Inspection on 13/07/06 for Avon Court Care Centre

This inspection was carried out on 13th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Avon Court Care Centre 07/07/08

Avon Court Care Centre 04/10/05

Avon Court Care Centre 18/04/05

Avon Court Care Centre 15/11/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Avon Court Care Centre Rowden Hill Chippenham Wiltshire SN15 2AJ Lead Inspector Susie Stratton Key Unannounced Inspection 13th July 2006 9:40 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 Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 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 Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avon Court Care Centre Address Rowden Hill Chippenham Wiltshire SN15 2AJ 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) 01249 660055 01249 461670 marshv@bupa.com www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited Mrs Elissa Beaven Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60), Physical disability (2), Terminally ill (1), of places Terminally ill over 65 years of age (1) Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users who may be accommodated in the home at any one time is 60 No more than 2 physically disabled persons under 65 years of age in receipt of nursing care may be accommodated at any one time of which one may only be the female service user named in the application 19 December 2003 The staffing levels set out in the Notice of Decision dated 10 May 2004 must be met at all times No more than one male or female service user may be accommodated in the home at any one time under the category of Terminally ill or Terminally ill (aged over 65) 4th October 2005 3. 4. Date of last inspection Brief Description of the Service: Avon Court Care Centre provides care with nursing and accommodation, for up to 60 people. Avon Court was originally registered in 1984. It is a purpose built, two storey building, set in its own grounds. Accommodation is provided on both floors. All rooms are single. Bathrooms for general use are on both floors. There is a passenger lift. The service is owned by BUPA, a national provider of care. The fee range is £650 to £550 a week. Mrs Elissa Beaven is the registered manager, she was appointed in May 2005. Mrs Beaven is an experienced manager and registered nurse. Mrs Beaven is supported by a deputy and leads a team of nursing, care and ancillary staff. The home is adjacent to Chippenhams hospital. It is a short drive away from the town centre. This offers a range of shops and other amenities. There is car parking on site, a bus stop is at the end of the road and there is a railway station in the middle of Chippenham. Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. The site visit for this inspection started on 13th July 2006, and took place between 9:40am and 4:40pm, in the presence of Mrs Elissa Beavan. During the inspection, the Inspector met with eighteen residents and observed care for thirteen residents who were unable to communicate. She also met with the deputy manager, two registered nurses, five carers, a domestic and the laundress. The inspector toured the home, including the laundry, bathrooms and sluice rooms and observed one group activity and one meal-time. The Inspector also met with an external trainer during the visit. As part of the inspection, the Inspector considered eight residents in detail, including reviewing their records and contacting their GPs and relatives. The Inspector reviewed systems for storage of medicines and observed one medicines administration round. As Avon Court is a large home, a second site visit took place on 11th August 2006 between 9:20an and 12:10pm to review areas which could not be considered on the first site visit. During this visit, the Inspector met with the administrator, chef, activities coordinator and maintenance man and reviewed their records. The Inspector also reviewed induction, training and supervision records and the records of three recently employed staff and three permanent staff. Other records inspected included accident records and complaints records. The Inspector also provided a feedback to the manager and her deputy. What the service does well: The owners of the home have put extensive work into improving the home environment and standards of care over the past few years. This has been recognised by residents, relatives and external healthcare professionals. More recently staff have put much work into improving the garden areas, which now provide a pleasant space for residents to sit out in during the warm weather. Staff have developed care plans, these are highly individualised and detail matters which are important to that resident. Staff were observed to work in accordance with these care plans. Care staff were observed to be attentive towards residents and to observe changes in their conditions and take prompt action when needed. The home consistently exceeds minimum staffing levels set out by the Commission and is supportive of staff training and development. Staff are led by an experienced manager, who residents, relatives and external healthcare professionals reported had led the improvements in the home. She Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 6 was described as open and approachable. The manager ensures that there are effective systems for supporting and developing staff performance. Residents and their relatives said they like the home, one said “It’s absolutely beautiful here”, another said “Its’ wonderful here” and another said “I’m lucky to be here”. Residents and their visitors expressed their appreciation of the staff, one said “you can discuss things with the staff here” another said “they know in detail what