CARE HOMES FOR OLDER PEOPLE
Avon Lee Lodge Preston Lane Burton Christchurch Dorset BH23 7JU Lead Inspector
Trevor Julian Unannounced Inspection 10th January 2006 11:00 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 Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 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 Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Avon Lee Lodge Address Preston Lane Burton Christchurch Dorset BH23 7JU 01202 476736 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) avonleelodge@abbeyhomes.com www.avonleelodge.co.uk Mr Leigh David Kennedy Miss Tracy Weller Miss Tracy Weller Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Avon Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st August 2005 Brief Description of the Service: Avon Lee Lodge is a small residential care home located in a rural setting on the edge of the New Forest. It is owned and managed by Mr and Mrs Kennedy, who live in an adjoining property. The home is registered with the Commission for Social Care Inspection to accommodate a maximum of 13 older people. The property is a converted vicarage with 12 bedrooms and a communal area. There are 5 bedrooms on the ground floor; 2 with en-suite W/C and hand washbasin. On the first floor are 7 bedrooms (one double); 5 with en-suite facilities including one full sized bath. A stairlift operates on the main staircase there is also an external fire escape. Outside the gardens are very well maintained and provide seating areas and a sun house. Local shops and amenities are available close by and a bus service travels to Christchurch. Avon Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first visit since Mr & Mrs Kennedy had taken over the home from the former owners in November 2005. The inspection took place between 11:00-14:30 on 10th January 2006. The whole process including preparation, travel, inspection and report writing took 8 hours. This was statutory inspection, not all key standards are considered during each inspection. Information was gathered through discussion with residents, visitors, staff and the owners. Other information was gained through the examination of records, procedures and a tour of the premises. Since the last inspection of the service in August 2005 several comment cards had been received by the Commission. The feedback showed high levels of satisfaction from service users and visitor with only one raising any points for consideration the issues are covered within this report. It should be noted that the replies were received around the time the home changed hands so the issues raised may not relate to the current ownership. For the purpose of this report, the terms resident and service user are interchangeable. What the service does well:
Since taking over Mrs Kennedy had reviewed practice in the home and was introducing several changes including a review of medication procedures, care planning and recording. These ideas were discussed and further guidance given during the visit. The new owners had admitted two new residents, in both cases an assessment of needs had been completed before admission. Residents said they were able to request GP visits at any time and there was good service to the home from the community nursing teams. A private chiropody service visited the home regularly. Nutritional intake was monitored informally and residents’ weight was monitored monthly. Residents were encouraged to remain as independent as their circumstances allow. Most retain control of their own finances with the help of family or friends. The owners do not assist any resident with financial matters. The residents confirmed there were no set times for breakfast, going to bed or getting up. Spiritual needs were covered during the admission assessment. Food continued to be described as very good. Residents said the food was home cooked, there was a good variety, and the portions were ample.
Avon Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 Page 6 A hairdresser was in the home and offered a service to all the residents; she had visited the home for 5 years and found the home well run. A notice was displayed in the hallway giving residents and visitors information about how to raise complaints. The notice includes contact information for the Commission. Staff were aware of their responsibilities regarding adult protection matters. They had access to the local Authority guidance “No Secrets”. They had covered the topic during their induction and NVQ training. The premises were warm and clean; one room had been redecorated to a good standard. Staffing levels were maintained at all times. Residents said the staff responded promptly to their call alarms. There were two members of staff completing NVQ level 2 in care. This would bring the number of care staff with the award to nine. There had been one vacancy since the last inspection and the residents appreciate the stable workforce allowing good continuity of care. The owners had the required qualifications and experience to operate the care home. The staff said the new owners were approachable and listened to their ideas and suggestions. What has improved since the last inspection? What they could do better:
The home should be able to demonstrate that residents or their representatives were involved in the initial care needs assessment and reviews. Please contact the provider for advice of actions taken in response to this
Avon Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Avon Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 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 Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Assessments were completed before admission to ensure the home was able to meet the residents’ needs. EVIDENCE: Since taking over the home two new residents had been admitted. In both cases, there was evidence that assessments had taken place before admission. The assessments were comprehensive and covered all the recommended topics. The records did not show involvement of the resident or their representatives in the process. Avon Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8 The home maintains good links with the local GP practices enabling residents to have good access to the community health services. EVIDENCE: Care records were in place but there were plans to revise the system. The medication system was being replaced with a monitored dosage system. The supplying chemist was visiting the home to train the staff. The previous recommendation is repeated for consideration at the next visit. Residents said that they, or the staff, call for GP visits. Community nurses were visiting to monitor a resident’s pressure area care. The home offers advice to new residents if they need to change their surgeries. A visiting chiropodist provided foot care and a visitor from a charity offered hand care. Staff monitor nutritional intake informally. Weight checks were recorded.
