Inspection on 07/07/08 for Avon Court Care Centre

This inspection was carried out on 7th July 2008.

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

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 13/07/06

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Avon Court Care Centre Rowden Hill Chippenham Wiltshire SN15 2AJ Lead Inspector Susie Stratton Unannounced Inspection 9:15 7 & 14th July 2008 th 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.V364110.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.V364110.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 beavene@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd 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.V364110.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) 13th July 2006 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 £780 a week. All people are provided with a copy of the service user’s guide in their rooms. 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 a railway station in the middle of Chippenham. Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. 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. As part of the inspection, 40 questionnaires were sent out to residents and their relatives and 33 were returned. Comments made by people in questionnaires and to us during the inspection process have been included when drawing up the report. As part of this inspection, the home’s file was reviewed and information provided since the previous inspection was considered. The home also submitted an annual quality assurance assessment prior to the inspection. As Avon Court is a larger registration, the site visits took place over two days, on Monday 7th July 2008, between 9:15am and 4:10pm and Monday 14th July 2008 between 10:05am and 12:30pm. The Manager, Elissa Beaven was on duty during the inspection. Mrs Beaven and her deputy were available for the feedback at the end of the inspection. During the site visits, we met with 16 residents, five visitors and observed care for 14 residents for whom communication was difficult. We reviewed care provision and documentation in detail for eight residents across the home, two of whom had been admitted recently. As well as meeting with residents, we met with four registered nurses, six carers, the chef, the activities coordinator, the laundress, the maintenance man and the administrator. We toured all the building and observed practice, including a lunch-time meal. We observed systems for storage of medicines and observed medicines administration rounds. A range of records were reviewed, including staff training records, staff employment records, maintenance records and financial records. What the service does well: Avon Court has an effective management team, who are keen to maintain and improve the quality of standards in the home. Quality of service is regularly reviewed and if areas are identified for improvement, action is taken to ensure that matters are addressed. All staff are fully supervised in their roles, ensuring that they are aware of their responsibilities for meeting residents’ needs. Mrs Beaven is fully aware of her responsibilities for investigating any concerns or complaints and is keen to hear how the service provided affects Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 6 people living in the home. She is also keen to ensure that residents are safeguarded, taking action to ensure that relevant bodies are informed where relevant, appropriate equipment is used to ensure safety and all staff are fully aware of their responsibilities. Residents and their supporters expressed their appreciation of the service. One person described how the home “provides a warm and caring environment for its residents”, another “it takes into consideration everyday needs and concerns of all its residents”. Another person said: “The ambiance of Avon Court is superb” and a resident commented “I’ve been in one or two homes, this one’s the most wholesome”. People commented on the staff. One person reported “they’re lovely to me – always a smile”, another said: “nursing staff are very dedicated”, another “I can’t fault anything all the staff are very caring and helpful” and another “that one [pointing out a carer] she’s lovely”. What has improved since the last inspection? What they could do better: No requirements were made at this inspection. Five good practice recommendations were made. Audit of care plans should continue, to ensure that all are consistently completed to the same standards. Signs relating to care in resident’s rooms should be dated and signed, to facilitate regular review. The registered nurse performing the medicines round should always lock the medicines trolley when going into a resident’s room or other areas. Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 7 Staff should wear disposable gloves when handling used laundry, to prevent risk of cross infection. Where care staff have been trained in the use of appliances, records should be made, including any reviews of their competencies. 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. The summary of this inspection report can be made available in other formats on request. Avon Court Care Centre DS0000059517.V364110.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.V364110.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5. Avon Court does not provide intermediate care, so 6 is N/A. Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Prospective residents and their supporters are provided with information about the home. They are able to visit before admission and a full assessment of need is carried out, so that they can be assured that the home will be able to meet their needs. EVIDENCE: Avon Court has a Statement of Purpose and Service Users’ Guide, which is available in the front entrance hall and each resident’s room. The documents are regularly reviewed. They provide a range of information to let people know about the services offered. People are also able to visit the home before admission. One person reported “we had two visits before deciding. Everyone was very helpful”, another “as soon as I came in the home, I said it looks like the one” and another “they showed me the rooms, I chose this one”. Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 10 People met with reported that a member of staff from Avon Court had come to meet with them before their admission, to assess their needs. Mrs Beaven reported in her annual quality audit that the provider has developed standardised admission assessment documentation. Records seen were clear and completed in detail. The assessment documentation enabled a review of changes in residents’ needs from admission, clearly showing where residents had improved and where they needed more support. Staff spoken with reported that they were informed about prospective resident’s needs prior to admission, so that they could have everything in place the residents needed at admission. They also reported that after admission, more detailed assessments of need were completed, as they got to know the resident. One resident’s relative reported, “the staff are trying hard to understand my relative’s needs – she cannot always express herself clearly. However both she and they seem to have better communication each time I visit” and another “my relative has not been in the care home for very long but I have been very impressed so far with the care and attention he has received”. Avon Court Care Centre DS0000059517.V364110.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents have their individual nursing and care needs met, in an atmosphere which respects their privacy and dignity. EVIDENCE: All residents have full assessments of need, which are regularly reviewed. Where a need or a risk is identified, a detailed care plan is completed, these are up-dated and changed when needed. Care plans reflected what residents and staff told us. Staff seek to consult residents and their supporters about care plans. During the inspection, we observed a registered nurse sitting with a resident and their family, discussing their care plan, we also observed a second registered nurse sitting with another resident discussing their care needs. Carers document the care that they have given in a daily record, writing down all interventions. Where people had high care needs, several records were completed per shift. Registered nurses reported that this was very useful in ensuring they were regularly up-dated about changes in Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 12 residents’ conditions and meant they could take action where changes in condition were identified. One person reported “They DO care, they’re very good really”, another reported that the home “meets a high standard” and a relative reported “staff are pretty good, they look after [my relative] properly”. Frail residents with complex needs had clear records to show that they had had their positions changed, to prevent pressure damage and were given fluids to prevent dehydration. The records reflected the care given. Five of the six records reviewed were very clear; one needed some more work and should, like the other ones, have stated how often a person needed their position changing, rather than just “regularly” and have stated the type of pressure relieving equipment to be used, rather than “pressure relieving cushion”. The home regularly monitors occurrences of pressure damage and it is much to their credit that since the current providers and manager took over the home they have successfully healed a person’s complex pressure. Where residents had difficulties in swallowing, there were clear care plans in place, which included how much thickening agent they needed in their drinks. We observed that staff were complying in full with these care plans. As well as care plans, information on such and other matters were placed in residents’ rooms on laminated signs, so that other persons, such as visitors would know how to support the resident. The information was clear, but these signs were not routinely dated and signed which they should be, to assist in review and identify who had made the instructions. There was clear evidence that the home sought the support of external healthcare professionals when needed. For example, one resident had a complex leg ulcer and the home had consulted with a range of healthcare professionals to support the resident. GPs were regularly consulted when indicated and clear records maintained of consultations. Of the 19 people who responded to this section of the questionnaire, 18 reported that they always and one usually, received the medical support that they needed. Two medicines rounds were observed during the inspection. Registered nurses were able to concentrate on the role and not be disturbed. One registered nurse was observed to be very supportive to a resident who appeared to be confused, reassuring them whilst they assisted them to take this medication. It was observed that whilst registered nurses went to give residents their tablets in their rooms, that they did not lock the medicines trolley. Both registered nurses clearly observed the trolley whilst giving out medication. It was discussed with Mrs Beaven that as a registered nurse could easily be distracted by a matter, particularly relating to resident care, whilst giving out medication, that she should always lock the trolley when in a resident’s room or not close to a trolley. There was a full audit trail of medicines received into the home, given to residents and disposed of from the home. It was particularly noted as good Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 13 practice that residents who were prescribed medicines which could affect their daily lives, such as painkillers, mood altering drugs or aperients, had clear care plans relating to this. This will enable effective evaluation of the effectiveness of medicines treatment. One resident reported how they appreciated that “they give me my sleeping tablet.” All personal care was provided behind closed doors. Frail people had small but significant details attended to, such as clean fingernails and spectacles. One relative reported “I have been very impressed by the care my mother has received and I believe she had the best quality of life she could have in the circumstances” and another “the management do their best to make people feel relaxed about being where they are”. Avon Court Care Centre DS0000059517.V364110.