Inspection on 08/10/08 for Averill House

This inspection was carried out on 8th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Averill House 18/02/09

Averill House 08/10/07

Averill House 29/01/07

Averill House 17/01/06

Averill House 31/08/05

Averill House 15/12/04

Averill House 17/06/04

Averill House 06/01/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

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:   two star good 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: Val Bell     Date: 0 8 1 0 2 0 0 8 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. the things that people have said are important to them: They reflect 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 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 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 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Jason King Type of registration: Number of places registered: Southern Cross Healthcare Services Ltd care home 48 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 1 48 Over 65 48 48 Care Homes for Older People Page 4 of 26 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 with both mental health and general nurse qualifications 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. Care Homes for Older People Page 5 of 26 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: two star good 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 was a key inspection, which included a site visit to the home. The visit was unannounced, which means that the manager was not informed beforehand that we were coming to inspect. During the visit we spent time talking to people living in the home, a visiting relative, nursing and care staff on duty, the acting manager and operational manager and the chef and activity co-ordinator. An annual Quality Assurance Assessment (AQAA), which is a self-assessment document had been completed by the manager and returned to the Commission prior to our visit. Six satisfaction surveys were completed by the relatives of people using the service Care Homes for Older People Page 6 of 26 and one member of staff also returned a completed survey. Relevant documents, systems and procedures were assessed and a tour of the home was undertaken. The fees for this service were not available at the time of our visit. What the care home does well: What has improved since the last inspection? What they could do better: We made one requirement and three good practice recommendations as a result of this inspection visit. One of the personnel files we looked at lacked the evidence to confirm that the member of staff had Home Office approval to work in the UK. We also recommended that personnel files be reviewed to ensure that the required documentation is held for each person employed to work at the home. Satisfactions surveys contained mixed views on certain aspects of the service being provided, although we found no evidence of negative outcomes in these areas during our visit. We recommend that relatives and other representatives of people using the service continue to be provided with regular opportunities to express their views on the quality of the service, so that issues of concern can be addressed at source. We found that staffing levels were not always sufficient to enable a group activity to regularly take place as planned. We discussed this with the management and Care Homes for Older People Page 8 of 26 recommended that staff support should be available during relevant activity sessions. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 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 10 of 26 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. A robust assessment process reassures people that they will receive the right kind of support if they choose to move into this home. Evidence: Information provided in the homes self-assessment document told us that people enquiring about moving into the home were assessed by the manager or his deputy. At the same time risks involved in providing care were assessed. This information is necessary for the manager and staff team to decide if they have the skills and resources to provide appropriate support. We looked at care records belonging to three people living in this home to decide if this assessment process had been followed. These three people and their representatives had been asked about the type of support they needed, so that the manager and staff team could decide if appropriate support was available. A relative Care Homes for Older People Page 11 of 26 Evidence: told us that, we were given an information pack and any questions were answered without hesitation on several unannounced visits (to the home). Risks had been carefully assessed and reviews had been undertaken six weeks after admission to determine if individuals needs were being appropriately met. This meant that people were given enough information and time to decide if the home would be the right place for them to live. This home does not provide an intermediate care service. Care Homes for Older People Page 12 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their experience of receiving care will be regularly reviewed and that appropriate action will be taken if they need additional or specialist support. Evidence: The manager told us in the self-assessment document he completed, about what information was recorded in care plans, and how outcomes for people using the service were monitored and reviewed. The three care plans we looked at contained detailed information to guide care staff in what they must do to meet that persons needs. Regular reviews had taken place and referrals had been made to relevant health care professionals when concerns had been identified. People using the service had different views about how individuals needs were being met. Some of the comments made in satisfaction surveys were, the general level of nursing is acceptable, overall we have been very happy with the care given, the care that my father is receiving is first class, we do not think that she always receives sufficient help with dressing as sometimes she is wearing multiple undergarments or that there are sufficient checks Care Homes for Older People Page 13 of 26 Evidence: for incontinence and the manager listens to what I say, but the staff make me feel I am talking to a brick wall. We did not receive any negative comments from people using the service or visitors to the home during our visit. The self-assessment document told us that the manager held regular relatives meetings and surgeries to give people the opportunity to discuss their opinions and views of the service being provided. Since our visit the registered manager has resigned and we recommend that these opportunities for relative feedback continue to be provided. We examined records and the 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. During our visit we observed interactions between staff and people living in the home. Staff referred to people by their preferred names and treated people in their care with dignity and respect. Care Homes for Older People Page 14 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The stimulating and interesting activity programme provided has resulted in positive outcomes for the wellbeing of people living in this home. Evidence: We had a conversation with the member of staff who provides activity sessions for people living in the home. She had undertaken specialist training in understanding how dementia affects peoples lives and how to provide suitable activities that engage and reorientate people living with dementia. It was evident that the variety of activities being provided had resulted in positive outcomes for people living in the home. People were observed to engage with their surroundings and the people they lived with and it was evident that they enjoyed the experience of these activities. The activity coordinator had also developed good relationships with relatives and provided support in helping them to understand the effect dementia had on the people they visited. This was commended as an example of best practice in person-centered dementia care. One of the group activities that people living in the home enjoyed, required additional staff resources to take place. The activity co-ordinator told us that this had not consistently taken place as planned because extra staff were not always available to assist with the session. She had been approached by several people, including a Care Homes for Older People Page 15 of 26 Evidence: relative, asking when the next session would be. We discussed this with the acting manager and operations manager and recommended that staffing