Inspection on 18/04/05 for Avon Court Care Centre

This inspection was carried out on 18th April 2005.

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 Care Centre 07/07/08

Avon Court Care Centre 13/07/06

Avon Court Care Centre 04/10/05

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 Unannounced 18th April 2005 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 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 D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Avon Court Care Centre Address Rowden Hill Chippenham Wiltshire SN15 2AJ 01249 60055 01249 461670 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes (CFC Homes) Limited Veronica Lena Marsh Care Home with Nursing 60 Category(ies) of OP Old Age (60) registration, with number PD Physical Disability (2) of places TI Terminally ill (1) TI(E) Terminally ill - over 65 (1) Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1.The maximum number of service users who may be accommodated in the home at any one time is 60 2. 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 3. The staffing levels set out in the Notice of Decision dated 10 May 2004 must be met at all times 4. 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) Date of last inspection 15th November 2004 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 was purchased by BUPA, a national provider of care, in May 2004. Mrs Veronica Marsh is the registered manager. Mrs Marsh is an experienced manager and registered nurse. Mrs Marsh is supported by a deputy and leads a team of nursing, care and ancillary staff. The home is adjacent to Chippenham’s 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 D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9.45am and 4.30pm on a Monday, in the presence of Mrs Veronica Marsh, the registered manager. During the inspection, the Inspector also met with the deputy manager, three registered nurses, five care assistants, the laundress, the maintenance man and a catering assistant. The inspector toured the home and talked with sixteen residents and observed care provision for seventeen residents who were not able to communicate. The Inspector also met with two relatives and observed a mealtime in the home. During the inspection, the Inspector reviewed the care plans and documentation for nine of the residents as well as discussing their care with staff. The Commission’s pharmacist made an additional visit to Avon Court on 17 December 2004, to review pharmacy arrangements in the home, this was at the request of Mrs Marsh. What the service does well: What has improved since the last inspection? Significant improvements have been made to the home environment since BUPA purchased it a year ago. Most parts of the home have been fully upgraded, only a few areas remain to be addressed and there are action plans in Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 Page 6 place for these areas. BUPA have run a successful recruitment campaign and the home are now fully up to establishment for staff at all levels. The home have met the requirements arising from the pharmacist’s visit. Of the eighteen requirements identified at the previous inspection, twelve have been addressed in full. The laundry service has been much improved by improved systems, attention to maintenance and new laundry bags. An audit of response times to call bells has been set up to monitor performance when call bells are activated. Recommendations from the inspection have been addressed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 Page 7 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 Standards Statutory Requirements Identified During the Inspection Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 Page 8 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 standard(s) 1, 3, 4 Residents are not provided with the most recent inspection report and so will not be aware of the home’s response to the inspection process. Full preadmission assessments take place, this ensures that the home can meet the needs of prospective residents. EVIDENCE: All residents are provided with a copy of the service users’ guide. The guide is a standard document produced by BUPA, it is informative about the services provided. Those guides examined did not include a copy of the most recent inspection report. Mrs Marsh or her deputy meet with all prospective residents prior to admission. Pre-admission assessments for three recently admitted persons had been completed in detail. One registered nurse said that the preadmission assessments provided a useful basis for care plan development and enabled them to properly prepare for residents when they were admitted. Two of the residents who had been recently admitted had complex care needs. A review of care plans, discussions with staff and one of the residents indicated that the home could meet their needs. Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 Page 9 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 standard(s) 7, 8, 9, The majority of residents are protected by clear assessments and care plans, but some are not. These residents are at risk as staff are not directed on how to meet their needs. Frail residents who need frequent care are not protected as there is no evidence that their needs are being met as regularly as they need. Improvements have been made in management of medicines, however attention is needed to three areas, to ensure that risk is avoided. EVIDENCE: To ensure that the needs of residents with complex care needs are being met, the home have recently introduced a system to document provision of frequent care, including fluids, diet and changes of positions. This inspection showed that staff were not complying with procedure. None of the residents who were visited during the morning had records relating to turns completed after 6am and where fluids were included, they appeared to be documented when the drink was left with the resident, not after the drink had been taken and several residents had no drinks documented. Discussions with staff and observations indicated that staff tended to document provision of care at the end of their shift, not as they provided care. Records relating to night care were of more concern as for some residents, care was documented as being given at the