Inspection on 16/03/06 for Avon Court

This inspection was carried out on 16th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Avon Court 09/06/09

Avon Court 16/01/08

Avon Court 29/06/06

Avon Court 08/09/05

Avon Court 08/02/05

Avon Court 03/08/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Avon Court All Saints Road Warwick Warwickshire CV34 5NP Lead Inspector Lesley Beadsworth Unannounced Inspection 16th March 2006 10:30 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 Avon Court DS0000004490.V287041.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. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Avon Court Address All Saints Road Warwick Warwickshire CV34 5NP 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) 01926 401324 01926 401324 Prime Life Limited Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th September 2005 Brief Description of the Service: Avon Court (owned by Prime Life Ltd) is a care home providing personal care and accommodation for up to 34 service users over the age of 65 years. Accommodation consists of all single bedrooms, over two floors. The services offered in this home are all based on rehabilitation. Two types of service are provided, intermediate care and transitional care. Avon Court does not take any privately funded service users. Service users are admitted from hospital or the community following assessment by the Intermediate Care team and the home manager. Accommodation on the first floor is for service users receiving rehabilitation and the ground floor offers personal care services. Service users admitted to this home are funded either by the local Primary Care Trust, for rehabilitation or social services for assessment and transitional care. Service users in this home are all short stay. The average length of stay is six weeks. The majority of service users then return home or move into care homes on a long-term basis. The services provided are delivered by the home’s care staff and professional therapists employed by the Primary Care Trust. The therapeutic services provided are based on person-centred care and current evidence-based practices. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Inspection took place on 16th March 2006 between the hours of 10:30 and 17:15. During this time the inspector had the opportunity to meet with the residents, tour the premises, spend time talking to residents in private and in groups and examine documents relating to residents, staff and the management of the home. The Director of Elderly Services of the organisation was present for the inspection and has been managing the home in the absence of a manager. The newly appointed manager was also in the home during some of the inspection as she was undergoing induction training prior to commencing work at the home. What the service does well: The home was free of any offensive odour and all areas viewed were clean and in the main well decorated and furnished, offering the people staying at the home comfortable surroundings. The gardens were tidy and adequately maintained with garden furniture for use by residents. There are two lounges on the ground floor and a further lounge on the first floor, all of which are nicely decorated and furnished. The dining room located on the ground floor caters for all those at the home and is adequately decorated and furnished. All areas of the home are accessible by residents by means of a passenger lift. There is a call bell system throughout the home to enable people staying at the home to summon assistance when required. No concerns relating to infection control were noted during the inspection. All care files looked at included a care management assessment describing the needs of individual residents. The local GP and district nurses provide the medical and nursing needs of residents in both units and the GP attends the home daily thereby addressing any medical/health needs. Residents spoken with complimented the food provided saying that it was “lovely”, always tasty and that they had a choice offered each day. The meals served at lunch and tea were attractively presented and looked of a good standard with further helpings available. Staff, including the cook, were available to offer assistance as required. The majority of the residents spoken with said that they were treated respectfully. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 6 There is a dedicated Intermediate Care unit on the first floor of the home where residents receive intensive assessment and rehabilitation with the aim of these residents returning home again. It is staffed by therapists employed by the Primary Care Trust (PCT) including physiotherapists, occupational therapist, a part time pharmacist and generic support workers during the day, with care staff employed by the home offering personal care and staffing the unit in the evenings and during the night. On the Intermediate Care Unit there is an identified therapy room and appropriate equipment for rehabilitation and equipment is also supplied by the Primary Care Trust as required to further develop the rehabilitation of the individual residents. What has improved since the last inspection? What they could do better: Following the change of registered manager earlier in the year the Statement of Purpose is now in need of updating. Staff training records provided by the Director of Elderly Services did not evidence that staff have undertaken any specific training related to specialist needs of people staying at the home, for example training related to physical disabilities, sensory impairments or such problems as Diabetes or Parkinson’s disease. The home has not achieved 50 of care staff achieving NVQ Level 2 or 3 in Care qualification that demonstrates competence. There is also no evidence of there being an appropriate Induction and Foundation training programme to train new staff in their role. It could therefore not be demonstrated that the staff group have the knowledge and skills to meet the specialist and basic care needs of residents. Care plans need improving to ensure that the arrangements for health, personal and social care needs of residents are easily accessible and up to date. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 7 One resident said that she had only had one bath in three weeks and that she was unhappy about this infrequency, although her hair had been washed each week. Her care plan did indicate how often she wished to be bathed. Residents’ personal care needs and wishes must be adequately recorded and provided. At the time of this current visit a delivery of medication from the pharmacy had been left inside the unoccupied and unlocked office. Because of the risk to residents an immediate requirement notice was issued. The Director of Elderly Services investigated the incident promptly, a book to record medications received into the home was initiated and assurances made that the incident would be addressed. However the home needs to be more mindful of the security of medication at all times to safeguard residents and the public. One member of staff was seen to be speaking disrespectfully to another member of staff in front of residents, which could cause distress to the residents as well as the other member of staff. This was discussed with the Director of Elderly Services. No organised activity was observed during the visit. A small group of residents observed to be sitting in a lounge watching television, other than at mealtimes, throughout the day with no evidence of any staff interaction or activity offered. Their capacity to understand was limited and they could benefit from organised occupation and stimulation. The dining room was very noisy during the meal due to the clearing and washing of crockery, creating a disturbing atmosphere. Closing the kitchen door and hatch once the washing of crockery begins could reduce this noise. Discussion with a resident who ate in her bedroom on the first floor indicated that meals were not always as hot as she would like by the time they were served, being brought on unheated trolleys and trays from the kitchen on the ground floor. Food needs to be kept piping hot until ready for eating to prevent the risk of food poisoning and should not fall below 65°C. Records need to be maintained of temperatures of food when cooked and at the time of serving. Some policies viewed did not include the procedures or practices required and this leaves staff not knowing what the requirements or expectations are of them from the organisation. Policies of the organisation need to be individualised for this home and appropriate procedures devised to enable staff to know how they need to be working and to know what is expected of them. According to a past and a current rota provided, the home does not provide sufficient numbers of staff to meet the needs of the residents. Given the number of residents that can be catered for at Avon Court, the size of the premises and the additional support and care planning required for short-term residents the organisation must consider this staffing situation. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 8 The home needs to undertake a risk assessment based on the needs of the service and the layout and size of the building and adjust staffing levels of all grades as required. Risk assessments must be reviewed on a regular basis. This must cover the weekend period as well as weekdays. The home should also indicate if any care hours are used for carrying out domestic tasks and thus hours that are taken away from the residents. 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. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 9 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 Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 10 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): 1,3,4,5,6 The home provides adequate information to give residents the information they require in order to make a choice about whether they want to stay at the home or not. Assessments are made to ensure that the home is suitable for meeting a resident’s needs. EVIDENCE: The home provides a Statement of Purpose and although this is brief it includes the majority of the information required or directs the reader to where the information can be found. However following the transfer several months ago of the named registered manager in this document this is now in need of updating. The home also has a brochure but this was not examined on this occasion. All residents are referred by health or social care services because of the nature of the intermediate and rehabilitation services offered. All care files looked at included a care management assessment from which care plans should be devised to meet the needs of individual residents. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 11 Staff training records provided by the Director of Elderly Services did not evidence that staff have undertaken any specific training related to specialist needs of people staying at the home, for example training related to physical disabilities, sensory impairments or such problems as Diabetes or Parkinson’s disease. It could therefore not be demonstrated that the staff group have the knowledge and skills to meet these specialist needs. However the Director of Elderly Services advised that approximately half of the staff had undertaken training related to dementia care to meet the needs of those residents with dementia. The nature of the services offered and the temporary duration of the stay at the home means that it is not always practical or necessary for residents to have a trial period at the home prior to deciding on whether to stay there or not, but the Statement of Purpose advises that this can be provided if a resident wishes. There is a dedicated Intermediate Care unit on the first floor of the home where residents receive intensive assessment and rehabilitation with the aim of these residents returning home again. It is staffed by therapists employed by the Primary Care Trust (PCT) including physiotherapists, occupational therapist, a part time pharmacist and generic support workers during the day, with care staff employed by the home offering personal care and staffing the unit in the evenings and during the night. People accommodated on this unit were visited and spoken with during the inspection and were generally satisfied with the Intermediate Care services they received from the Intermediate Care Team. The Director of Elderly Services advised that the full team changes at six monthly intervals, which could create a lack of continuity and team building within the home. The average stay for residents at Avon Court is six weeks but there is some flexibility in this. On the Intermediate Care Unit there is an identified therapy room and appropriate equipment for rehabilitation and equipment is also supplied by the Primary Care Trust as required to further develop the rehabilitation of the individual resident. The local GP and district nurses provide the medical and nursing needs of residents in both units and the GP attends the home daily thereby addressing any medical/health needs. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 12 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, 8, 9 Care plans need improving to ensure that the arrangements for health, personal and social care needs of residents are easily accessible and up to date. Some practice related to medication poses a potential risk to residents. EVIDENCE: Each resident has a single assessment care plan brought with him or her from hospital. The residents’ health, personal and social care needs are not clearly set out in the individual plans and it is difficult for care staff to extract what information there is. The Director of Elderly Services advised that a new form of care plan was in the process of being devised in order to improve this. There was no evidence in the plans viewed to demonstrate that they are reviewed, at a minimum of monthly intervals and revised as necessary, and one single assessment plan viewed did not contain any care plan describing the care needed by that person. These shortfalls increase the risk of residents’ health and care needs not always being fully met. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 13 All residents spoken with were appropriately dressed and their personal care appeared appropriate but one resident said that she had only had one bath in three weeks and that she was unhappy about this infrequency, although her hair had been washed each week. Her care plan did not indicate how often she wished to be bathed. Other observations made had not been addressed in her care plan or mentioned in her daily records. Medication had been assessed more fully at a previous and recent additional visit made by another inspector following concerns about medication procedures and when further concerns were raised. At the time of this current visit a delivery of medication from the pharmacy had been left inside the unoccupied and unlocked office. Because of the risk to residents an immediate requirement notice was issued. The Director of Elderly Services investigated the incident promptly a book to record medications received into the home was initiated and assurances made that the incident would be addressed. However the home must be mindful of the security of medication at all times. The requirement made at the additional visit for the person administering medication to be identified had been met. Staff continue to undertake training related to medication to safeguard residents and records show that three people have completed this training. Advice was given that a medication audit has been carried out by the organisation and the Primary Care Trust pharmacist involved in the Intermediate Care Unit was due to look at the system the day after this inspection. The majority of the residents spoken with said that they were treated respectfully and this was the general observation made. One member of staff was seen to be speaking disrespectfully to another member of staff in front of residents, which could cause distress to the residents. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Activities provided within the home do not meet the residents’ expectations. Residents are able to make some choices about their daily lives. A varied and nutritious choice of meals is provided and enjoyed by residents. Visitors to the home are made welcome and can visit at any reasonable time. EVIDENCE: The Director of Elderly Services advised that there is some ad hoc activity most days but that there was very little take up from the people staying at the home. Reasons given for this was that the resident received visitors all day, families and friends continuing to visit in a similar daily pattern as when the resident was in hospital, and the Intermediate Care residents were occupied by their therapy and rehabilitation sessions. There are organised outings in the organisation’s vehicle twice a month but no staff or resident spoken with could recall where the last outing had been to. The Director of Elderly Services said that these outings were not heavily attended. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 15 No organised activity was observed during the visit. A small group of residents observed to be sitting in a lounge watching television throughout the day, other than at mealtimes, with no evidence seen of any staff interaction or activity offered, whereas they could benefit from organised occupation and stimulation. Another resident spoken with said that her therapy sessions took up a very short time in the day and for the rest of the day she had nothing to do. There was some evidence to support that residents are assisted to exercise choice and control over their lives apart from the choice of meals and some residents spoken with confirmed that this took place. People staying at the home have the opportunity to bring in personal possessions and some small items, such as photographs were seen in bedrooms. The large majority of residents spoken with complimented the food provided saying that it was “lovely”, always tasty and that they had a choice offered each day. On the day of the inspection lunch consisted of a choice of cottage pie or liver followed by lemon meringue pie. The meals served at lunch and teatime were attractively presented and looked of a good standard with further helpings available. Staff, including the cook, were available to offer assistance as required. The dining room was very noisy during the meal due to the clearing and washing of crockery, creating a disturbing atmosphere. This noise could be reduced by the kitchen door and hatch shutter being