Inspection on 20/04/10 for Avon House

This inspection was carried out on 20th April 2010.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Avon House 15/07/08

Avon House 09/07/07

Avon House 23/05/06

Avon House 13/12/05

Avon House 19/01/05

Avon House 17/05/04

Similar services:

Ashlong House

Spring Lane Care Home

Avenues (The) (Neave Crescent)

Barrington Lodge Nursing Home

Beacon House Nursing Home

St Mary`s Convent & Nursing Home

1-3 Frederick Gardens

The Royal Star and Garter Home

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2010.

Key inspection report Care homes for older people Name: Address: Avon House Allen Street London W8 6BL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ann Gavin     Date: 2 0 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Avon House Allen Street London W8 6BL 02079373307 02077956288 avon.house@craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Craegmoor Older People Care Limited Name of registered manager (if applicable) Grace Corriea Type of registration: Number of places registered: care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 35 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Eiither whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD The registered person may provide the following category of service only: Care Home with nursing - Code N, to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD Date of last inspection Brief description of the care home Avon House is a purpose built home, managed by Craegmoor Healthcare, that provides accommodation and nursing care for up to 35 older people. The home is close to the shops and transport links of Kensington High Street. Residents bedrooms are located Care Homes for Older People Page 4 of 32 Over 65 0 35 Brief description of the care home on all three stories in the home, with lift access to the upper floors. On the ground floor there is an open plan lounge, a dining room, the main kitchen, a conservatory, the managers and administration offices. There are individual small lounges and dining areas on the first and second floors. The home has twenty-six single and four double bedrooms, all with en suite facilities. To the front of the home there is limited off street parking, and a small garden to the rear. Care Homes for Older People Page 5 of 32 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: one star adequate 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 was an unannounced inspection carried out on 20th April from 10.30 am to 19.30 pm by an inspector with a colleague shadowing. Time was spent talking with people who live in the home, with relatives, nursing and care staff, the administrator, and the activities coordinator. The Manager was at another home helping with an investigation but travelled back to join the inspection at lunchtime. The care of three people who live in the different floors within Avon House were tracked. This involves talking to them, the staff involved in their care, reviewing their care plan and all other documentation linked to them. Everyone was very welcoming, open and receptive to the inspection process. The lack of sufficient staffing and the lack of a deputy manager has had implications for the care Care Homes for Older People Page 6 of 32 of the people who live in the home as is demonstrated throughout the report and reflected in the requirements. On the day of the inspection an immediate requirement was made to ensure that the sufficient level of staff were in place from the following day. A number of questionnaires were sent out to people who live in the home, staff, and health and social care professionals and there feedback is included in the report. People who live in the home and their relatives were on the whole very positive and spoke highly of the dedication and caring of the Manager and staff. Current fees at Avon House range from £850 - £ 1200 per week Care Homes for Older People Page 7 of 32 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 32 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 9 of 32 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 have an assessment of their healthcare needs prior to being admitted to the home. There are opportunities for prospective residents to visit and spend time in Avon House before admission. Evidence: Fantastic senior manager very caring Quote from Healthcare professional questionnaire Good friendly manager and staff Quote from questionnaire from person who lives in the home The care of three people who live in the home was tracked. Looking at the assessment of their support needs prior to being admitted it was clear that the nursing care needs had been assessed. There was some variation in the amount of detail and level of assessment of the other social, cultural and communication assessments. The Care Homes for Older People Page 10 of 32 Evidence: assessments would be carried out by the Manager and the deputy manager. However the impact of not having a deputy or a full compliment of staff has also affected the quality of assessments with some not being completed in all areas. Four of the six questionnaires that were received from people who live in the home said that they had received enough information about the home prior to admission Care Homes for Older People Page 11 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in planning their care and have good healthcare assessments and links with healthcare professionals. However staffing levels can impact on people receiving support. More focus needs to be placed on peoples social, cultural and spiritual needs. Evidence: The staff really care for their residents that is the most important thing Maybe changing incontinent pads before lunch rather or as well as after as people can get sleepy and so hoisting is difficult Quotes from relatives Staffing