should be sufficient to enable this group activity to take place regularly. Meals provided in the home are based on the Nutmeg system, which is a healthy eating plan developed by dieticians for use in care homes owned by Southern Cross Health care. The chef in this home told us that people are encouraged to eat a healthy diet, although personal preferences and choice will always be given priority. Two choices are provided on the menu at mealtimes and alternatives to these choices are always available. A relative told us, the family have dined with residents and found the meals enjoyable. Anniversaries and birthdays are celebrated with tea-time parties and religious and cultural diets can be catered for. Care Homes for Older People Page 16 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to listen to the concerns of people using the service and to afford protection to their safety and welfare. Evidence: The homes procedure for expressing concerns and complaints was posted on noticeboards in the home and a copy had been provided in each bedroom. We looked at the system for recording complaints and found sufficient detail along with the action that had been taken to resolve them. Each person making a complaint had received a written response. Completed satisfaction surveys provided evidence that people knew who to speak to if they had any concerns. Systems were in place to afford protection from harm to people using the service. Both provider and local authority procedures were available to inform staff what action they must take if abuse was alleged or suspected. Staff on duty told us that they had been trained in how to recognise abuse and who to report to if they suspected people using the service to be at risk of abuse. Care Homes for Older People Page 17 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes maintenance and development plan ensures that people living in the home are provided with a safe, clean, hygienic and comfortable environment. Evidence: We undertook a tour of the home to assess the standard of the environment in relation to cleanliness, hygiene, maintenance and safety. No health and safety concerns were identified and the environment was found to be clean and hygienic. A faint malodour was detected on the first floor and the acting manager explained that a quote had been obtained to replace the corridor carpet as this was thought to be the source of the malodour. Comments from relatives in satisfaction surveys varied in relation to cleanliness around the home. Comments included, individual rooms and bathrooms spotless and the standard of cleaning in the home varies. Sometimes the home can smell, particularly in the evening. As far as my mothers room is concerned the chair she sits in is covered with spills and is not cleaned on a regular basis. The carpet can also need cleaning more often than it is done. Some of the bedrooms are in need of refurbishment or even just a lick of paint, but apparently there is no budget to do this. We did not find any evidence of these concerns during our visit. However, as recommended in this report, providing regular opportunities for relatives to express any concerns they have will enable the provider to deal with such issues at source. Care Homes for Older People Page 18 of 26 Evidence: It was pleasing to find that the activity co-ordinator had introduced tactile boards and other facilities around the home to provide emotional and psychological support to people living with dementia. This had been based on current good practice in therapies used in dementia care. Equipment, furniture and fittings appeared to be well maintained and a rolling programme of redecoration was in evidence. The laundry area was clean and tidy and each person living in the home had a basket with their name on for clothes to be returned to their rooms. Two relatives commented in satisfaction surveys that the laundry system could be improved as clothes, although marked, very often go missing. Again this is an issue that can be addressed as part of the homes quality assurance system. Care Homes for Older People Page 19 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Thorough pre-recruitment checks are generally undertaken to establish that selected members of staff are suitable to work with people using this service, although omitting to do this can potentially place people at risk of harm. Evidence: Sufficient staff had been deployed to meet the personal and health care needs of people living in the home at the time of our visit and staff rotas provided further evidence that these staffing levels were being maintained. However, as recommended in this report, consideration should be given to ensuring that sufficient staff are available to provide support in maintaining the planned activity programme. The care team was comprised of qualified nurses and care assistants, 67 of whom had achieved a National Vocational Qualification at level 2 or above. It was pleasing to note that the provider sponsored care assistants to take this qualification at level 3. Further training had been undertaken by staff in understanding dementia, mandatory health and safety and abuse awareness. We looked at three personnel files to assess what pre-recruitment checks had been undertaken to establish that the staff selected were suitable to work with people using this service. Two personnel files contained the required documents, such as written Care Homes for Older People Page 20 of 26 Evidence: references and Criminal Record Bureau checks. However, the third file belonged to a member of staff that needed Home Office approval to work in the UK. This persons Home Office permit had expired in December 2006 and there was no evidence that he had been asked to provide a current work permit. We also recommend that a review of the personnel files be undertaken to establish if all the documents required by employment anf immigration law are in place. Care Homes for Older People Page 21 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of people using the service and their representative are listened to and action is taken to respond to suggestions for improvement wherever possible. Evidence: The registered manager was not present during our visit and a Southern Cross project manager was temporarily in charge. The operations manager for the home informed us that the registered manager had tendered his resignation. Procedures, systems, records and policies had been subject to regular review as part of the quality assurance system used by the provider. This auditing system also provides a means of surveying the views of people using the service and their representatives. We looked at a sample of the surveys and found that comments were mainly positive. Where suggestions for improvement had been made these had been actioned where possible. Care Homes for Older People Page 22 of 26 Evidence: People using the service were encouraged to retain responsibility for managing their personal spending money for as long as possible. For people needing support with this a system was in place for the safekeeping of their money. The balance of their spending money had been deposited in a dedicated bank account and daily expenditure was funded through a cash float held in the home. Income and expenditure had been reconciled each week and the accounts audited on a regular basis. We looked at a sample of health and safety records and found these to be accurate and up to date. No health and safety issues were identified during our visit. Care Homes for Older People Page 23 of 26 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 24 of 26 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 29 19 Evidence must be provided to confirm that holders of non-EU passports have the right to work in the UK. To demonstrate that the homes recruitment practices afford protection to the welfare of people using the service. 08/11/2008 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 1 7 People using the service and their representatives should continue to be provided with regular opportunities to express their views on the quality of the service being provided. Sufficient staff should be made available to ensure that activities can take place as planned. Personnel files should be reviewed to ensure that the required pre-employment checks have been obtained to protect the welfare of people using the service. 2 3 12 29 Care Homes for Older People Page 25 of 26 Helpline: 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 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 © (2008) 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 26 of 26 - 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!