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are supported in living the life that they chose in their daily lives, social activities and at mealtimes. EVIDENCE: This home employs an activities coordinator, she came into post in the spring of 2008. The person was highly motivated and showed a good understanding of the residents’ needs and her role. Staff are also available to support residents. During the afternoon, the activities coordinator was observed to run a Bingo game, she supported residents in being involved. A carer also helped her, supporting residents who needed more assistance. At the time of the site visits, the provider had organised a “virtual cruise” and there were decorations about this in the front entrance hall and dining rooms. One person reported “I go down to a few of the games or something I fancy”, another “I go whenever they have the entertainers or something different, I went to the front entrance this morning because of the decorations” and another “Last week I went to the coffee morning”. Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 15 All residents have care plans relating to their individual recreational needs. Many prefer one to one activities, finding larger group activities more complex to cope with. One person reported “they come in to talk often” and relative commented “[My relative] enjoys the chats”. Other residents liked going out. One person reported how they appreciated that one of the domestic staff would come in, in their own time and push them in a wheelchair into the centre of the town. Other residents commented that their family took them out. Where resident were not able to go out of the home, their visitors said that they could come when they wanted. One visitor reported “I come every day” and another “staff are very helpful; the registered nurses tell me anything that happens”. People felt that the home tried to support residents in living the life that they chose. One person reported “within the limitations of a nursing home this is achieved to a high standard” and another “Sometimes it is hard to do this as [my relative] wants things sometimes which can’t be done but they try hard to find an alternative”. One resident reported that they appreciated staff always closing their door at night as they had asked them to do. Another person reported that they appreciated that “They get me up early because of my legs” and another “Oh yes I can go to bed when I want”. We met with the chef, who reported that she regularly reviews the menu, to give people what they wanted to eat. She reported that all meals are cooked from raw ingredients. She showed a good knowledge of which residents were on special diets and also knew where to gain information from if any residents had special needs in relation to their diets. Of the 19 people who responded to this section of the questionnaire, eight reported that they always, ten usually and one sometimes liked the meals. Nearly all the comments were received were favourable, including “the food is of a high standard and the kitchen staff very obliging”, “everything seems good, I just sit down and eat it” and “you get a good variety if you want it”. People also commented on the choice of meals. One person reported “you just have to ask & they’ll cook you something different” and another “I can have something different, I have an omelette if I don’t like what they offered”. A mealtime was observed during the inspection. Residents could eat in one of two dining rooms or their own rooms. Staff are available to support residents throughout the lunchtime period, sitting and helping people who need assistance to eat their meals. People are given a choice of different drinks with their meals, including sherry and wine if they want it. Residents who were artificially fed had clear records relating to their feeding regimes. Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is excellent. This judgement has been made using available evidence, including visits to this service. Residents and their supporters will be full supported in raising issues of concern. Any matters reported are fully investigated and actions taken, to ensure that people are safeguarded. EVIDENCE: Avon Court has a complaints policy, which is displayed in the front entrance hall and is available in the service users’ guide, which all residents and their supporters have access to in their room. Of the 33 people who responded to this section of the questionnaire, 28 reported that they knew how to make a complaint. One resident reported “I complained about……and [Mrs Beaven] came up to see me straight away” another “any complaint I have made has been dealt with very successfully and sympathetically” and another “I see the lady manager”. People reported that people were prepared to listen to any matter which troubled them, even if it was apparently small. One person reported “Oh yes, you can talk to the staff”, another “if necessary I’d talk to the manager, she’s quite good about listening” and a visitor reported “I feel able to say if I’m not happy with something”. The home maintains a log of complaints made, both formal and informal. The log shows that the home actively and impartially investigates any issues raised and takes action to address deficits if any issues are raised. Records and Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 17 discussions showed that Mrs Beaven regards complaints in a positive light as they inform her of how the service affects people. Records also showed that if the home had been at fault, she is consistently prepared to apologise and take action to rectify any short-fall. No complaints have been made to us since the last inspection, although we were copied in on correspondence about one matter sent to the purchasers of care. The home were in the process of following the matter up at the time of the inspection. The manager also supports frail people in raising issues relating to deficits in care provision from other providers. Mrs Beaven reported in her annual quality audit that new Director of Quality has been appointed within BUPA and the home now has access to an expert team if needed. The can also complete an early warning audit tool so that any issues will be identified and rectified more quickly. The home has a clear policy on safeguarding adults. All staff are regularly trained in their responsibilities. Discussions with a range of staff, including for example, the maintenance man and laundress showed that all staff at all levels were aware of their responsibilities for safeguarding adults. The manager has experience of working within local policies and procedures and is keen to follow up matters with relevant authorities to support people. One referral has been made about this service since the last inspection. It was investigated and the home were found to have acted at all times in the best interests of a vulnerable person. It was noted as good practice that the home limits the use of safety rails as much as possible, and actively used other means of keeping residents safe. Where safety rails or lap belts were in use, this was supported by full risk assessments, which were regularly reviewed. Where a resident was not able to use a call bell, there were written assessments relating to how the person was to be safeguarded. One such resident reported to us that “I just rattle something when I want a member of staff” and that they knew someone would come to attend to them. Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are cared for in an environment which meets their needs, is regularly up-graded and clean. EVIDENCE: Avon Court is a two story building, with a passenger lift in-between. It was purpose built as a care home and underwent a major re-furbishment in 2005. Some parts of the building are now beginning to need attention, due to scrapes and general wear and tear. Mrs Beaven was fully aware of all the matters noted during the inspection and had an action plan in place to address them. The call bell system has been fully up-graded since the last inspection. Staff reported that it was much easier for them to respond quickly to residents, now that they used a bleep system. Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 19 During the inspection we met with the maintenance man. He reported that he regularly reviews the building and addresses immediate matters, such as dripping taps or faulty light bulbs. Staff spoken with also reported on how quick he was to respond then they asked for help. Avon Court has a choice of sitting and dining rooms on both floors. The front entrance hall has recently been improved. One visitor commented “The dining room is always beautifully presented. Coffee is available in reception for visitors which creates an amazing aroma as you enter”. Much work has been put into improving the garden space since the last inspection, with paved walkways, improved flower beds and the provision of a gazebo. One person who spent all their time in bed commented “I look out of the window and see what’s happening, I’m lucky to have this spot”. The home has several bathrooms on each floor, however in practice only one of them on each floor is used. This was discussed with Mrs Beaven, who reported that this had been identified and works were to be progressed to improve bathing facilities for residents during the next year. Improvements will include baths and hoists more suitable for people with a disability and may include a wet room on one of the floors. All of the home was clean, including high and low surfaces and difficult to reach areas such as the backs of bath hoists. Of the 19 people who responded to the questionnaire, all people commented that the home was always fresh and clean. A cleaner was observed performing their role, they were careful, moving items to clean beneath and underneath them. It was particularly noted as good practice that where residents went to the dining room for lunch, that the domestics waited until then to give the residents’ room a thorough clean, so that cleaning took place at a time that was not inconvenient to the resident. We met with the laundress, who showed a good knowledge of her role. She reported that staff complied with company policy on separation of infected and potentially infected laundry. During the inspection it was observed that staff were carrying used laundry without gloves, holding the laundry away from their uniform. As this is a care home with nursing, as best practice, used laundry should be handled using gloves, to prevent risk of cross infection. There was a ready supply of gloves and plastic aprons and staff were observed to use them. Registered nurses reported that they had a good supply of sterile gloves for aseptic procedure. Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents will be supported by a mix of staff who have been safely recruited and are trained in their roles. EVIDENCE: Avon Court states the number and skill mix of staff on duty at different times of the day in their service user’s guide. A review of off duties shows that they keep to these staffing levels and at times go over them. As well as nursing and care staff, the home also employs domestic, catering, laundry, maintenance, activities and administrative staff. Of the 18 people who responded to this section of the questionnaire, eight reported that there were always, and ten usually, staff available when they needed them. Some people felt staff were not always available, for example reporting “if I ring the bell, they come eventually, not immediately” or “when staff are feeding (residents), you can’t find anyone to help”. However the majority of people did not echo this, reporting “if I ring my bell they come, they tell me I don’t ring enough”, another “they come quickly” and another “if I ring my bell, she’ll look in”. Agency staff are rarely used and as much as possible, the homes’ own staff will support the team in unplanned absences, such as sickness. The home has systems for monitoring sickness to support staff and keep unplanned absences to a minimum. Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 21 The home has safe systems for recruitment of staff. All staff submit an employment history and there was evidence that any gaps in employment history are probed at interview. All staff have police checks and complete a health status questionnaire. Two satisfactory references are obtained for all staff, this includes contacting previous employers who are abroad if necessary. The personal identification numbers for registered nurses are verified on employment and regularly thereafter. The employment status of staff from aboard is checked and copies of relevant documentation held on file. All staff are interviewed using BUPA’s standard interview assessment tool. On commencement of employment, all staff are allocated to a mentor, who supports them through their induction. Two recently employed staff reported on how supportive they had found their induction period as they gradually learned their role. In completion of induction, staff have a formal supervision and are confirmed in their role. BUPA supports staff in developing their skills. One carer reported that she was being supported whilst she worked towards National Vocational Qualifications and also how much it had taught her. Staff also commented on the other training opportunities. Several staff commented on recent