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Inspection on 18/02/09 for Averill House

Also see our care home review for Averill House for more information

This inspection was carried out on 18th February 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Averill House Averill Street Newton Heath Manchester M40 1PD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Geraldine Blow     Date: 1 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Averill House Averill Street Newton Heath Manchester M40 1PD 01616886690 01616886602 averillhouse@schealthcare.co.uk www.schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross Healthcare Services Ltd care home 48 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: Residents requiring care by reason of dementia shall be aged 65 years or over with the exception of one named resident. Should this resident no longer reside at the home or their primary need for requiring care change, this place will revert to the category of dementia, over 65 years of age (DE(E)). Residents requiring care by reason of mental disorder, excluding learning disability or dementia, shall be 60 years of age or above with the exception of one named resident, who is currently below this age. The maximum number of residents shall be 48, of whom no more than 46 require nursing care. Date of last inspection 0 8 1 0 2 0 0 8 1 48 Over 65 48 48 Care Homes for Older People Page 4 of 27 Brief description of the care home Averill House Nursing Home provides accommodation, with nursing care, for a maximum of 48 older people. 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. Averill House is a large purpose built home set in its own grounds. Another home operated by Southern Cross is also on the same site. Registered nurses are on duty throughout the 24 hours and a manager who is also a registered nurse manages the home on a day-to-day basis. The home offers 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. The last CSCI inspection reprot is in the main reception area for people to access. Fees for accommodation at the home range from 399.44 pounds to 643.50 pounds per week. Additional charges are also made for hairdressing and chiropody services, newspapers and personal toiletries. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report is based on information gathered by the Commission for Social Care Inspection (CSCI) since the last inspection visit on 8 October 2008. This visit was unannounced, which means that the manager and staff were not told that we would be visiting. The visit was undertaken following some concerns that were raised with us from the local Primary care Trust (PCT). The visit took place on Wednesday 18 and Thursday 19 February 2009. This report is an overview of what the inspector found during the inspection. As part of the visit we (the commission) spent time examining relevant documents and files. We also spent time talking with the operations manager, the deputy manager, several people living at the home and members of staff. A tour of the building was undertaken. Feedback was given to the operations manager during the course of this Care Homes for Older People Page 6 of 27 visit and on conclusion of the visit. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using 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. Peoples needs are assessed before admission to ensure they can be met. Evidence: As detailed in the previous inspection report the deputy manager confirmed that admissions are only made to the home after an assessment of the persons needs has been undertaken. The manager also said that information from the care managers assessment of the placing authority or the funded nurse assessment is obtained in addition to the their own assessment of needs. A copy of the Statement of Purpose and the Service User Guide is available in the main reception area for people to look at. This home does not provide an intermediate care service. Care Homes for Older People Page 10 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some shortfalls were identified in ensuring that the health care needs of people living at the home were being met. Evidence: Three care plans were looked at during this visit. It was of concern that not all identified care needs had been incorporated into the care plans in all three files looked at. For example, one person was identified to be very aggressive on intervention, but there was no plan of care to meet this identified need. In another file the person had been prescribed medication for depression but there was no care plan addressing this and there was no record to ascertain if the medication was having any effect. In one care file the dietitian had documented that due to significant weight loss it had been agreed that the person would be offered extra snacks and there was agreed dietary targets. None of this had been incorporated into the care plan and there was no evidence that the extra snacks had been offered. Some parts of the care plans were vague and did not contain detailed information of Care Homes for Older People Page 11 of 27 Evidence: how care needs were to be met. For example, one file did not contain any information of how the persons personal hygiene needs should be met, even though the deputy manager said they needed all care. Other entries lacked detail such as ensure staff are aware of nutritional needs and ensure all staff are aware of Mental State. In was of concern that the care plan for one person was from a previous respite admission and not the current admission date and the care plans for another person were dated 2006. In one file looked at the body mapping chart made frequent references to various old bruising. This person was dependent on staff to meet their personal hygiene needs so it was of concern that bruising was not noticed until it was old. To ensure that peoples health is promoted staff must be more vigilant and report and document any bruising so that appropriate action can be taken. Care plans were not seen to promote peoples personal choice or preferences. For example one care plan stated give food