issues can affect delivery of care Quote health and social care professional questionnaire The support care needs of people living in the home are high. Most people are wheelchair users. There are also a number of people who are bed bound and a number of people who have difficulty in communication. Observing the staff relate to Care Homes for Older People Page 12 of 32 Evidence: the people who live in the home was generally very positive. There were some good care observed with staff talking and encouraging people. However the lack of staff does impact on all areas of support and care planning. It is recommended that the home carry out a review of the level of dependence of the people who are living in the home to ensure that their current level of support is sufficient. The three care plans tracked were all based on a person centred care plan though the way it is devised makes it difficult to gain an overview of the person, their support needs and their preferences. It is recommended that these be reviewed to include an at a glance resume. The care plans seen had health records which were mainly completed though there were areas which lacked information and where the impact of staffing meant that there was a lack of up to date information on peoples care plans. One persons fluid chart had not been completed and had restrict fluids to 1,500 written though the nurse on duty said that was no longer valid. This lack of correct information meant it was not possible to tell how much fluid should be given and if this had had taken place. Also contradictory information was entered on someones nutritional assessment so it was unclear whether this person required assistance or could manage unaided. Another person spoken with and their documents looked at stated that they did not like water but it was on their table in their room as a drink rather than squash that they could tolerate. There was no clear system of follow through for things that needed to be concluded. For example there was no note of who would follow up an admission to hospital for a procedure which had been canceled the previous day by the ambulance service. The staff on duty spoke of two different ways it would be followed up but neither had been followed which links to the shortage of staff on that day. There were very clear guidelines and care plans on peoples pressure care with the involvement of the tissue viability nurse and follow up plans. One person had made excellent recovery from very severe pressure sores. The Manager outline the situation of a person who lives in the home who was admitted with very severe Grade 4 pressure sores which the home have been tending. This persons mental capacity to decide about their treatment is unclear. The home has sought professional advice including that of a tissue viability nurse. There have been Care Homes for Older People Page 13 of 32 Evidence: different ideas around where and how to treat this person with the family being very adamant about one course of action. It was raised with the Manager that any such decision and management of this persons health and welfare needs to be taken under Mental Capacity Act guidance in the best interest of the person. The Manager had been on annual leave and did not think these steps had been taken. An immediate requirement was made to ensure that decisions are taken in accordance with the Mental Capacity Act but the day after the inspection notes about such a meeting having been held were found and sent to the commission. One of the people whose care was tracked has difficulty in communicating. There was little description of their actual way of communicating nor how best to facilitate it. The home needs to be sure that the best way of communication for each person is sought and acted on. At lunchtime a staff member was observed supporting someone with their meal. The person did not appear to have much verbal communication and had their eyes closed. The staff member had very little communication with this person who understandably looked shocked every time a fork appeared at her mouth. Equally anyone with any challenging behaviour needs a clear plan of possible triggers and how best to relate to and what action to take to ensure continuity and the best outcome for the person. The care plan seen had neither of these although they had been seen by a professional there was no mention of this nor any action plan. The home is working towards Gold Standard Framework for end of life care. Medication was looked at on one of the floors and found to be well kept and recorded. Care Homes for Older People Page 14 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The family and friends of people who live in the home are welcomed. There is a full time chef who provides freshly cooked meals with in the home. The opportunity for people to be able to access daily activities of their choice needs to be increased. Evidence: Activities for individuals needs maybe in smaller groups to cater for similar functional people More drinks could be offered to people Weekend meals could be better Quotes from relatives questionnaires The home gives care for the elderly with dignity and personal service Quote health and social care professional questionnaire Avon House has a full time activities organiser who has been working within the home Care Homes for Older People Page 15 of 32 Evidence: for a number of years. They are experienced and are in the process of completing an NVQ level 3 in care. It was clear from observing them that they have a good knowledge of the people in the home and that they are dedicated to working with them. However it was also noted that their planned morning activity session with people did not happen as they were doing other care duties within the home due to the shortage of staff on that day. There is an