Dementia - over 65 years of age (0), Mental registration, with number disorder, excluding learning disability or of places dementia (0) Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The maximum number of service users requiring nursing care shall be 46. The maximum number of service users requiring personal care only shall be 2. All service users shall require care by reason of mental disorder (excluding learning disability) or dementia and shall be above 60 years of age. Minimum nursing staffing levels specified in the Notice served in accordance with Section 25(3) of the Registered Homes Act 1984 on 3 June 2001 must be maintained. 31st August 2005 Date of last inspection Brief Description of the Service: Averill House Nursing Home provides accommodation, with nursing care, for a maximum of 48 older people. The home is able to accommodate 45 residents assessed as requiring nursing care and 3 residents assessed as requiring personal care only. All residents had been assessed as having mental health needs. The premises are owned by Nursing Home Properties (NHP) PLC and are leased to Southern Cross Healthcare Limited. The home is situated in the Newton Heath area of Manchester close to a local market, shops, public houses, a park and other social areas and amenities. The home was first registered with the National Care Standards Commission, now the Commission for Social Care Inspection (CSCI), on 30th July 2002 and consists of a large purpose built home set in its own grounds, which was shared by its sister home operating on the same site. The home offered accommodation in 48 single, en-suite bedrooms. Accommodation for residents is provided on two floors accessed via a passenger lift and stairways. Each floor offers 2 lounges and one dining room. Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on 17th January 2006. During the inspection time was spent talking to the manager, several of the residents, a visitor and some members of staff to find out their views of the home. Some relevant documentation was also examined. Since the last inspection, the Commission for Social Care Inspection (CSCI) has not received any complaints about the service. It is commendable that all of the requirements made at the last inspection had been met. The previous inspection looked at the majority of the standards. As this inspection only looked at a very limited number of standards the report will be brief should be read together with any previous reports to gain a full picture of how the home is meeting the needs of the people living there. What the service does well:
As stated in the last inspection report the staff were seen to have good relationships with the residents and were seen laughing and chatting together. The manager said that residents get choice with regard to their daily lives, unless it is detrimental to their care, for example residents can go to bed and get up when they choose. The staff spoken to confirmed this. Through discussions with the manager and staff it was obvious that the home was committed to improving the service delivered to residents. The home had an open visiting policy and comments from a visitor were all positive. The visitor told the inspector that the family really liked the home and staff kept them informed of any changes in care. He said that the family had recently been invited to a meeting with the staff to discuss his relative’s care. He also said that his relative had spent time in 2 other homes and they definitely liked this one the best - they liked the bedroom and the home was always clean. The home carries out assessments of each prospective resident before admission to the home to ensure that the home can meet all the needs of the individual. The home had recently sent out an annual quality audit survey to a percentage of the relatives to try and find out their views of the home and ways to improve the service. At the time of inspection only a small number had been returned. Some of the comments received included, “The cleanliness of the
Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 6 home has improved”, “Staff are always polite and welcoming” and one response stated, “I am pleased as I am informed as soon as a problem arises.” This shows that the home is taking the issue of improving the quality of the service seriously and is devoting time and resources to involve people in finding out whether they are succeeding. The manager also told the inspector that a Consultant Psychiatrist from the local hospital had personally rang the home manager to ask if they could accommodate a patient who had been in hospital for a year. The consultant had in the past referred patients but has never rang in person to make an enquiry. This further demonstrates the improving quality of the home. From the systems in place it appeared that the financial interests of residents are safeguarded. The home has information available about independent advocacy services that will act in the interests of residents. During a recent relatives’ meeting an advocacy service called ‘Care Aware’ gave a presentation and left information for relatives to access regarding the service they provide. The home also has contacts with Age Concern and the Citizens Advice Bureau. What has improved since the last inspection? What they could do better:
There were some short falls identified in one of the files inspected, which were the use of restraints such as bed rails must be risk assessment before they are used and if possible consent must be given for their use. Also pressure sores and their treatment must be recorded in the residents’ plan of care. Despite these two issues it was obvious from inspecting the files, talking to the manager and staff that the home were continually striving to improve the care planning process on an going basis.
Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 7 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. Averill House DS0000021631.V278621.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 Averill House DS0000021631.V278621.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): 3 The home undertakes an assessment of prospective residents care needs prior to their admission. EVIDENCE: Prospective residents have a pre-admission assessment to ensure that the home can meet all of their assessed needs. The assessment included the involvement of the prospective resident, his/her representatives and any relevant professionals. For residents who are referred through Care Management arrangements, the home obtains a summary of the Care Management Assessment prior to admission. Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 10 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 and 8 Overall the health and personal care needs of the residents appeared to be met at the home. EVIDENCE: A random sample of files were inspected. It was obvious that the home had worked hard to fully implement the new care plan documentation since the last inspection. Each file was seen to have an up to date photograph of the resident for easy identification. Some files contained consent for photographs to be taken. In the file where this was not present the manager said that in the documentation change over the consent had been filed with the old paperwork. The inspector was assured that the consent would be put in the file. In the main the plans of care were found to be detailed, informative and clearly set out the action that needed to be taken by care staff to ensure that all aspects of health, personal and social care needs of the residents were met. Appropriate risk assessments had been included and the plans of care had been reviewed on a monthly basis to reflect changing needs and current objectives for health and personal care. However some shortfalls were identified in one of the files inspected. The resident had bed rails in situ but the risk assessment had not been completed
Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 11 and although the deputy matron told the inspector that verbal consent had been obtained from the next of kin no evidence could be found to support this. The resident had a pressure sore to his sacrum. There was no evidence of a specific care plan relating to the pressure sore. The deputy manager said that she was waiting for advise from the Tissue Viability Nurse regarding the type of dressing to be used. However a plan of care must be implemented detailing the dressing to be used, the frequency of dressing changes, a description of the sore and an ongoing progress report of the treatment. The file contained a recent photograph of the wound. As already stated in this report no consent for the photograph could be found in this file although assurances were given by the manager that consent had previously been obtained and would be included in the file. In addition, the risk assessments in this particular file had not been updated since November 2005. However the resident had spent a short period of time in hospital and the other files inspected did contain monthly reviews. This area of practise will be inspected again at the next inspection. It is commendable that the manager conducts a weekly audit of a sample of the care plans in an effort to main a high standard. Staff are continually given feedback on the results of the audit to encourage the on going development of the care planning process. The manager confirmed to the inspector that the requirements made at the last inspection in relation to the care plans and the medication process had been met. The remaining core standards were assessed during the previous inspection. Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 12 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): 13 and 14 Residents were able to maintain contact with family and friends, and were able to exercise choice and control over their lives. EVIDENCE: The home had an open visiting policy and visitors could be seen in the privacy of the resident’s own room or in any of the communal areas. Staff and the visitor spoken to during the inspection confirmed this. From observations and discussions with staff it appeared that residents were able to exercise choice and control with regard to their day-to-day lives. In order for the home to promote and maximise resident choice the manager said that he was due to undertake recognised Alzheimer’s training called ‘Yesterday, Today and Tomorrow.’ As already stated, the home has information regarding independent advocacy services that will act on behalf of the residents. Several of the bedrooms had been personalised with residents’ belongings brought in from their own homes. The requirement made at the last inspection regarding staff using inappropriate and patronising language towards residents appeared to have
Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 13 been met. The inspector heard no evidence of patronising language being used and the manager said that he had spoken to the staff regarding the requirement and he had not heard any further inappropriate language. The requirement regarding the kitchen ceiling had been met. The recommendation made at the last inspection that the home improves communication with relatives regarding activities had been met. A relative’s meeting was held in October 2005 where activities were discussed and a suggestion box was situated in the main reception area. The manager said that the recommendation that residents are given a choice of accompaniments with their meal had been met. He said he regularly witnessed staff asking residents what accompaniments they would like with their meals. He also said that he had planned to carry out an unannounced ‘drop in’ from 4am later this week to observe the working practises of the staff. The manger told the inspector that the Dietician was due to come to the home on 7th February to discuss the home’s menus. The remaining core standards were assessed during the previous inspection. Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 14 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): Judgement was not made at this inspection. EVIDENCE: The manager said that each unit had a copy of the policy for the Protection of Vulnerable Adults and he had spoken to staff on an individual basis on the actions to be taken in the event of an allegation of abuse. Formal training for all staff is planned for the near future, although dates are not yet available. This meets the requirement made at the last inspection. The remaining core standards were assessed during the previous inspection. Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 15 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): Judgement was not made at this inspection. EVIDENCE: Following on from the requirement made at the last inspection on 31st August 2005, the manager said that the weeds had been cleared from the flagged patio area. Also as required at the last inspection, the manager had obtained the up to date Infection Control Guidelines and Infection Control Training was arranged for 15th February 2006. All hoists had been thoroughly cleaned and new waste bins with lids had been purchased and were in use. During a tour of the building the inspector noted that a number of tiles were missing from the wall in bathroom 57 on the 1st floor. The manager said he was aware of this and gave assurances that they would be replaced as soon as possible. The maintenance man was due to leave at the end of the week and the home was in discussions regarding his replacement. The remaining core standards were assessed during the previous inspection. Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 16 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): 30 Staff have access to the training and learning they require to support the residents accommodated at the home. EVIDENCE: As already stated in this report each member of staff had an individual training and development programme. Systems were in place to ensure that all staff undertake the mandatory training. The home has a structured Induction process. The Induction is currently based on the TOPPS guidance. However, the organisation that set the standards of training for all social care services and workers recently introduced new guidance on what an induction programme for new staff should include. These new standards will be compulsory in September 2006. The organisation is aware of this new development and the Quality Department is currently reviewing the Induction programme to make sure that it meets the new standards. The authenticity of references are now being appropriately checked as required at the last inspection. The manger demonstrated that every effort had been made to meet the recommendation made at the last inspection regarding 50 of care staff are trained to NVQ level 2. The home employs 22 care staff, 3 members of staff have successfully completed the training, 5 members of staff are currently undertaking it and 1 member of care staff is due to start the training. Three
Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 17 members of care staff are overseas nurses who are not yet eligible to undertake the training. The remaining core standards were assessed during the previous inspection. Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 18 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): 33, 35 and 38 The home has the systems and practices to monitor and develop the service based on people’s views. Systems and procedures were in place, which safeguards and protects residents’ financial interests and the home was seen to promote the health, safety and welfare of the residents and staff. EVIDENCE: Evidence was seen of an annual quality monitoring system to seek feedback from the relatives of the residents who use the service. At the time of inspection only a small number of responses had been received. The manger said that he would be reviewing the responses and cascade the information to the staff. If practises were to be changed as a result of the survey an action plan would be implemented. Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 19 Evidence was seen that the systems in place did safe guard residents’ financial interests. During the course of the inspection the inspector spoke with the Regional Administrator who said that Southern Cross Healthcare Ltd had agreed nationally with CSCI’s Provider Relationship Manager (PRM) regarding residents’ finances. Policies and procedures reflecting this agreement were in the development stage. Evidence was seen that the manager ensures the health, safety and welfare of the residents and staff are protected at all times. The manager said he is due to undertake the Registered Managers Award and is awaiting a start date. Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 20 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 21 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 13 Requirement Timescale for action 28/02/06 2 OP8 17 Schedule 3 The use of restraints such as bed rails must be thoroughly risk assessed and consent for their use obtained. The incidence of pressures sores, 28/02/06 their treatment and outcome must be recorded in the resident’s individual plan of care. 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 Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Averill House DS0000021631.V278621.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