she likes but their was no evidence of what that food was and there was no details of peoples preferred rising and retiring times of if people preferred baths or showers or at what time of day. One person, due to weight loss, was on a food record chart. However the chart only recorded how much food was eaten rather than what the food was. To ensure the diet is nutritionally balanced the actual food eaten should be recorded. We examined the records and stocks of medication held for the three people whose care plans we looked at. These were found to be accurate, secure and up to date. Suitable provision had been made for the safe disposal of unused medication from the home. It was of concern that the nurse call buzzer was constantly ringing. This could cause irritation or distress for the people living at the home. The operations manager said it was activated when staff went out of the key coded doors as well as when people rang for assistance. However on one occasion the bell was ringing, for some considerable time, in a persons bedroom. When we went to access the situation three members of staff were on the corridor, outside the bedroom, but nobody had gone into the bedroom to see if anybody needed them. This was discussed with the staff members and the operations manager. On day two of the visit the operations manager stated that she had made inquires regarding the buzzer going off when people went through the key coded doors. Care Homes for Older People Page 12 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using 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. Activities are provided and a varied and nutritious diet is available. Evidence: The previous inspection report detailed that the person responsible for providing activity sessions for people living in the home had undertaken specialist training in understanding how Dementia affects peoples lives and how to provide suitable activities that engage and re-orientate people living with Dementia. The deputy manager and the operations confirmed that this was unchanged. Various activities were on display in the main reception, some of which included a party that was held for Valentines day, tea dances, reminiscence group and art and crafts. Meals provided in the home continue to be based on the Nutmeg system, which is a healthy eating plan developed by dietitians for use in care homes owned by Southern Cross Health Care. Two choices are provided on the menu at mealtimes and alternatives to these choices are available on request. Staff spoken to during this visit confirmed this. Anniversaries and birthdays are celebrated with tea-time parties and religious and cultural diets can be catered for. As already stated in this report care plans did not detail peoples personal choices and Care Homes for Older People Page 13 of 27 Evidence: preferences so it was not evident that peoples personal choice and autonomy is promoted in relation to their preferred lifestyle and choices. Care Homes for Older People Page 14 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems need improving to fully protect people living at the home. Evidence: There is a complaint procedure on display in the entrance of the home and the details of a managers surgery where she makes herself available for people to talk to if they so wish. The operations manager said that there is a file where all complaints are recorded which include details of the complaint, copies of any correspondence and details of the investigation and a conclusion to the complaint. However the file could not be found during this visit as the manager was off sick. This is of some concern as she had been on sick leave for over three weeks and access to the file might have been necessary in her absence. The operations manager stated that they had policies and procedures around safeguarding adults and copies of the Local Authority Adult Safeguarding guidelines. However none of these could be found during this visit. It was of concern that the deputy manager was unable to accurately describe what actions to be taken in the event of an allegation of abuse being made. Since the last inspection visit 3 incidents have been investigated under safeguarding adults. Care Homes for Older People Page 15 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were not provided with a clean, odour free environment in which to live. Some areas of the home were not well maintained. Evidence: A tour of the building was undertaken as part of this visit. There was a strong unpleasant smell, particularly on the first floor. All the dinning room chairs, in the ground floor dining room, were dirty and contained encrusted food. Many of the lounge arm chairs were also dirty and stained, particularly on the arms. The wheelchairs seen were dirty and contained encrusted food and the corridor carpets were stained and dirty in appearance. The carpet in the smoke room was full of cigarette burns and many of the carpets in the bedrooms seen were dirty in appearance. One of the curtains, in the first floor lounge, was hanging off the curtain track. It was noted that two hoists were being stored in a bathroom and that in the same room one of the lights was not working and there was no head on the hot tap. In addition the hoists were dirty and required a thorough clean to reduce the risk of cross infection. Care Homes for Older People Page 16 of 27 Evidence: There was a tap head missing from the hot tap in the visitors toilet on the ground floor and the bin was overflowing. The carpet strip under one persons bedroom door was missing, causing a trip hazard. It was discussed with the operations manager and a carpet strip was put in place before the end of the inspection visit. It was also noted that a pane of glass in one of the fire doors was cracked. This caused a potential risk to people and we requested that it be repaired immediately. During the course of the visit the window was taped up and we were informed that the glass pane would be replaced as soon as possible. Care Homes for Older People Page 17 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all staff