activities programme which includes one to one sessions each morning Monday to Fridays which also includes giving and reading, if people wish, any mail. Every afternoon there an activity for example arts and crafts, board games, ball games, bingo, cake making and two sessions of videos or film. The activity takes place in the ground floor sitting room. It was noted on the day of the inspection that the group of five people who were waiting for their activity all appeared to have communication difficulties, all were seated in wheelchairs. A radio was on and people were sat in a group dozing. This again reflects the shortage of staff in the home on that day. Staff were observed spending more time with the people who had greater ease of communication. Staff training needs to focus on communicating with people with communication difficulties. Feedback from questionnaires confirms that there needs to be more one to one sessions especially for people with limited communication or whose movement is limited. A number of suggestions were discussed with the activities coordinator such as bringing in outside groups regularly, more interactive sessions, developing people life stories. The volunteers that were linked to the home are no longer around and there has been no move to replace them. It is recommended that volunteers are actively sought so as to support and meet peoples social and cultural needs There were some pictures on the walls in the corridor of cartoon animals drawn by people who lived in the home in 2007 but none of a more recent date. The sitting room and activity areas could reflect more of the personality of the people living in the home. Talking with the people who live in the home, relatives, reviewing questionnaires highlighted that people rarely have the opportunity to go outside of the home unless accompanied by a relative. Consideration should be made of ways to improve peoples ability to go outside of the home. Care Homes for Older People Page 16 of 32 Evidence: The chef was on duty and there were two choices for midday meal both of which were hot meals cooked in the home. There was also a dessert. People were observed enjoying their food. The dinning room is not that spacious given that the majority of people come with their wheelchairs. Staff were observed supporting people with their lunch. Generally they were seen talking with and encouraging people to eat. Though some staff were also observed being quick and having very little communication with the people they were supporting to eat their lunch. This again reflects the need for staff to improve their communication skills with people who have difficulty in communicating. Everyone needs to be supported at their pace and in their preferred way. There is also a chef employed to cover the weekends. The dining room could be made more attractive and if possible spacious. Normally there are about sixteen people who choose to have their lunch in the dining room, a number of people are supported with their meals in their rooms. Care Homes for Older People Page 17 of 32 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. Avon House has a complaints policy which is displayed in the entrance to the home. The staff spoken with showed understanding of, and were trained in, safeguarding people Evidence: Since the last inspection there has been just one complaint which was about the lack of domestics at the weekend, laundry and the leaving and collection of laundry from the front door. The complaint was actioned and recorded. As at the last inspection there were no concerns or informal complaints noted. This was discussed with the Manager. The recommendation to record any concerns with the action taken so as to be able to monitor practice was repeated. There were a number of compliments from relatives and friends. Speaking with staff they were aware of safeguarding. The Manager said that all staff have received training in safeguarding adults. A discussion was held with the Manager about the Mental Capacity Act and advocacy given that staff did not appear to have knowledge on this. The Manager said she will discuss this with her staff and ensure all have training. The administrator manages the records of peoples finances. The financial books of the Care Homes for Older People Page 18 of 32 Evidence: people case tracked were looked at. Everyones monies are held at head office and the home holds a float from which they give people their monies all monies were accounted for with receipts. Care Homes for Older People Page 19 of 32 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. The home was fresh. Evidence: The standard of the cleaning at the weekends is not good there are no domestic staff on duty Quote from relative Avon House is a purpose built home, close to the shops and transport links of Kensington High Street. Residents bedrooms are located on all three levels in the home, with lift access to the upper floors. On the ground floor, there is a lounge, dining room, the main kitchen, a conservatory, the Managers and administration offices. There are individual small lounges and dining areas on the first and second floors. The home has twenty six single and four double bedrooms, all with en suite facilities. To the front of the home there is limited off street parking, and two small gardens one to the rear and one in the courtyard. The courtyard is a small attractive garden with raised flowerbeds. It is accessible to wheelchair users with the addition of a paved area throughout. A tour of all communal parts of the home, and some bedrooms with residents Care Homes for Older People Page 20 of 32 Evidence: permission was made. Each bedroom has an en suite shower, toilet and wash hand basin. All the flooring furnishings and fittings were changed in peoples rooms throughout the home. The front of the