is wrong with [my relative]” another said “They’re very thoughtful – they’re as good as my wife”, another described staff as “lovely people” and another as “very dedicated” What has improved since the last inspection? What they could do better: One requirement and six good practice recommendations were identified at this inspection. A call bell system, which is audible to staff when working in residents’ rooms must be in place, to ensure that staff are able to hear when residents ring for assistance. Care plans for residents who are assessed as being at risk of pressure damage should state how often they need to have their position moved to direct staff on actions to take. All residents who are at risk of skin tears or bruising should have an assessment of risk performed and a care plan put in place to direct staff on how risk is to be reduced. All care plans should avoid generalistic wording. Records relating to residents’ past life experiences should be further developed. If relevant issues are identified, these should be reflected in care plans. The home should consider employing more activities staff to improve Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 7 support in meeting residents’ social care needs. Where a resident has specific preferences for their care needs, these should always be documented. Staff who provide or support residents with special dietary needs should be further trained in how to meet such needs. 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 Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 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 Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 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, 3, 4 & 5. The home does not offer intermediate care, so 6 is N/A Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visits to the service. All residents have information made available to them about the services offered by the home. Full and detailed assessments of nursing and care need are carried out prior to admission. The inspection shows that the home can meet the needs of its residents. Pre-admission visits for prospective residents or their supporters are encouraged. EVIDENCE: All residents have a copy of the home’s comprehensive service users’ guide in their room. Additionally, further information, including the home’s statement of purpose, BUPA’s quality audit of services provided, a copy of the last four inspection reports, letters of thanks and pictures of activities and events put on for residents are also available in the front hall. Residents have full assessments of their needs completed by a registered nurse prior to admission. Assessments seen were comprehensive and individualised, detailing prospective residents’ needs. These assessments were Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 10 then used to form the basis of the care plan. One resident was due to be admitted to the home shortly after the site visit and it was observed that their room had been prepared for them individually, with a profiling bed and other equipment to meet their needs. Discussions with residents, relatives, observations of care, discussions with staff and reviews of notes indicated that the home were able to meet the needs of residents. Most residents said that they had been too frail or unwell to visit the home prior to admission but that their relatives had done so on their behalf. One staff member reported that one recently admitted resident had been transferred from another home further away and that their relative had come several times before this happened, to ensure that Avon Court could meet their relative’s needs. Several of the current residents used to live in Chippenham and at least one person said that when they had needed nursing care, they had chosen Avon Court because they had known about it from general information and reports from other people living in Chippenham. Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 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): 7, 8, 9 & 10 Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visits to the service. Residents are supported by detailed care plans, which reflect their nursing and care needs and which are regularly up-dated. There are safe systems in place for the administration and storage of medication. The home shows high standards in respecting residents’ needs for privacy and dignity, according to their individual nursing and care needs. EVIDENCE: All residents have care plans in place. A new documentary system for care planning has recently been introduced to the home and it is much to the credit of staff that they have accurately transferred information into the new format, in a short space of time. They have also further developed their approach to care planning since the previous inspection. Staff no longer complete daily records in service users’ notes, they complete hourly sheets to indicate that they have seen that the resident is comfortable and has what they need. They also up-date care plan evaluations as the resident’s conditions changes. Staff at all levels have been supported in doing this. Care plans direct care and are individualised. Two residents met with were not so well on the day of the site Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 12 visit, their care plans clearly showed that this was not their usual condition. One resident had improved by the afternoon and was showing their usual condition and action was being taken by staff to address the needs of the other resident. Where residents have manual handling care needs, are at risk of pressure damage, falls, incontinence or nutritional deficit, an assessment is completed and a care