had received appropriate training to meet the assessed needs of people living there. Evidence: From reviewing the duty rota and from observations during the visit there were sufficient numbers of staff on duty to meet the needs of the people living there. Care staff who were spoken to said they had received induction prior to starting work and that they had access to training and development. There was a training matrix and staff had an individual training record. Care staff confirmed that they are encouraged and supported to undertake National Vocational Qualifications (NVQ) at level 2 and 3. The home is registered to accommodate people who have been assessed as needing care due to having dementia. It was of concern that the home employed one Registered Mental Nurse (RMN) and the rest of the nurses are Registered General Nurses (RGNS). In addition there were gaps in staff training in relation to Dementia care and Challenging Behavior. To ensure that staff are able to appropriately meet the needs of the people living at the home all staff must attend the appropriate training. Three personnel files were looked at during this visit to assess what pre-recruitment Care Homes for Older People Page 18 of 27 Evidence: checks had been undertaken to establish that the staff selected were suitable to work with people using this service. All files contained the required checks and documentation. Care Homes for Older People Page 19 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements are needed to the management systems to ensure that the home is running in the best interest of the people living there. Evidence: There were some shortfalls in the management of the home, which have been clearly identified in the report. Particularly in relation to the care planning process, the cleanliness and maintenance of the home, the unavailability of the safeguarding adult procedures and the lack of the deputys knowledge around safeguarding adults. In addition the current manager of the home took up post in October 2008 and has not yet applied for registration. The application must be submitted as a matter of some urgency. The manager was not present during this visit. Policies and procedures are subject to regular reviews by the quality department at head office. There is also a system for obtaining peoples views of the service being delivered. Care Homes for Older People Page 20 of 27 Evidence: Evidence was seen that the systems in place safe guarded peoples financial interests. There was a contract in place if it had been agreed that staff would purchase certain items of behalf of a person living there. This is considered good practice. At the previous visit on 8 October 2008 a sample of health and safety records were viewed and found to be accurate and up to date. They were not looked at during this visit. Care Homes for Older People Page 21 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 Staff must receive appropriate training in Dementia care and managing Challenging Behavior To ensure that staff are able to appropriately meet the needs of the people living at the home 20/03/2009 2 7 15 A detailed plan of care, which includes peoples personal choice and preferences, must be implemented for each identified care need. To ensure that the health and welfare of people living at the home are fully met. 25/03/2009 3 7 12 When people ring the nurse call buzzer staff must respond in a timely manner. To ensure that peoples health and welfare is promoted. 09/03/2009 Care Homes for Older People Page 23 of 27 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 8 17 The record of peoples dietary intake must include the food eaten as well as how much. To ensure that peoples dietary intake is nutritionally balanced. 20/03/2009 5 8 13 Staff must immediately report and record any new bruising. To ensure that peoples health and welfare is promoted and receive any necessary treatment or advice. 09/03/2009 6 18 13 The deputy manager must be aware of the correct procedure to follow in the event of an allegation of abuse being made. To ensure that people living at the home are protected from potential harm or abuse. 27/03/2009 7 19 13 The cracked pane of glass in 04/03/2009 the fire door must be replaced. To ensure that people living at the home are not put at any unnecessary risk. 8 19 23 All areas of the home must be clean and well maintained. 26/03/2009 Care Homes for Older People Page 24 of 27 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure a clean, safe and pleasant environment for the people who live there. 9 26 13 The dirty chairs, wheelchairs 04/03/2009 and hoists must be throughly cleaned. To reduce the risk of cross infection. 10 31 9 The manager must apply to CSCI for registration. To ensure that the home is run in the best interests of the people living there and the staff working there. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 18/03/2009 1 7 1. To ensure any shortfalls are identified and addressed it is recommended that a review of all care plans is undertaken. 2. It is recommended that peoples individual plans of care include details of their personal choice, preferences and social care needs. 2 8 In an attempt to stop the constant ringing of the nurse call buzzer it is recommended that either staff cancel the buzzer once they have identified it is due to people opening the key coded doors and not a person requiring assistance or a system should d be implemented to address the issue. It is recommended that people living at the home are encouraged and supported to have some control over their day to day lives. Page 25 of 27 3 14 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 16 It is recommended that the deputy manager and the operations manager have access to the complaint file in the absence of the manager. It is recommended that the Local Authority Adult Safeguarding guidelines are easily accessible in the home. It is recommended that an alternative storage space, other that the peoples bathroom, is found for the hoists as they are a potential trip hazard. 5 6 18 19 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!