house was also decorated and a new storage shed put in place. The people spoken with were happy with their room. Although some rooms are personalised with peoples own furniture or belongings some show no or little signs of peoples identity. Work could be done to create rooms that help express peoples taste and personalities. Avon House employs domestic staff. Currently there is neither a cleaning supervisor nor a weekend domestic. The Manager said they have advertised and are hoping to have someone start shortly. The lack of domestic staff was the source of some discussion by relatives who have noted the effects on the home. Although the home was fresh some areas could have been cleaner. One of the empty rooms needed a thorough clean including the bedding. The dining room and downstairs lounges would benefit from being redecorated consulting the people who live in the home. The laundry is sent out though peoples personal laundry is done within the home. On arrival at the home there was all the laundry piled in the entrance of the home waiting collection. This is not ideal, and consideration should be given to create an outside storage area for laundry collection away for the main entrance of the home. Care Homes for Older People Page 21 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at Avon House were aware of their roles and responsibilities in supporting the people who live in the home. The lack of staffing is of concern because of its impact on the people in the home being supported in all their health, social and cultural needs. Evidence: There is always an atmosphere of genuine care in the relationships between staff and patients Quote from relatives questionnaires Avon House had until recently a stable group of staff who had worked in the home for over five years. Over the last six months three staff nurses have left. This coupled with the deputy Manager vacancy has meant that the Manager has often been covering shifts, given that the company do not use agency staff. The current staffing for the home during the day is three registered nurses and six carers. At night it is two staff nurses with three carers. The staff work twelve hour shifts. On arriving at the home, at 10 30 am there were two registered nurses and five carers on duty. As stated there is no Deputy Manager at present and the Manager was at Care Homes for Older People Page 22 of 32 Evidence: another home helping with an investigation. The person in charge was the registered nurse on the second floor who was also covering nursing duties on the ground floor. No action had been taken to seek either nursing or care staff cover. The Manager said that she has said to staff that if someone has not arrived for a shift they must contact staff to see if they can cover. There is a small core staff group which is expected to cover extra shifts having already completed long twelve hour shifts. The provider must put in place a system that ensures there is adequate staffing cover at all times so that all the health, social and cultural needs of people can be met. The impact on the people who live in the home was that people were left for longer to have their support needs met. There was a lack of up to date information on peoples care plans, a fluid chart had not been completed and wrong information was entered on someones nutritional assessment, as noted previously in the report. Peoples social and interaction activities were neglected as the staff were not available. A group of five people with communication difficulties were left in the lounge without any activities or interaction as the activities coordinator was doing other duties due to the staff shortage. There was a general lack of supervision for people. The deputy managers post also covers the nursing post on the ground floor. The Manager spoke of the interviews held and of a suitable, experienced deputy candidate but they were not a registered nurse. Given the high level of support needs that people have it is difficult to see how the deputy manager can be proactive in caring for the people on their floor whilst sharing the responsibility of running the home with the Manager. It is recommended that the provider consider the roles and responsibility of the staff nurses and the deputy Manager in their review of dependency levels of the people in their care and their staffing levels. It was of concern that there has not been three staff nurses on duty each day consistently for some time. This was confirmed by talking with staff and looking at the staff rotas for the last few months. It showed that there has not been a full week with a full nursing staff compliment since at least January. This is unacceptable and an immediate requirement was to ensure a sufficient level of staffing was in place from the following day. The staff files seen showed that not all staff supervision was up to date which is again linked to the staffing levels and lack of deputy. This has a direct effect on people who live in the home who are being cared for by new staff who are not receiving sufficient Care Homes for Older People Page 23 of 32 Evidence: support in their personal and professional development. Each file had written references and all staff undergo full checks prior to employment. The staff spoken with are completing NVQ level 2 and some are now working on NVQ level 3. Staff spoke about receiving training and that the Manager was very supportive. All staff have completed their statutory training a few staff have completed equality and diversity training. The Manager says that one of the nurses is going to start dementia facilitator training with Sterling University with the idea for them to cascade training to all staff. As mentioned previously the home must focus on training in communicating with people with communication difficulties and also