plan put in place to reduce risk. These are evaluated regularly. It is recommended that care plans relating to prevention of pressure damage include reference to how often a residents’ position should be changed. One staff member spoken with had a detailed knowledge of how a resident’s position needed to be changed when sitting out as opposed to when they were in bed. To ensure that all staff have such information, this should also be documented. Two of the residents met with had a tendency towards skin tears or bruising. Both residents had individual care plans relating to each skin tear and bruise. One other service user who also bruised easily had an assessment and care plan to direct staff on how to reduce risks of bruising. It is advisable where residents have such tendencies, to always perform overall assessments for risk and produce care plans to ensure risks are minimised. The home have worked hard to ensure that directions in care plans are precise and measurable and most care plans showed improvement. Some work is still needed for some care plans, for example one care plan stated that a resident’s limb should be “exercised prn” without stating what exercises were needed or defining how often this was needed. One resident’s care plan stated that they should be encouraged to eat their diet by giving them the food that they liked, however there was no record of their likes and dislikes in their records, so it could not be used as a basis for directing care. By the second day of the inspection, the home had commenced drawing up detailed individualised care plans relating to residents’ preferences for meals and how they needed support to eat their meals. The chef had been provided with copies of these care plans and reported that they found them useful in menu planning. Where residents have secondary diagnosis for metal health care needs, there are clear care plans in place, these are written in non-judgemental language and direct actions to be taken by staff. There is also evidence that the Community Psychiatric Nurses are contacted when needed. Where residents had wounds, there were clear care plans in place, which enabled staff to assess the wound’s response to the treatment plan. Wounds were regularly photographed. Residents with urinary catheters had clear care plans and full records relating to changes of their catheter. Where a resident needed artificial feeding there were very clear records, which were written in clear language and directed care. Where residents were unwell, it was clear that there were regular contacts with their GPs and full records of visits and communications are maintained on each Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 13 resident’s file. One relative said that the home “always” called out the doctor if their relative was unwell. The home have also developed effective working relationships with other professionals such as the Speech and Language Therapist for residents with swallowing difficulties, the nutritional specialist and tissue viability nurse. One relative reported that the nursing care in the home was just right” for their relative. One other relative reported on how helpful the home had been when supporting their relative in going to the dentist. The home shows high standards in care plans relating to personal care and night care. These care plans have been written by key workers and other carers closely involved in caring for each individual resident. They are clear and highly individualised, including apparently small but highly significant details about how a resident wishes to be cared for. Individual records also include the name a resident preferred to be called by and it was noted that staff at all levels, including the kitchen assistant who was giving out drinks during the morning, used this preferred name. Staff clearly knew residents well, it was observed that one carer was concerned that one resident was not so well during the inspection, they made enquiries of other staff about the condition of the resident, about how they had been during the morning and worked with the resident to support them, regularly reporting to the registered nurse about the resident’s condition. The kitchen assistant giving out drinks during the morning noted where a restless resident needed attention to ensure their privacy and dignity. One resident who had needs relating to communication had a care pan in place to direct staff on how to communicate with them and this was observed to be being followed by staff. Despite a wide range of the residents experiencing some problems with continence, there was no evidence of odour in the home. One relative reported that although they were aware that their relative could drop items on their clothing at times, that there was “not a single mark on them” when they visited. The home has two clinical rooms for storage of drugs. They have recently moved to a new medication system and report that they are still working through a few “teething” problems with their supplier. All drugs were safely and securely stored, this included controlled drugs and drugs requiring cold storage. There was a full audit trail of drugs received into the home and disposed of from the home. All limited life medication was dated. Where a resident was prescribed regular administration of drugs by injection, there were records to show that the injection site was rotated to prevent tissue damage. A new British National Formulary had been made available to staff administering medications, to advise them on actions of drugs being administered. Where drugs administration instructions had been changed or completed by hand, these had been checked and countersigned by a second staff member. A medicines round was observed and the registered nurse performed it in a safe manner, within accepted guidelines. There were clear systems in place for regular audit of systems for administration of medicines and the manager makes sure that any anomalies noted during audit are dealt with promptly and appropriately. Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 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 Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visits to the service. Residents are supported by an activities programme which is working towards meeting their individual interests and needs. Contacts with the local community and relatives are supported. Residents felt that they could choose how to spend their lives in the home. Residents are offered a choice of meals and can chose where they eat. EVIDENCE: Avon Park provides an activities programme for residents. This was displayed and made available to residents. A range of group and individual activities were provided. On the morning of the first day of the inspection, the activities coordinator was observed running a small group playing skittles, she encouraged all attending to take part. Many of the residents were too frail or did not wish to leave their rooms. Some of these residents said that they preferred their own company and did not like mixing. For these residents, the activities coordinator performs individual room visits. There were a range of opinions about the activities provided. One resident said that they were quite happy, watching the television and reading books from the library. Another resident said that, with the activities coordinator, they Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 15 were making a construction, using their plastic jam containers from breakfast. However one person said they felt that there was “Not enough stimulation” and another felt that there was not much “quality of life”. There is only one activities coordinator in post for all the residents in the home. This means that if she is taking residents out of the home on a trip or taking one resident into the local town, other residents’ recreational needs cannot be supported. It also means that when she takes residents into the lounge for an activity, that the first few residents will have to wait for all the rest to arrive without supports and this can take a period of time, as nearly all of the residents are wheelchair dependant or are only able to mobilise slowly. Discussions with the activities coordinator, staff and a review of records indicate that the activities provided are adequate but an increase in designated activities staff would mean that improved support could be provided in this important area of care. All residents have an activities plan drawn up. Records are also made of what residents become involved with. All residents have a pen profile on their file, not all of these have been completed, to show their previous life experience. While many of the residents come from the locality, not all do and this is an area which could be further developed, to reflect the diverse needs of residents and acknowledge their previous lifestyles. The home have started sending out requests for information to residents’ supporters and plan, once more information about residents’ previous lifestyles is more available, to start incorporating this into residents’ care plans. Trips out of the home are arranged for residents and one resident described a trip they had taken part in earlier in the year. Photographs of such trips have been taken and were available in the entrance area. All residents said that their visitors could come when they liked and some described how they were able to take them out of the home. One relative described how the home was “very easy for us to pop in to at any time”. One resident said that they enjoyed the staff taking them out to the garden in the nice weather. One visitor commented on how supportive staff were in contacting them about any matter which affected their relative. Residents consistently said that it was up to them when they get up and went to bed. They also said that they could choose their meals, where they ate their meals and if they went to activities or not. One resident told the Inspector that they did not like having baths and preferred a wash in bed, this was reflected in their care plan and staff spoken with were aware of this. One other resident was observed to like their sheet to be placed in a particular position and staff spoken with were aware of this, but this had not been documented. A range of different opinions were expressed about the meals. Two residents did say that they did not like the meals, however the majority of residents were favourable about the meals, describing the meals as “very good” and “excellent”. One resident said that they were a vegetarian and that they were Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 16 given a varied diet to meet their needs. Residents can choose to take their meals in one of two dining rooms or in their own room. The dining rooms are attractive with cloths table cloths and napkins on all the tables. Meals were individually plated up for residents. Where residents needed assistance with eating their meals, staff sat with them encouraging them. All residents were offered a choice of fluids with their meals. The chef has experience of providing meals in a range of care settings. She reported that she draws up menus to meet residents’ needs using records, discussions with residents and staff and reviews of what is eaten well and what is returned to the kitchen. She is also able to meet the individual needs of residents, for example she has drawn up a menu for vegetarians. If residents do not wish to eat a full meal, she will prepare a smaller snack for them. The chef showed a good knowledge of individual residents’ needs and preferences for meals. The manager also reported that the home had worked through a distance learning pack provided by BUPA to support staff in meeting residents’ dietary needs. Discussions with some staff indicated that they may need more support in developing some knowledge in certain areas. For example one choice on the menu would have allowed diabetic residents to choose a three carbohydrate option for their lunch and not all staff were aware of the implications of carbohydrates for diabetics. Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 17 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 Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visits to the service. The home has a complaints procedure, which staff comply with and residents and their supporters felt worked in practice. Staff are regularly trained in abuse awareness and showed an awareness of the importance of the area. EVIDENCE: While some service users and their relatives said they did not know who to talk to if they wanted to make a complaint, others were very clear on what they would do. Two people said that they would talk to their named nurse, other people said that they would take it up the nurse in charge, the deputy manager or the manager. One person said that they were of a shy disposition but that they knew that they could always speak to the manager and another person described her as “very approachable”. The home’s complaints procedure is displayed and is made available to all residents in the service users’ guide, a copy of which is made available to them in their rooms. A review of records shows that the home complies in full with BUPA’s procedure for responding to and documenting complaints. All issues raised are documented, including concerns. BUPA’s quality audit department regularly reviews all complaints. It was observed that some of the issues raised related to response times to nurse call bells (see Environment below). The manager has experience of working within local vulnerable adults procedures. Where allegations have been made in accordance with those Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 18 procedures, they have all been made by the manager in support of a vulnerable adult. Such allegations have been investigated either by, or with full support of the manager and detailed records of the investigations maintained. If indicated, appropriate actions have been taken by the manager to address matters identified during the investigation. All staff spoken with, including the chef and activities coordinator have been trained during the last year in abuse awareness. The maintenance man and administrator showed an awareness of how they could be involved in such issues and understood the importance of whistle blowing in protecting vulnerable adults. Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 19 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, 21, 22, 23, 24 & 26 Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visits to the service. Avon Court presents a well maintained environment for residents, with a choice of communal areas for residents to use. Rooms are large. The furnishings and fitments in the home are appropriate for the home’s atmosphere. Relevant equipment is provided to support residents, however residents could be put at risk by a call system which is not fit for purpose. The home was clean throughout, with effective systems to prevent risk of cross infection. EVIDENCE: Avon Court presents a well maintained atmosphere. The maintenance man was in evidence throughout the first site visit and was observed to respond promptly when asked for assistance. One relative described the home as “A nice place to walk into”. The maintenance man maintains extensive and clear records relating to regular maintenance of all areas, as required in accordance with BUPA’s procedures. He is on-call throughout the 24 hour period, with Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 20 cover from another BUPA home when he is on leave. He showed an awareness of the importance of safe working practice and monitoring the work of external contractors when working in the home and was fully aware of actions to take if he considered that the standard of work was not up to the standards required. The home has three sitting rooms and two dining rooms, additionally the front entrance is large and has seating available for visitors to wait in or residents to sit. The home have put much effort into improving the garden area during the past year and it now presents an attractive area for resident to sit out in and enjoy during the summer months. At present the garden area is open and residents with dual care needs, including those with wandering behaviours could be put at risk by this. The manager reported that she had already identified this as an issue and had put in a bid for all the garden area to be made safe. She reported that this has been approved by BUPA. All residents are cared for in single rooms. All rooms are en-suite. All rooms exceed National Minimum Standards for room sizes and staff can adjust each room round the resident’s needs, so that for example, the bed can be placed with access to both sides for nursing care or against the wall to provide more space in the room. Residents can bring in items of their own if they wish and if they do not wish to do this, the home fully meets residents’ needs for furniture. One relative described the views from the first floor as “lovely”. A review of care plans showed that all residents with complex needs have variable