Avon Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Residents are encouraged to make choices in their daily lives dependant on individual circumstances. EVIDENCE: The owners do not manage the finances for any of the residents, which are managed by family or solicitors. Personal expenditure for hairdressing, chiropody etc. is dealt with by the resident or the cost added to the invoice. All the residents have support from family and friends. Mrs Kennedy said she would approach local Social Services to identify independent advocacy services if the need arose. Several residents said they were very satisfied with the level of choice offered in the home. There were no set times for breakfast or getting up and going to bed. Religious preferences were respected and arrangements were already made for one new resident to receive church visitors. All the residents seen said that the food had always been of a very good standard but they had even noted an improvement. The meals were balanced and there was always a choice.
Avon Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 Page 12 The home had a visiting hairdresser who was in the home at the time of the visit doing some perms for the residents. She had visited the home for five years and she was very confident about the way the home was run. Avon Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Systems were in place to ensure complaints could be made and investigated. There were procedures in place to help protect residents from abuse. EVIDENCE: The home’s complaint procedure was posted in the entrance hallway; it included contact details for the Commission. Since taking over, one issue had been passed to the owners and this had been resolved. During the visit several members of staff were spoken to, they were clear in their responsibilities to act should they become aware of any signs or allegations of abuse. The topic was covered during their NVQ level 2 training. There was a copy of local procedures accessible to the staff. The residents and visitors said they were comfortable with discussing concerns with the owners or the staff. Avon Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not fully assessed during this visit. EVIDENCE: The home was clean and warm at the time of the visit. One person said she felt the home was kept a little warmer this year but added that it had never been cold. The rooms visited were comfortably furnished and well presented; one room had been redecorated recently to the satisfaction of the occupant. One comment card expressed concern about the standard of cleaning in the home, this had been around the time of the change of ownership, and no problems were noted during this inspection. Residents said that the staff keep the home clean and in good order. Avon Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 30 The home’s training programme provided the staff with appropriate skills to carry out their role. EVIDENCE: Staffing levels were not fully assessed during this visit, however staff confirmed that there were three people in the home at weekends and that was normally sufficient to meet the needs of the residents. None of the residents expressed any concerns about staffing levels and said the staff were always attentive and responded promptly to the call bells. There were records showing the training completed by the staff; these were not examined on this occasion. Two carers were completing their NVQ level 2 in care which will ensure that the home exceeds the target of 50 of carers trained with NVQ2. The home benefits from having a stable workforce, one recent vacancy was being filled at the time of the inspection. Avon Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35. The home is well run by a competent and accessible team. In order to reduce the risk of financial abuse in the home the owners do not assist residents with financial management. EVIDENCE: The owners have the required level of qualifications and experience having previously run another home. The staff said they had attended one staff meeting and another was planned, they said they have been able to offer their views on improvements and felt they were listened to. Avon Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 Page 17 The owners stated they have no involvement in any of the residents’ financial matters. The residents and visitors seen said the managed their own finances some with assistance from family and friends. Avon Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 Page 18 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 X X X Avon Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 Page 19 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 Refer to Standard OP9 Good Practice Recommendations Guidance from the Royal Pharmaceutical Society on the handling of medicines should be followed. It recommends that medicines should be given directly from the labelled container in which the pharmacy supplies them. This recommendation is held over for consideration at the next inspection as the medication system was being revised. The registered person should provide written confirmation to the resident, or their representative, that their assessed needs can be met. 2 OP4 Avon Lee Lodge DS0000064926.V277604.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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