for people with challenging behaviour. It was noted that two of staff had completed a course of aggression and violence. Care Homes for Older People Page 24 of 32 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. The people who live at Avon house benefit from having a qualified, experienced and dedicated Manager. The lack of a deputy Manager and consistent levels of staff has a direct effect on the management of the home and the support of the people who live there. Evidence: The director in charge is very helpful person and always available for advice Quote from relatives questionnaires The registered Manager is a qualified experienced nurse as well as qualified as a NVQ level 4 Registered Managers Award. They have successfully managed the home over the last seven years. They are working, with the staff, towards accreditation to the GSF Golden Standard Framework Award which is concerned with helping people to live well until the end of life and includes care in the final year of life for people with any end stage illness. They have demonstrated great commitment to the care of the Care Homes for Older People Page 25 of 32 Evidence: people who live in the home and the feedback received from residents, relatives and professionals has been very positive. Since the last inspection there have been two deputy managers both leaving for good reasons unrelated to the position. However this has placed greater responsibility onto the Manager who has had to assume both posts and complete some hands on work in order to cover the shortage of staff. This needs to be addressed. The Manager has held Residents and Relatives meetings as well as care staff and nursing meetings though the frequency of the later has been dependent on staffing levels. There are a selection of self audits covering amongst which are medication and health and safety. A selection of health and safety records were checked during the inspection. They were up-to-date, showing that equipment is regularly serviced and checked. The home has a fire risk assessment which has been verified by the local fire brigade. Care Homes for Older People Page 26 of 32 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 27 of 32 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 1 8 12 The provide must ensure, 21/04/2010 from 21 April 2010 that any decision about peoples healthcare where there is a question of capacity are managed in accordance with the Mental Capacity Act 2005 and in line with the Care Homes Regulations so that people are sure that their rights and dignity are upheld at all times. 2 27 18 The provider must ensure that by the 21st April 2010 there is a sufficient level of staff to meet peoples health and social needs at all times. 21/04/2010 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 3 12 All assessments must be completed fully and be available in current notes to ensure that peoples full needs are met 31/05/2010 Care Homes for Older People Page 28 of 32 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 2 7 12 The home needs to be sure that the best way of communication for each person is sought and acted on so that peoples can communication can be facilitated 31/05/2010 3 8 12 The home must carry out a review of the level of dependence of the people who are living in the home to ensure that their current level of support is sufficient to meet peoples needs 31/05/2010 4 8 12 Peoples charts and records must be kept up to date ensure that their healthcare needs are met. 30/04/2010 5 12 12 Staff training needs to focus on communicating with people with communication difficulties. to further peoples dignity and choice 31/05/2010 6 12 16 The home must be more proactive in supporting people in their social and cultural interests and in enabling them to be part of the local community 31/05/2010 Care Homes for Older People Page 29 of 32 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 so that they can have more flexibility and choice over their activities 7 18 18 That all staff have training on the Mental Capacity Act and the implications for the people they support. in order to safeguard peoples rights and dignity 8 26 16 The home must make sure that there is domestic cover at the weekend to ensure the standard of hygiene is maintained. 9 27 18 The provider must put in place a system that ensures there is adequate staffing cover at all times so that all the health, social and cultural needs of people can be met. 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 31/05/2010 31/05/2010 21/04/2010 1 2 9 12 To create an at glance care plan for people to use with key ways of communicating That the homes seek volunteers to help support people who live in the home pursue their social and cultural and spiritual aspirations. Care Homes for Older People Page 30 of 32 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 3 12 That the home focuses on more one to one sessions especially for people with limited communication or whose movement is limited. The dining room could be made more attractive and if possible more spacious The home could record any concerns with the action taken so as to be able to monitor practice Although some rooms are personalised with peoples own furniture or belongings some show no signs of peoples identity. Work could be done to help people create rooms that help express their taste and preferences. Consideration should be given to create an outside storage area for collection of laundry away for the main entrance of the home. It is recommended that the provider consider the roles and responsibility of the staff nurses and the deputy Manager in their review of dependency levels of the people in their care and their staffing levels. 4 15 5 6 16 24 7 26 8 27 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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