Inspection on 02/01/09 for Avon House

This inspection was carried out on 2nd January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Avon House 04/01/07

Avon House 17/10/05

Avon House 12/05/05

Avon House 16/12/04

Avon House 17/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Avon House 40/42 Shakespeare Road Worthing West Sussex BN11 4AS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sheila Gawley     Date: 0 2 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Avon House 40/42 Shakespeare Road Worthing West Sussex BN11 4AS 01903233257 01903531313 avonhouse@ntlbusiness.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Cobham Care Ltd care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 26 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Dementia (DE) Date of last inspection Brief description of the care home Avon House is a home for older people with a past or present mental illness. It is registered to accommodate up to twenty-six residents. Two semi-detached houses are joined together with a passenger lift serving both floors. Accommodation is provided in twenty-four single and one double room. The home has a small rear garden. Avon House is situated in a residential area of Worthing close to local shops, the railway station and the seafront. The service is managed by Mrs Amanda OHagan and the Registered provider is Cobham Care Ltd. 26 Over 65 0 Care Homes for Older People Page 4 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This site visit as part of the inspection process was carried out on 02/01/09. It was undertaken by a lead inspector from the Commission for Social Care inspection. Prior to the visit all files held by the commission, complaints and safeguarding issues were reviewed. The home had sent us their Annual Quality Assurance Assessment for the inspection, which gave us the information we needed on the home and any documents required on the day were made available. We were not in receipt of any surveys but people who use the service and staff were spoken to on the day and surveys undertaken by the home were available. Care Homes for Older People Page 5 of 24 People who use the service spoken to stated that they are happy in the home and that they enjoy the food. All appeared happy, were well dressed and the atmosphere in the home was relaxed. One person stated that the staff are lovely. Two community nurses visiting the home stated that people who use the service are appropriately referred to their service and that when they visit the home is organised. They stated that people always look well cared for. Staff spoken to on the day stated that they were happy working in the home and that the management was supportive. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality in this outcome area because needs are assessed and information needed to make an informed choice is available. Evidence: People who use the service are fully assessed prior to admission to the home. All medical and personal care need is assessed and recorded, this includes continence, eating and drinking, mobility, transfers, bathing and sleeping. Four people who use the service were case tracked and their pre admission assessment was present in the care plans. The AQAA stated that the home continues to meet this standard on preadmission assessment. An up to date statement of purpose and service user guide is available. Care Homes for Older People Page 9 of 24 Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality outcomes in this area because all needs are assessed, set out in a plan and met, People who use the service are treated with respect. Medicines are handled safely according to policy. Evidence: The AQAA stated that all needs are met, medicines handled safely and nutritional need addressed. All residents have a plan of care which is drawn up following full assessment. Four people who use the service were case tracked, their care plans were inspected and these contained information on health, personal, and social need. This includes nutrition, mental health, pressure areas, allergies, monthly review and social services review, and daily records. There is a full social history included. One of these people was spoken to and she stated that It is lovely here. Nutritional assessments were seen in the care plans and weight is monitored monthly. Care Homes for Older People Page 11 of 24 Evidence: A chiropodist visits six weekly. Aids and equipment is available as assessed, a pressure relieving cushion was delivered during the inspection for one person and it was put in use immediately. People access health services via the local general practitioner and the home has the support of the district nursing team as required. These interventions are recorded in the care plans. Two community nurses visiting the home stated that people who use the service are appropriately referred to their service and that when they visit the home is organised. They stated that people always look well cared for. The local community psychiatric team is also consulted as necessary , evidence of this was seen in one care plan when difficulties in administering medication and solutions to this were discussed. Evidence of families being consulted was seen. Care needs are met with respect and dignity and all interventions observed were carried out in a calm manner. Medicines are received, administered, recorded and returned correctly. Medicine administration charts inspected were up to date. The home does not currently have a controlled drug cupboard. The provision of this cupboard will be a requirement of this inspection. The new CSCI guidance Management of controlled drugs in care homes gives details of which common medicines need to be stored in a Controlled Drugs cupboard and can be referred to by the registered manager. Medicines are administered by staff trained to do so and policies are in place to support this. The registered manager is currently working on a covert drugs policy and is consulting guidelines from the relevant bodies. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality outcomes in this area because they have choice in daily life, activities suit their lifestyle and contact with family and the community is encouraged. Evidence: There is a programme of activities in the home and one carer has responsibility for this area. Activities are typically undertaken in the afternoon between two and four pm and again between seven and eight pm. The home has purchased a rabbit which is brought in from time to time for people who use the service to stroke. There are at least four external entertainers who attend the home once a month and provide a variety of music, exercise and singing. All activities participated in are recorded in an activities diary. The home had a Christmas party which all relatives were invited to. Children from a local school came in to the home and sang a carole service. Letters of appreciation were seen in relation to this. There is a cream tea each summer which relatives are also invited to. Birthdays are always celebrated with cake, one person who uses the Care Homes for Older People Page 13 of 24 Evidence: service had a birthday on the day of the inspection and had Happy Birthday sung to her. The Church of England vicar attends once a month and people who use the service attend these hymms as they wish. Other denominations do not attend the home at present but they could be accessed if requested by any person. There is a three week menu in place which has recently been revised. There is choice in food and the cook is aware of likes and dislikes. The lunch seen prepared and served today appeared appetising and people who use the service enjoyed it. Those spoken to stated that they enjoyed the food. Those requiring assistance. with their meal were offered this in an unobtrusive manner. The kitchen meets the requirements of the local Environmental Health Authority. Carers were observed offering care and assistance in a respectfull manner and the autonomy and choice of people who use the service is respected. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality outcomes in this area because complaints are listened to and people are protected from abuse. Evidence: There is a clear complaints procedure which is on display and which is included in the Statement of Purpose and Service User Guide. The procedure clearly identifies whom a complaint should be addressed to and the timescales in which a complaint will be dealt. It displays the Commissions contact details. The registered manager is giving consideration to providing the complaints prodedure in other formats such as easy read or pictorial. People who use the service were clear as to whom they can raise concerns with. Any concerns highlighted in surveys are dealt with without delay. Recent comments on items of clothing going missing in the laundry has been addressed by the purchase of a new tagging machine. There are safeguarding policies and procedures in place and staff have had safeguarding training. Staff spoken to demonstrated an awareness of procedures to follow. There is some training planned on challenging behaviour in February. Care Homes for Older People Page 15 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality outcomes in this area because the home is well maintained, safe and clean. Evidence: The home on this occasion was neat , clean, and free from offensive odours. The sitting and dining rooms are comfortable and are domestic in style with comfortable furnishings. Bedrooms are clean, comfortable and personalised, all have a sink. There are appropriate toilet and bathing facilities for people who use the service. Some upstairs windows, although very high, do not have window restrictors and the registered manager agreed to have these fitted. The home meets the requirements of the local Fire and Environmental Health Authorities. There are suitable laundry facilities sited away from food preparation and storage. Machines have the neccessary temperature programmes to deal with all laundry. There is a proposal to buile a large conservatory on the back of the building which will greatly enhance the communal areas. This is hoped to commence in the new financial year. These plans have yet to be approved by the local planning authority. Care Homes for Older People Page 16 of 24 Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality in this outcome area because needs are met by suitably qualified staff. Evidence: Staff rota showed staffing levels were sufficient to meet the needs of residents. There is housekeeping, kitchen, and maintenance support. There are robust recruitment procedures in place and staff files inspected contained all the documentation required to ensure the protection of people who use the service. There was evidence of application forms with employment history. Criminal Records Bureau Clearance and Protection of Vulnerable Adults (POVA) check, two references, identity documentation, and photograph were all in place. POVA First is used appropriately. Staff turnover is low. Staff spoken to stated that the home is a pleasant and supportive place to work and that there are many training opportunities. People who use the service find the find the staff helpful. One person said Staff are lovely here. Staff were observed offering care and attention in a timely and respectful manner. Care Homes for Older People Page 18 of 24 Evidence: There is a staff training programme in place which covers all mandatory training. Ten of the eighteen carers have attained National Vocational Qualification Level 2 or above. Staff were aware of Whistleblowing procedures. Staff confirmed supervision is in place. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality in this outcome area because the home is run in the best interests of the people who use the service and families are consulted. Evidence: The Registered Manager has been in post for five years although has worked in the home for thirteen years. She obtained National Vocational Training level 4 and the Registered Manager Award. The registered manager has a good rapport with the providers and is able to access facilities and equipment as required. She is aware of the financial planning required to provide a service and any constraints on this. She discussed the planned conservatory build in the new financial year. She also has regular contact with the manager of a sister home for support and discussion. Staff confirmed that this is a supportive home to work in. Interactions and communication observed on the day evidenced an open and transparent style of management. Care Homes for Older People Page 20 of 24 Evidence: Quality assurance systems are in place to ensure that the home is run in the best interests of the people who use the service. The home sent us the AQAA when we requested it and it contained the information we needed. Surveys are sent anually to relatives and professionals. Some comments seen on these surveys were Staff attitude is excellent, Very clean and lovely ambience, Avon House is special, In our opinion could not be better and Care, management and staff of Avon House are very good. The results of surveys are collated and any issue highlighted is addressed, see comments on laundry above. Staff meetings and supervision are in place and the home produces a quarterly newsletter informing people of events ahead. The home recently arranged a Dementia Awareness talk in a local church hall for relatives of this home and a nearby sister home. Feedback on this was very good, not only on the informative level but the benefit of relatives in similar situations meeting and being supportive was also hoghlighted on the feedback forms. There are annual summer and winter social events for families to attend. The home holds money for people in an Avon House Residents Account. They are currently reviewing how they can change this system as they recognise the current system of one residents bank account is not acceptable. The sister home does not hold any money for their people who use the service and invoice families as expenditure occurs. Avon House is likely to adopt this system. The registered mamager ensures the health, safety and welfare of people who use the service and staff by the provision of mandatory training. The home meets the requirements of the local Fire Authority and Environmental Health Department. All contracts for maintenance of lifting equipment, lifts and utilities are in place Substances hazardous to health are stored securely. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person must 10/04/2009 ensure that Controlled Drugs are stored in a Controlled Drugs cupboard complying with the Misuse of Drugs (Safe Custody) Regulations 1973. To ensure the safe storage of controlled drugs. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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