CARE HOMES FOR OLDER PEOPLE
Avon Court All Saints Road Warwick Warwickshire CV34 5NP Lead Inspector
Lesley Beadsworth Unannounced Inspection 8th September 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 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.V249293.R01.S.doc Version 5.0 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 Gillian Mullany Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th February 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.V249293.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day from the hours of 09.30 and 18.00. The registered manager was present for all of the inspection. The registered manager and the other members of staff present, cooperated fully with the inspection process. The inspection included a tour of the premises, talking with the registered manager, staff and residents and looking at resident records. A period of time was also spent talking with the Intermediate Care manager regarding the way the Intermediate Care unit worked. Four residents were spoken with at length and three members of staff were also spoken with. What the service does well:
The home is welcoming with good first impressions. The front garden was being tended at the time of the inspection. There has been a great deal of refurbishment and the home looks bright, cheerful and attractive. Final exit doors are alarmed with pleasant sounding chimes, there being a different sound for each door, thus staff know if anyone has left by that door and the safety of those residents with limited understanding is increased. There appears to be good communication between the teams at the home and the Primary Care Trust team. Both managers spoke well of each other. Residents staying at the home at the time of the inspection made such positive comments as, “wonderful place”; “Love it here”; and “It’s like home” ; “I didn’t think that there was anywhere like this” and spoke very highly of the manager and the staff. Relatives spoken with at the inspection also spoke very highly of Avon Court, adding that they were always made welcome. Good interaction was seen between manager, staff and residents and gentle banter went on between them. At the time of the inspection residents and their visitors were enjoying the pleasant garden at the rear of the building. Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
There were some areas of concern but no major problems. Medication was delivered to the home and kept in the office which was then left unattended fro relatively long periods. This created a risk of being accessed by unauthorised persons and posed a risk to residents. Whilst complaints records were satisfactory in content they were not recorded in line with the Data Protection Act, as the complainant could not read it without records regarding others also being read. Some wash hand basins were found to be cracked and a bath was stained. As these could be a source of infection they need to be replaced. There is a requirement for 50 of the care staff to have achieved NVQ Level 2 in Care, to demonstrate their competence in their care role. At present there are only six of the 18 care staff who have achieved this but with 6 more staff currently undertaking the training the home is on target to have 50 of the staff with this qualification by the end of the year. At the time of the inspection the kitchen was badly in need of refurbishment. The registered manager advised that this was due to be done in the autumn. It is essential that this work is not postponed as there is the potential risk of cross infection with the kitchen as it is at present. The floor was also wet when viewed and this had caused the floor to be slippery. There is a need for the registered provider to ensure that the floor covering is non-slip when wet or dry. A member of staff was involved in an incident at the inspection when serving tea and coffee to residents in their bedrooms. The teapot, coffee pot and cups and saucers were being carried on a tray, which was then accidentally tipped causing the hot liquids to fall onto the floor. The registered manager advised that the beverages are normally taken round the bedrooms on a trolley and it is thought that the use of a tray may have been for the benefit of the inspector. Whilst on this occasion no one was hurt this was not a safe practice. Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,6 The home is in the process of updating the Statement of Purpose and Service User Guide. Intermediate Care enables intensive rehabilitation to be provided. EVIDENCE: It was noted that the Statement of Purpose and Service User Guide were in the process of being updated and were not fully assessed on this occasion. The home advised that they will forward a copy of the documents to Commission for Social Care Inspection, as is required, when this has been completed. There is a dedicated unit on the first floor of the home where residents receive intensive assessment and rehabilitation with the aim of these residents returning home again. Mainly therapists employed by the Primary Care Trust (PCT) including physiotherapists, occupational therapist, a part time pharmacist and generic support workers, none of whom work the evening or night shift, staff the unit. Care staff from the home provide personal care to
Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 10 residents on this floor, although for the purposes of therapy the generic support workers often provide the required care. However the registered manager must ensure that there are always sufficient care staff available to provide personal care. The average stay for these re sidents is six weeks but the Intermediate Care manager advised that there is some flexibility in this. There is an identified therapy room and appropriate equipment for rehabilitation. Equipment is also supplied by the PCT as is required by the individual resident. There is also a small flat on this floor that is also intended to be used for rehabilitation but is currently used to accommodate two transitional placements. The remaining transitional beds are on the ground floor. The manager of the Intermediate Care unit and the overall manager of the home appeared to work well together and both advised that there was good communication and cooperation between them. It was noted that if a resident initially admitted onto the Intermediate Care unit is no longer considered able to return home they are technically transferred to a transitional bed. However they are not usually physically transferred to a ground floor bedroom to avoid further disruption of relocation. Whilst this occasionally means that the first floor unit is not totally dedicated to Intermediate Care, limiting the frequency of moves that an older person experiences also minimises the risk of confusion and disorientation due to relocation, and is good practice. The local GP and district nurses provide the medical and nursing needs of residents in both units. Two residents on the Intermediate Care unit who were spoken with at the inspection both said that they were grateful for the opportunity to learn how to manage in their changed circumstances. Both had suffered injuries that changed their ability to manage their own self care and household tasks. Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 11 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): 9 The administration of medication is generally well managed and the policies and procedures generally protect the residents. EVIDENCE: The administration of medication is generally well managed. There is a pharmacist employed by the PCT for the Intermediate Care unit but the rest of the home also benefit from her advice and support. There are records kept of the receipt of medication on the Medication Administration Record Sheets and discharge of medication in a designated book. The registered manager has access to the Royal Pharmaceutical Society Guidelines. All staff responsible for medication have undertaken the appropriate accredited training to minimise the risk to residents. At the previous inspection the home was required to record all controlled drugs in line with the Royal Pharmaceutical Society Guidelines and this has now been done. At the time of the inspection a supply of medication was delivered to the home and left unsupervised in the unlocked office for a relatively long period of time. Medication needs to be stored safely at all times, to protect all residents but
Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 12 particularly those with limited understanding, and also to keep safe from unauthorised persons. Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 13 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): No standards from this section were assessed on this occasion. EVIDENCE: Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 The home has a complaints procedure that gives residents and relatives the confidence that their complaints are listened to. The record keeping for complaints is not in line with the Data Protection Act 1998. EVIDENCE: The home has a complaints procedure that is also contained in the home’s Statement of Purpose/Service User Guide. The records related to complaints consists of sufficient detail and information but are kept in a book that does not comply with the Data Protection Act, as it does not allow a complainant to see their records without seeing those of others. Details of the Commission for Social Care Inspection are displayed in the reception area with a summary of the complaint procedure. The registered manager advised that enabling residents to vote is not in her control unless residents are in the home at the time of elections and live locally, as they are only living at the home for an average of six weeks. Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,26 The home offers clean, well-maintained and attractive surroundings for the people living at the home. EVIDENCE: The premises provide the residents with comfortable and generally wellmaintained surroundings. All communal and bedroom areas viewed at the time of the inspection were attractively decorated and clean and free of offensive odour. The gardens were also attractive and well maintained and popular with residents. Residents were moving freely around the premises. All rooms are of single occupancy offering residents privacy. There are sensor lights in corridors and toilets that come on automatically as anyone enters the sensor zone. This assists residents to be able to see safely where they are going without needing to find the light switch. There are sufficient toilets and bathrooms to meet the needs of the number of people living at the home although it was noted that several washbasins were
Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 16 cracked and one bath was badly stained which are sources of infection. These were indicated to the registered manager at the time of the inspection. The home has a sluice facility on the ground and first floors. The Intermediate Care Manager advised the inspector that there are some concerns from the PCT regarding the risk of the spreading of a specific infection (Clostridium) given the high turnover of residents in this home, particularly as a result of emptying commodes in the sluice. The registered manager advised that this concern was being addressed by the organisation to minimise this risk to residents. The registered manager advised that the majority of the laundering of residents’ clothing is carried out by family as a continuation of what they had been doing whilst their relative was in hospital, although some is carried out by the home. An outside contractor launders bed linen. The laundry was seen at the time of the inspection and was clean and in good order, and provided hand washing facilities. The vegetable room in the kitchen was dirty, in particular the industrial potato peeler. There was also food spillage on some of the worktops in the kitchen, which had been left. The kitchen is in need of complete refurbishment with some areas being a potential risk to hygiene. The registered manager advised that this is planned for the autumn. It is advised that this must go ahead as planned because of this potential risk. Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 17 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): 28 The home has not achieved 50 of care staff having completed NVQ Level 2 in Care to confirm their competence in their work. EVIDENCE: The home has not yet achieved the required 50 of care staff with NVQ Level 2 in Care qualification before the end of the year. However the home is on target to do so with six care staff out of 18 having already completed and a further six care staff currently undertaking this training. Having this qualification demonstrates that the holders are considered competent to carry out their work and that residents are in safe hands. A domestic assistant is also undertaking a relevant NVQ qualification. Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30,32,37,38 A person with the appropriate experience and qualifications manages the home. There are in general safe working practices to protect the residents of the home. There are minor shortfalls in record keeping. EVIDENCE: The registered manager has held the post for two years and has the appropriate qualifications for this post. She demonstrated clear understanding of the home and areas in which it needs to improve. She also showed an understanding of health and safety issues. There was good interaction observed between the manager, her line manager, staff and residents, indicating that there is a good personal and professional relationship between them. This also appeared to be the case between the registered manager and the Intermediate Care team and an open, positive and transparent atmosphere was apparent. Residents benefit from this approach.
Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 19 The registered manager advised that there are weekly multidisciplinary meetings between her and the therapists in the Intermediate Care unit and daily handover sessions with staff at the home. As previously mentioned the recording of complaints does not allow anyone to look at their records without seeing other records, which is not in line with the Data Protection Act. It was also noted that staff initial daily records but it is recommended that these are signed. The standard related to health and safety was not fully assessed on this occasion and may be further assessed at the next inspection. However it was noted that temperature control valves are in place to maintain temperatures of 43°C from hot water outlets accessible by residents. Window restrictors were in place on all windows checked. The floor in the kitchen was wet when viewed making this slippery. It is suggested that the kitchen floor covering is guaranteed non-slip when wet or dry when the kitchen refurbishment takes place. A member of staff was involved in an incident at the inspection when serving tea and coffee to residents in their bedrooms. The teapot, coffee pot and cups and saucers were being carried by him on a tray, which was then accidentally tipped causing the hot liquids to fall onto the floor. The registered manager advised that the beverages are normally taken round the bedrooms on a trolley and it is thought that the use of a tray may have been for the benefit of the inspector. Whilst on this occasion no one was hurt this was not a safe practice. Security appears good with doors locked and chimes on all final exit doors to alert staff if a resident that might need assistance or supervision goes out of the home. Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 x 2 3 3 X X X X 2 STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X 2 3 Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? 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 2 Standard OP9 OP16 OP37 Regulation 17 sch.3 13(2) 20 sch 4 (11) 23(2) Requirement The registered manager must ensure that medication is stored securely at all times. All records must be maintained in line with the Data Protection Act 1998, including the records regarding complaints. The registered provider must ensure that the cracked sinks and stained bath are repaired or replaced. The registered persons must ensure that the plans for the refurbishment of the kitchen materialise. The refurbishment needs to include ensuring tha the kitchen floor is non-slip when wet or dry. The registered manager must ensure that staff are aware of the need to keep the home free of hazards, including the transporting of heavy and hot items. Timescale for action 15/10/05 30/10/05 3 OP19 30/10/05 4 OP26 OP38 12(1) 13(4) 16(2)(j) 30/11/05 5 OP38 13(4) 15/10/05 Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 22 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 2 Refer to Standard OP37 OP26 Good Practice Recommendations It is recommended that staff use their full signature rather than just initials when signing documents such as daily records for residents. It is recommended that the registered person seek advice regarding infection control in relation to Clostridium and in particular regarding the emptying of commodes. Avon Court DS0000004490.V249293.R01.S.doc Version 5.0 Page 23 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
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