training in dementia care and how it had supported them in caring for residents who had additional mental health needs. Registered nurses are supported in developing skills for their role and will be sent on relevant courses, for example phlebotomy or complex catheterisation. Of the 16 people who responded to this section of the questionnaire, nine reported that staff always and seven usually had the right skills to look after people. All members of staff have an individual training profile. This is reviewed during supervision. Mrs Beaven has systems in place to ensure that all staff attend mandatory training and are encouraged in attending other training relating to resident care. It was discussed during the inspection that some residents needed certain appliances, such as stoma bags or male continence aids. The types of appliances in use can be put on residents by carers, once they have been trained. It was discussed that records should be maintained of competence skills for such tasks, so that the home can verify that all staff who apply such items have been trained and have the competencies to support residents. Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence, including visits to this service. Residents will be supported by a manager who is fully able to discharge her responsibilities to ensure that quality of care is maintained to a high standard and the principals of health and safety fully up-held. EVIDENCE: Avon Court is managed by an experienced manager, who is also a registered nurse. She is supported by a deputy. One person described the managers as “very helpful and approachable”, another described how Mrs Beaven “likes everyone to be happy”. Staff also reported on how supportive and approachable Mrs Beaven was. One person who had come into post since the last inspection described her has the best manager they have worked for. As Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 23 well as being supportive and approachable, Mrs Beaven also has systems in place to ensure that staff perform in accordance with their job roles and she clearly takes action if deficits in performance are identified. Mrs Beaven holds regular staff meetings, including head of department meetings, night and day staff meetings. Meetings are minuted and they clearly showed that staff were able to bring up matters of concern to them and that these concerns were answered. The activities person has set up resident and visitors meetings; these are minuted and points passed on to the manager for action, where relevant. For example one meeting indicated that some people felt that there was not enough cutlery at lunchtimes. By this inspection, Mrs Beaven had taken full actions to rectify this. BUPA has established systems in place to ensure that the quality of the service provision is monitored. Questionnaires are sent out regularly and responses collated. Where issues are identified, the manager has to draw up an action plan and submit it to the provider to identify how the areas identified are to be addressed. The manager sends in monthly returns relating to issues such as incidences of pressure damage, complaints and accidents. Mrs Beaven and her deputy regularly monitor care plans and medicines management. Evidence from this inspection showed that Mrs Beaven was keen to ensure that action was taken if issues were identified, to improve quality of service provision to residents. BUPA has a standard monthly invoicing system for individual residents’ payments for items such as hairdressing, chiropody and newspapers. Individual accounts are held on computer files and resident’s supporters can obtain a copy on request. The administrator has a system for identifying when individuals need more moneys paying into their account. The home also has safe storage systems when residents’ valuables are handed in for safekeeping, with a full audit trail. The home has a system to ensure that staff are supervised in their roles. Supervisions can be on a 1:1 basis or in small groups, with observed practice being included. Full records of supervision are maintained. Mrs Beaven reported that they tend to use themed supervisions, looking at a range of different topics relating to current resident care, such as nutrition or communication. Training needs are considered during supervisions and action plans put in place where training or development needs are identified. All staff have an annual appraisal. These are individual in tone and relate to the member of staff involved. BUPA has standard systems to ensure that all services and equipment are regularly maintained. All records inspected were fully up-to-date. Training records showed that staff were regularly trained in areas such as manual handling, first aid and fire safety. Mrs Beaven has systems in place to ensure that staff do attend mandatory training as required. Manual handling practice Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 24 was observed during the inspection and staff were observed to perform manual handling in a safe manner. Accident records were clear and all accident reports were reviewed by Mrs Beaven or her deputy. Accident records included any unexplained bruising observed on a resident. Accidents are reviewed for trends and actions taken to reduce risk if necessary. Where a resident hurts their head, neurological observations are always carried out for at least 24 hours. Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 3 3 3 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 4 X 3 Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action 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. 3. 4. 5. Refer to Standard OP7 OP7 OP9 OP26 OP28 Good Practice Recommendations All care plans should be consistently written in measurable terms and precisely describe equipment to be used. Signs relating to care in service user’s rooms should be dated and signed. The registered nurse performing the medicines round should always lock the medicines trolley when going into a resident’s room or other area. Staff should wear disposable gloves when handling used laundry. Where care staff have been trained in the use of appliances, records should be made, including of any reviews of their competencies. Avon Court Care Centre DS0000059517.V364110.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V364110.R01.S.doc Version 5.2 Page 28 - 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. 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