same time, for example 2am. It would not be possible for all care to be given Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 Page 10 to all residents at the same time. One resident had two different records in their room, these documented that the service user was moved into different positions at the same time. This means that these records are not made contemporaneously and therefore are not an accurate reflection of care provided. Frail residents, who need frequent care, are put at risk by inaccurate and falsified documentation. When BUPA purchased Avon Court, the home had had a history of inadequate care planning. Care plans are now regularly audited and extensive improvements have been made in standards of assessments and care plans, for example, one resident who was assessed as being nutritionally at risk had a clear care plan in place and regular assessments of their weight indicated that their condition was improving. Another service user had a supportive care plan relating to a recent bereavement. However some areas continue to need development, two of the nine persons who were assessed as being at risk of developing pressure damage, did not have care plans to detail how risk was to be reduced in place. The date of commencement for different interventions was not included on all care plans. Care plans relating to prevention pressure damage need to be clear to direct staff and prevent risk to service users. Dates for commencement of interventions need to be included so that the home can show that interventions were made in a timely manner. Two residents had evidence of challenging and complex behaviours in their daily records, one had a care plan directing staff how to meet the resident’s needs, one did not. Residents with complex behaviours need clear care plans to ensure that staff consistently manage such behaviours. Two residents had urinary catheters, one had a full record of interventions, and one did not. Records relating to catheter management need to be kept in full, to prevent risk of infection. The falls risk assessment does not include an assessment of footwear, one service user who was assessed as being at risk of falls was noted to be walking with ill-fitting footwear. Ill-fitting footwear can be a factor in falls. Effective systems for assessment and care planning will protect residents and ensure that their needs are met. Records showed that residents’ GPs were regularly consulted when indicated. Referrals to external professionals such as the tissue viability nurse and community mental health nurses were made when needed and records maintained. Records of the management of wounds were clear and provided evidence of the wound’s response to treatment. Medicines were stored in a safe manner, apart from the oxygen cylinders on the first floor, which were not secured. Oxygen cylinders are heavy and present risk, due to this they must be fully secured at all times. All controlled drugs and drugs requiring cold storage were properly stored and records maintained. One of the medicines trolleys is becoming old and rusty and will need replacement in due course, to ensure that it can continue to be maintained in a clean condition. Two registered nurses spoken with were aware of the actions of the drugs they were giving out and where they were Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 Page 11 not, referred to the British National Formulary. Records of the administration of drugs showed some improvement from the previous inspection, however eleven administration records had not been completed. If administration records are not completed, the home cannot evidence if a resident has been administered a drug or not and if they have not, why this is. One resident was prescribed a sliding scale of a particular drug, records relating to this were handwritten on the medicines’ administration record, they had not been signed by two persons to provide evidence that the doctor’s instructions have been checked and counter checked by two persons. One registered nurse was not following the home’s procedure for appropriate disposal of found/dropped tablets. All such tablets need to be disposed of safely in accordance with current guidelines. Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 Page 12 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 standard(s) 13, 14, 15 Residents felt able to exercise choice and were supported by relatives, this was supported by records. The atmosphere at lunchtime varied across the home, meals were served in an organised and supportive manner on the ground floor. On the first floor meals were not served in a manner to support service users and provide a social occasion. EVIDENCE: Residents said how their families came and visited when they wanted. One relative said how welcome the staff made them feel. Several residents said they went out of the home with their families at times. There was evidence of planned trips out of the home for residents on the activities board. Residents spoken with said that it was up to them when they got up and went to bed and how they spend their day. One resident, who was sitting in one of the sitting rooms but who could not locate where their room was, was confident that they could call “the people here whenever I want” and they would take them back to her room. One resident said “I do what suits me here.” A resident who was assessed as being at risk of falling out of bed but whose family did not wish to have safety rails in place had had this respected, with full documentation to support their decision. Residents commented on the breakfasts, saying that they enjoyed the choice offered. One resident said Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 Page 13 that they appreciated being given a sandwich and banana for supper, as that was what they wanted. A mealtime was observed, residents can eat in a choice of two dining rooms or their bedroom. One resident said that the food was “good and there’s plenty of it”. Another resident said “My favourite food is their chocolate pudding”. The ground floor dining room was busy and one carer had taken on the role of organising the meal, ensuring that all tables were served at the same time. Staff tried to make the meal a social occasion, sitting with residents to assist them. The other dining room was not so well organised and some residents on one table had finished their meal before other residents were given theirs. One member of staff was observed to just put a plate in front of a resident with no comment to them and another resident who appeared to have difficulty with concentration was not supported in remembering to eat. There were not enough chairs for staff to sit with residents who needed assistance with meals, so staff had to stand. Care staff did show a clear knowledge of different residents’ needs for meals, however staff were not organised so as to be able support residents. Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 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 standard(s) 16, 18 Residents felt supported by the home’s complaints procedure, this was reflected in records. Residents are protected from abuse by staff training and the home’s systems for documentation. EVIDENCE: Avon Court has a complaints procedure, which is provided to all residents and their supporters in the service user’s guide. Records are maintained of communications between relatives and the home and evidence that areas of concern are documented and relevant actions taken. BUPA maintains standard records relating to complaints, these are reviewed by the responsible individual during monthly visits, to ensure a consistent approach. Records completed are clear and letters to complainants are written in an approachable style. One resident said “I can talk to anyone here”, another “staff are easy to talk to” and another “If they’ve got something wrong, I mention it and they find some way of getting it right.”. A review of training records showed that all staff had recently been provided with training in protection of vulnerable adults. Staff spoken with were aware of the importance of the areas. Accident records showed that unexplained bruising was documented and investigated. Where service users needed restraints such as safety rails or wheelchair belts, this was documented and consent obtained. Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 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 standard(s) 19, 20, 21, 22, 23, 24, 26 Avon Court is well-maintained, clean and provides comfortable furniture and equipment to give residents a homely setting in which to live. Staff do not always respond promptly to call bells, thereby placing residents at risk. EVIDENCE: When BUPA purchased Avon Court a year ago, it required extensive up-grading and improvement. Works in these areas are now nearly complete, the dining room and sitting room on the first floor are still to be up-graded and some of the bedrooms were not occupied while they were being up-graded, there is a clear action plan in place. The up-graded rooms and areas presented an attractive, modern appearance. The maintenance man was in evidence throughout the inspection and clear records were in place of areas which he needed to address and timescales for action. Avon Court has a range of sitting areas available for service users, including larger and smaller sitting rooms, two dining rooms and a court-yard garden. One resident said that they had enjoyed the garden the previous summer and Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 Page 16 was looking forward to enjoying it again this summer. All residents have single rooms with ensuite facilities, all are provided with furniture and equipment needed to meet their needs. Residents can bring in items of their own and many of the rooms presented a highly individual atmosphere. All areas of the home inspected were clean. Variable height beds are provided and a range of pressure relieving equipment and hoists were observed in use. BUPA have upgraded the bathing and toilet facilities since they purchased the home and a range of assisted bathing facilities are now available. One resident said that they had had a bath that morning and had enjoyed it. A call bell system is available throughout the home. Some residents said that staff responded quickly when they used it, others said that staff responses varied, one said “they’re quite prompt here”. The Inspector rang the call bell for one resident who said they felt uncomfortable. This resident had not been left with access to their call bell, their notes did not indicate that they would not be able to use their call bell. There was no response after three minutes when the call bell was rung, so the Inspector went to look for a member of staff and found one after five minutes, the Inspector was not sure if this person would have answered the bell if the Inspector had not drawn their attention to it. The laundry showed much improvement since the previous inspection, it was organised, tidy and well maintained. The laundress showed knowledge of systems to prevent risks of cross-infection. Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 A full range of staff with a skill mix to meet residents’ needs are in post. However residents care needs are not being met at all times due to the lack of staff availability within the home. EVIDENCE: Avon Court is required to staff the home in accordance with a Condition of Registration set out by the Commission. They were meeting the requirements of this Condition. BUPA have run a successful recruitment campaign and Mrs Marsh reports that they are now fully up to establishment in all areas, with a waiting list for some posts. For a home with a significant history of problems with recruitment, this shows a considerable improvement. Both floors of the home are managed by a senior registered nurse, supported by the deputy manager, who reports to Mrs Marsh. Staff spoken with knew about residents’ needs in some detail. This inspection showed that while some staff are supportive of residents’ needs, others were not. At various times during the inspection, particularly in the afternoon, the Inspector noted a resident who needed support but was not able to find a member of staff on that floor although staff had been allocated to work on that floor. Observations such as these were noted amongst some staff prior to BUPA’s purchase of the home, they were also noted amongst some staff when answering call bells at the previous inspection. Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35 Residents are protected by an experienced manager who is working to improve service provision. The owners have a system in place to find out residents’ views and regular review of quality of care. Residents’ property is not properly stored and nor is it handed in to an appropriate person promptly. EVIDENCE: Mrs Marsh, registered manager is an experienced manager and nurse. Prior to her appointment to Avon Court, she managed a smaller home for BUPA. Mrs Marsh has the registered managers’ award. Mrs Marsh is aware of the issues relating to the past management of Avon Court and has action plans in place to further improve services, she is aware that improvements in staff morale and performance can take some time, in a home with a history of low performance. The improvements noted to date provide evidence of her management abilities. Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 Page 19 BUPA regularly performs quality audits of service provision. Several residents said that they had been asked to complete a questionnaire recently, two said that they found it a useful way of letting the organisation and the manager know what they thought of the service. The area manager visits the home monthly and makes a report. During the visits, they review quality indicators such as the complaints log, the incidents of accidents and falls and outbreaks of infection. BUPA has a standard set of policies and procedures to support practice, which are held by all BUPA homes. These are reviewed regularly and relevant staff are able to comment on them. Two envelopes containing residents’ property were identified in the Controlled Drugs cupboard. It was reported that they had been handed in at the weekend. The registered nurse was advised that only Controlled Drugs may be stored in the Controlled Drugs cupboard and that alternative secure storage systems must be used for service users’ moneys. These moneys had also not been handed in during the morning to the administrator for logging. A system for logging in of service users property has been introduced since the last inspection, however it does not include the date when it was handed in or handed back. Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 3 x N/A 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 x 13 2 14 3 15 2 COMPLAINTS AND PROTECTION 3 3 3 2 3 3 x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x 2 x x x Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 Page 21 Yes 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. Standard 1 Regulation 5(1)(a)(2) Requirement A copy of the summary of the inspection report must be included in the service users guide. Frequent care charts must always be accurately completed at the time care is provided to the service user. All service users at risk of pressure damage, with mental health care needs and urinary catheters must have full care plans and all other relevant documentation in place. All oxygen cylinders must be fully secured at all times. (This requirement was identifed at the previous inspection, with a compliance date of 31st December 2005.) All medicines adminstration records must be fully completed at the time of adminstration. If a medicine is not adminstered, the reason why must always be documented. (This requirement was identified at the previous inspection, with a compliance date of 31st December 2005. Improvements have been noted at this Timescale for action 31 May 2005 18 May 2005 30 September 2005 2. 7 12(1)(a) 3. 8 12(1)(a) 15(1) 4. 9 13(4)(c) 31 May 2005 5. 9 13(2) 31 May 2005 Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 Page 22 6. 9 13(2) 7. 22 12(1)(a) 13(4)(c) 8. 35 13(2) 17(2) scedule 4(9)(a)(b) 9. 36 18(2) inspection, but full complaince has not been achieved.) All registered nurses must comply with the homes procedure on the disposal of found/dropped tablets. Call bells must be promptly answered when they are used by service users. (This requirement was identified at the previous inspection, with a compliance date of 31 March 2005, some service users reported an improvement in response at this inspection) Service users moneys handed in for temporary storage must not be stored in the Controlled Drugs cupboard. Any property handed in when the adminstrator is not on duty must be proptly handed in to her to ensure that appropriate accounting procedures are in place. (This relates to requirements which were identifed at the previous inspection, with compliance dates of 30 November and 31 Decemebr 2005. An accounting system has been set up for service users valuables) The persons registered must complete their development of a full supervision and appraisal system for all staff. (This requirement was not reviewed at this inspection as it was not due.) 31 May 2005 31 May 2005 31 May 2005 30 Septemebr 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations Version 1.20 D51_D01_AVONCOURT_V204276_180405_Stage4.doc Page 23 Avon Court Care Centre 1. 2. 3. 4. 5. Standard 7 8 9 9 15 6. 7. 8. 15 15 35 Falls risk assessments should include an assessment of the service users footwear. Documentation relating to prevention of pressure damage should include when a particular intervention/type of equipment is provided to a service user. The medicines trolley on the first floor should be replaced. Where instructions are wirtten by hand on medicines adminstration instructions, they should be checked and countersigned. Managements systems should be put in place to ensure that all service users are given their meals in an orgaised manner and that appropriate support is given to service users who need assistance. There should be enough chairs in the first floor dining room to enable all staff who need to assist service users with their meals to sit down with them. Mangement should set up systems to ensure that all staff who are on duty continue to work on the floor to which they have been allocated. The homes accounting system for valuables handed in should include the date when the valuable was handed in/ handed back. Avon Court Care Centre D51_D01_AVONCOURT_V204276_180405_Stage4.doc Version 1.20 Page 24 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, 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. 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