closed once the washing of crockery begins. The Director of Elderly Services advised that the organisation was looking at improving the appearance of the dining room. It was noted that the cutlery, particularly the teaspoons, were badly stained, and therefore unappealing and unpleasant to those who would have to use it. Discussion with a resident who often ate in her bedroom on the first floor indicated that meals were not always as hot as she would like by the time they were served, being brought on unheated trolleys and trays from the kitchen on the ground floor. Food needs to be kept piping hot until ready for eating to prevent the risk of food poisoning and should not fall below 65°C. Records need to be maintained of temperatures of food when cooked and at the time of serving. A bowl of fresh fruit was available in the lounge alongside a bowl of sweets for residents to help themselves, however care needs to be taken that residents with special dietary needs and limited understanding are assisted to monitor the amount eaten. The kitchen continues to be in need of refurbishment or replacement. The Director of Elderly Services advised that this is due to be completed shortly. In the meantime some of the worktops create a risk of cross infection. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 16 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): 16,18 The home has a complaints policy but is not easy for a complainant to follow. The home has an Adult Protection policy but procedure for referral inadequate. EVIDENCE: The home has a complaints policy but may not be sufficiently adequate for a complainant to extract the information they need to be able to follow the procedure. A user-friendlier version was displayed on the home’s notice board but this omitted to mention that a complainant is able to contact the Commission for Social Care Inspection at any stage of a complaint. Records of complaints made to the home are maintained in the same manner as at the previous inspection when there were concerns that the information cannot be confidential as several complaints are recorded on the same page. The organisation advised at this time that to maintain data protection a photocopy is made of the individual complaint record if a complainant wishes to see it. This procedure is not included in the complaint policy creating the potential for it to be overlooked. A current complaint regarding a medication error was listed in the records but no further details were recorded regarding the action being taken. The Director of Elderly Services advised that this was because the complaint was being dealt with by head office and because of the absence of a manager over recent months. However a record needs to be maintained in the home. is Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 17 The home’s policy includes information regarding the Department of Health’s guidelines, ‘No Secrets’, with all staff receiving a copy a summary of this document. However there is no instruction for staff regarding what steps to take if there is an incident or allegation of adult abuse although there is information from Social Services related to this on the office notice board. This lack of organisation information poses a risk of staff being unsure of the organisation’s requirements should a vulnerable adult referral need to be made. Staff had not undertaken training to give them the skills and knowledge to be able to identify or prevent incidents of abuse thereby posing the potential of residents to be at risk. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 26 The residents at the home enjoy clean, safe and pleasant surroundings both inside and outside the home. The kitchen facilities are in need of replacement and have the potential to pose a hygiene risk. EVIDENCE: The home was free of any offensive odour and all areas viewed were clean and in the main well decorated and furnished, offering the people staying at the home pleasant, clean and safe surroundings. The gardens were tidy and adequately maintained with garden furniture provided for the residents’ use. There are two lounges on the ground floor and a further lounge on the first floor, all of which are nicely decorated and furnished. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 19 The dining room located on the ground floor caters for all those at the home and is adequately decorated and furnished but would benefit from brightening up, and the remains of streamers removing from the walls, to offer more pleasant dining facilities. As previously mentioned the Director of Elderly Services advised that this was planned. Bedrooms viewed were attractive and fitted with modern furniture and fabric, although there was only room for one armchair in the bedrooms visited. As previously mentioned, on the Intermediate Care Unit there is an identified therapy room and appropriate equipment for rehabilitation and equipment is also supplied by the Primary Care Trust as necessary to further develop the rehabilitation of the individual resident. All areas of the home are accessible by resident by means of a passenger lift. There is a call bell system throughout the home to enable people staying at the home to summon assistance when required. It was noted that not all walking aids are labelled with the owner’s name, and this caused some confusion in the dining room after lunch relying on the memory of members of staff for those aids to be returned to their rightful owner. This could create the risk of people having the incorrect walking aids and subsequently cause an accident as well as the indignity of residents’ not having their own possessions returned to them. The risk of this occurring is high given the rate of admission and discharge of residents in this home. No concerns relating to infection control were noted during the inspection. However, as with other policies discussed in this report, the policy related to Infection Control did not include the procedures or practices required and this leaves staff not knowing what the requirements or expectations are of them from the organisation. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29,30 The home does not provide sufficient numbers of staff to meet the needs of the residents. The appropriate checks on new staff had been made to protect people staying at the home from inappropriate persons being employed. EVIDENCE: Copies of a previous and a current rota provided by the home indicated that the number of care staff varies from five to three care staff in the mornings and from five to two care staff in the evenings, with a manager, a cook and a cleaner on duty each weekday. At weekends the home is without a cleaner or manager. There are no designated laundry staff. The Intermediate Care unit also has therapists, including physiotherapists, occupational therapist, a part time pharmacist and generic support workers all of whom are employed by the Primary Care Trust and work only mornings and afternoons. The care staff of the home continue to be responsible for the dayto-day care of residents on the Intermediate Care Unit. Given the number of residents that can be catered for at Avon Court, the size of the premises and the additional support and care planning required for short-term residents the organisation must consider this staffing situation. The home needs to undertake a risk assessment based on the needs of the service and the layout and size of the building and adjust staffing levels of all grades as required. Risk assessments must be reviewed on a regular basis. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 21 This must cover the weekend period as well as weekdays. The home should also indicate what care hours are used for carrying out domestic tasks and that are consequently taken away from the residents. At the previous additional visit a staff file examined revealed that the Protection of Vulnerable Adults and Criminal Records Bureau checks for the employee had not been made. On inspection of this file on this visit the checks had been satisfactorily carried out. The home has not yet achieved the 50 of care staff having achieved NVQ Level 2 or 3 in Care. This number must also include agency and bank staff that cover care shifts. NVQ in Care demonstrates that staff are competent to carry out their role. The Director of Elderly Services advised that staff have undertaken some mandatory training but records provided show that only one member of staff has undertaken health and safety training, and that no recent training has been undertaken related to infection control; records do not show any training related to fire prevention, basic food hygiene or moving and handling; apart from being advised of some dementia care training there is no evidence to support that that staff have undertaken any specialist training, including continence management and tissue viability, skin care or pressure sore prevention; there is no record of staff having attended any induction or foundation training. Without adequate training staff are not able to safely meet the needs of residents or carry out their role effectively thereby putting residents at risk. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 22 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): 31,33,35,36,37 The home is currently without a registered or designated manager and had been without the supervision required to maintain consistent working practices. A Quality Assurance Programme is in place to monitor the standard of the services provided. Whilst there are appropriate policies in place these are not individualised and do not link in with the procedures necessary to enable staff to have the information they require to carry out their job. EVIDENCE: The Director of Elderly Services for the organisation had been managing the home for approximately two weeks previous to the inspection as the registered manager had been, and continued to be, on long-term absence from the home. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 23 Consequently the day-to-day leadership and direction required to ensure a consistent approach to safe working practices and meeting the needs of the people living at the home was being restored. The lack of this leadership has been particularly apparent in the areas of medication, care planning, some record keeping and in the absence of formal staff supervision. A new manager has now been appointed and was due to start work at the home the week after the inspection. She was present during part of this inspection as she was undertaking induction training with the Director of Elderly Services. She will need to complete the fit person process through the Commission for Social Care Inspection in order to become the registered manager of the home. As previously mentioned some record keeping was not up to date and complaints and accident records were not in line with the Data Protection Act, in that it is stored in such a way that there is a potential risk that anyone wishing to access information about themselves could also have access to personal information about others. Accident records did not indicate what action had been taken following an accident. Daily records viewed did not always reflect observations or discussion made with individual residents resulting in a risk of health and social care needs and wishes not being met. Body maps were not seen in the documents viewed and therefore the relative requirement was not assessed on this occasion. The policies and procedures manual was not initially available but a copy belonging to a member of staff was located. The policies have been written in a bound book form by the organisation and distributed to each home. However these had not been individualised and those viewed did not have accompanying procedures to enable staff to be informed of the appropriate, safe and accepted manner in which the policies needed to be implemented, consequently risking that the residents health, safety and welfare of the people living and working at the home. The home does not currently hold any monies or valuables for people staying at the home. Each bedroom has a lockable place so that any valuable items held in the home by residents can be kept safe. If a resident wishes for any valuables to be looked after by the home there is a main safe and items kept here are receipted in and out to safeguard residents. There is a Quality Assurance Programme in the home to enable the home and organisation to monitor the service and make changes and improvements. Questionnaires are distributed by the organisation at regular intervals, and a comments book was available in the reception area, for residents and visitors to feedback their opinions of the services provided. This programme was not fully assessed on this occasion. With regard to health, safety and welfare the lack of evidence of mandatory training raised concerns about safe and up to date working practices in the home as residents and staff are put at risk. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 24 Regulation 37 notifications regarding incidents that had occurred in the home are now being received by the Commission as was required following the previous additional visit. Records related to health and safety and maintenance were not examined at this visit. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 25 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 2 X 3 2 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 2 2 Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 26 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 OP1 Regulation 4 Requirement The home must provide and up to date Statement of Purpose and forward the revised copy to the Commission. Timescale for action 30/06/06 2 OP4 18 The registered persons must 30/06/06 provide adequate specialist training to ensure that at all times there are suitably trained persons to meet the needs of the people living at the home. Each resident must have a care 31/05/06 plan as to how his or her health and welfare needs are to be met. The plan must be reviewed at least monthly and revised as the resident’s circumstances change. The home must ensure that the personal care needs and wishes are maintained. Security must be maintained regarding the receipt and storage of medication. 31/05/06 3 OP7 15 4 OP8 12 5 OP9 13 16/03/06 Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 27 6 OP9 13 The registered person must ensure immediately that staff sign for medication that has been administered or they must indicate why medication has not been taken or given. If the code ‘F’ is used, staff must write what ‘F’ means at the bottom of the MAR sheet. 31/05/06 7 OP12 16 The registered persons must consult people living at the home about their social interests and make arrangements for leisure and social activities that meet their needs, preferences and ability. The home must provide suitable cutlery for the use of the people living at the home. Food must be served at appropriate temperatures and records maintained of the temperature of food when cooked and at the point of serving. All records must be maintained in line with the Data Protection Act 1998, including the records regarding complaints and recording of accidents. (The previous timescale of 30/10/05 was not met.) 30/06/06 8 OP15 16(2)(g) 30/06/06 9 OP15 16(2)(i) 31/05/06 10 OP16OP37 20 Sch 4 (11) 31/05/06 Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 28 11 OP16 20 The complaints policy needs to be written so that the complainant can follow the procedure and must include That the complainant can contact the Commission at any stage of the complaint. The procedure that staff need to take to maintain confidentiality using the current recording practice. Records must be kept up to date. Staff must undertake training that gives them the skills and knowledge related to adult protection. 31/05/06 12 OP18 13(6) 30/06/06 13 OP19OP26 OP38 12(1) 13(4) 16(2)(j) The Adult Protection policy must include the procedure to be followed by staff if an incident or allegation of abuse occurs. The registered persons must 30/06/06 ensure that the plans for the refurbishment of the kitchen materialise. The refurbishment needs to include ensuring that the kitchen floor is non-slip when wet or dry. (The previous timescale of 30/11/05 was not met.) The registered provider must ensure that the cracked sinks and stained bath are repaired or replaced. Having regard for the size of the premises, the number of residents and needs of the service the registered persons must provide sufficient staffing numbers and mix of skills. 14 OP19 23 30/06/06 15 OP27 18(1) 31/05/06 Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 29 16 OP28 OP30 18(1) 12(1) The registered persons must ensure that staff have the appropriate qualifications and training to meet the needs of the service, including NVQ Level 2 in Care having been achieved by 50 of the care staff. An action plan of how this is to be achieved must be forwarded to the Commission. The registered person must ensure that staff complete an induction and foundation programme. The registered person must ensure that staff undertake appropriate mandatory training, including in Moving and Handling, Health and Safety, Fire Prevention, Food Hygiene. An action plan of how this is to be achieved must be forwarded to the Commission. The home must have a suitably qualified and experienced manager in post that has completed the registration process for Avon Court. The registered person must ensure that staff receive supervision at the required frequency of six times a year. The registered person must ensure that any ‘body maps’ that show marks or bruising must be signed dated. The registered person must ensure that service users’ daily records are accurate and up to date. (The previous timescale of 07/03/06 was not met.) 30/06/06 17 OP30 18 01/05/06 18 OP30OP38 18 30/06/06 19 OP31 9 30/07/06 20 OP36 18 01/05/06 21 OP37 17 07/03/06 22 OP37 17 01/05/06 Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 30 23 OP37 26 The registered person must ensure that the person undertaking the unannounced Regulation 26 visits must examine the medication records, staff files and service users’ care records. This is in addition to talking with service users and staff. 14/07/06 Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP37 Good Practice Recommendations It is recommended that a discharge process and summary record be developed that can be filed with the service users record. Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Avon Court DS0000004490.V287041.R01.S.doc Version 5.1 Page 33 - 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. 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