height beds. A number of profiling beds are also provided. Where residents can manage with divan beds, these are new and homely in style. A range of hoists are provided on each floor to aid manual handling and residents are provided with pressure relieving mattresses and chair cushions when they are assessed as needing them. Communal wcs and bathrooms are provided to meet residents’ needs. The home continues to up-grade their facilities, with a new assisted bath replacing an older non-assisted bath on one floor since the last inspection. A new staff room has been provide for staff and an area for the activities staff to plan their work in and store items. Additional secure storage has also been provided for chemicals. All residents had been left with access to their call bells and checking that the resident had access to their call bell was part of the system for hourly checks on residents. One carer was observed to support a resident when they had dropped their call bell. One resident who could not use their call bell had a care plan relating to how they were to receive support because of this. Many of the residents commented that staff were slow at responding when they used their call bell, although they were very supportive when they did come. It was also noted that this had been identified during the home’s own quality audit and complaints records. The home does not have a system for monitoring response when call bells are used, so it is complex to assess the extent of the problem. It was observed during the morning that if the Inspector was in a Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 21 room behind a closed door, that the call bell system was not audible. The system is audible in corridor areas and staff were observed to respond promptly if they heard a bell ringing while in those areas. Discussions with staff indicated that this was an issue, as if two members of staff were caring for a resident, as was generally the case, neither would be able to be aware of when a resident had rung for assistance. The system does have an emergency mode, however, this is not much more audible than the normal sound. In order to ensure resident safety the owners must ensure that residents are not put at risk by the current situation. All of the home was clean. A domestic was observed during the inspection and they were observed to carefully perform their work. They reported that if they ran out of cleaning supplies, it was easy to get more. They also reported that if they were not sure of anything, they would ask the nurse in charge of the floor for advice on what to do. The home has sluice rooms and a washer disinfector for bed pans is provided on each floor, both were clean and free of limescale. The laundry was clean and well organised. A new dryer had been provided since the previous inspection. A separate storage area for dirty items had also been provided. Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 22 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 Quality on this outcome area is exceeded. This judgement has been made from evidence gathered both during and before the visits to the service. Avon Park exceeds minimum staffing levels set out as a condition of their registration. Training, including NVQ training for staff at all levels is supported. Residents are protected by a safe recruitment procedure and the manager’s awareness of how to work within BUPA’s established staff performance procedures. EVIDENCE: As a condition of registration, the home is required to provide nursing and care staff in accordance with set minimum staffing levels. A review of past rosters indicated that the home frequently exceeds these levels across all shifts, including the night shift. A full team of ancillary staff are employed. A review of rosters indicate that staff are prepared to work flexibly to support the home. Staff turnover is low and the manager reported that they were able to recruit to vacant posts without resort to complex procedures or external agencies, when they fell vacant. The home is supportive of training and 50 care staff are trained to NVQ2 or above. Domestic staff are also supported in undertaking NVQ training. Relevant training is also provided to ancillary staff, the administrator and activities coordinator. The manager draws up a training plan each year and she and her deputy also identify areas for staff training when they arise, to meet residents’ nursing and care needs. All staff are given an induction, in Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 23 accordance with BUPA’s procedures and full records are maintained. All staff have an individual training programme, which shows the range of training opportunities offered, to support resident care. An external tutor was leading a training session for senior carers and registered nurses during the afternoon of the first site visit. Other recent training has included supporting staff on all levels on how to complete documentation care plans. Training is planned on mouth care and infection control. Registered nurses are supported in developing their skills, including supra-pubic catheterisation and venepuncture. The files of three recently employed staff and three current staff were reviewed. The newly employed staff showed all necessary pre-employment checks, including proof of identity, pova & CRB checks, two references, an application form and a health status questionnaire. The manager has developed interview assessment tools for staff at all levels, to ensure that interviews are performed in an appropriate manner, which supports equal opportunities. Staff files are maintained in an orderly manner. Where issues relating to performance have been identified, files clearly show what actions have been taken. The manager showed an awareness of how to use BUPA’s procedures to improve and develop staff performance. She was also fully aware of how to use the disciplinary procedure when it is indicated. Letters were individualised to the staff members and issues of concern and written in clear English. One staff member said that if matters were brought up that the manager was always “very fair” and listened to their point of view as well as informing them of what needed to be improved. Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 24 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, 32, 33, 35, 36 & 38 Quality on this outcome area is good. This judgement has been made from evidence gathered both during and before the visits to the service. The home is led by an experienced manager and registered nurse who is an effective leader. BUPA regularly reviews the quality of service provision. Residents’ financial interests are safeguarded by BUPA’s procedures. Staff are regularly supervised. The health and safety of residents and staff is supported. EVIDENCE: The manager of the home is an experienced manager and registered nurse. She holds appropriate managerial and nursing qualifications. This inspection shows that the manager plans ahead and puts in bids to the parent company, to ensure residents’ safety and nursing and care needs are met. She is aware of the need to work reasonably within a financial framework. Where issues are identified, she develops strategies to ensure that residents are protected and she is prepared to take action with staff if needed to ensure residents’ needs Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 25 are met. At the same time, she is aware that her staff are her main resource and need to be supported by a range of interventions to enable them to perform their roles effectively. Since she took over management of the home, marked improvements in the quality of care have taken place. One relative described the manager as “very open” and another as “very accessible”. One external professional stated that in their opinion the home had improved “dramatically” under the new manager. The manager regularly holds meetings with staff at all levels, these are minuted. Staff, residents and their supporters reported that they felt able to approach the manager, her deputy or senior staff. The manager shows clear leadership skills both supporting and directing her staff. The manager is supported by an experienced and motivated deputy. BUPA has a system for regularly monitoring the quality of service provision and a copy of their most recent quality audit was available to all in the front hall. The home is also regularly visited by a manager from BUPA and a report drawn up. BUPA has established systems for the management of residents’ moneys, which the administrator complies with in full. Records of all transactions are maintained in accordance with these procedures. There are safe systems for the recording and storage of valuables. The manager has now established a full system for staff supervision. She maintains a matrix, so that she can see at a glance which staff have received supervision and when. Records show that supervisions vary according to individual staff members’ needs and preferences. Records are maintained of issues discussed and actions to be taken by the supervisor or supervisee. All staff have an annual appraisal. The home has full systems in to ensure the health and safety of service users and staff. All staff were regularly trained in manual handling. All staff who perform food handling were trained. The fire log book is maintained in full and showed evidence of regular checks on the fire safety system and staff training. Regular unannounced fire drills take place. There are safe systems for the disposal of clinical waste. Accidents are fully documented and regular reports sent up to the main quality audit department. Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 26 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 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 3 3 2 4 3 X 3 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 x 3 3 x 3 Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 OP22 Regulation 13(4)(a) (c) Requirement A call bell system, which is audible to staff when working in service users’ rooms, must be in place. Timescale for action 31/03/07 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 OP7 OP7 Good Practice Recommendations Care plans for service users who are assessed as being at risk of pressure damage should state how often they need to have their position moved. All service users who are at risk of skin tears or bruising should have an assessment of risk performed and a care plan put in place to direct staff on how risk is to be reduced. Care plans should use precise, measurable terms and avoid generalistic wording. Records relating to residents’ past life experiences should be further developed. If relevant issues are identified, these should be reflected in care plans. Consideration should be given to providing more activities staff to meet DS0000059517.V300493.R01.S.doc Version 5.2 Page 28 3. 4. OP7 OP12 Avon Court Care Centre 5. 6 OP14 OP15 such needs. Where a service user has specific preferences for their care needs, these should always be documented. Staff who provide or support residents with special dietary needs should be further trained in how to meet such needs. Avon Court Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Care Centre DS0000059517.V300493.R01.S.doc Version 5.2 Page 30 - 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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