CARE HOMES FOR OLDER PEOPLE
Avon Lee Lodge Preston Lane Burton Christchurch Dorset BH23 7JU Lead Inspector
Trevor Julian Unannounced Inspection 11th May 2007 10:00 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.V339196.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 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 Mrs Tracy Kennedy Mrs Tracy Kennedy Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st March 2007 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 stair lift 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. At the time of the inspection, the fees ranged between £420.00 and £535.00 per week for personal care and accommodation. Additional charges were made for hairdressing, newspaper, private chiropody etc. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_c hoos.aspx Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 11th May 2006 between 10:00 and 16:00. The inspection looked at issues raised during previous visits and performance against the National Minimum Standards. Information was obtained through discussion with residents, visitors, staff, community nurse and the owners, a tour of the premises, examination of records. Before the visit, residents and visitors were invited to complete a questionnaire giving their view of life at Avon Lee Lodge. 14 responses were received from residents and their friends and families with another two replies were from GP’s. The responses showed good levels of satisfaction. Mr & Mrs Kennedy had submitted an application to the Local Authority to extend the existing property to increase the facilities and places offered in the home. The home was full with 12 people in residence, the double room being let for single occupancy. What the service does well:
The home continued to carry out assessments for new residents before offering a placement in the home. One visitor said his relative had been visited at her previous address to help ensure that the care and social needs could be met. He was able to view the home before accepting the trial period and he felt the home had provided a good level of information about the services offered. He had been given a copy of the terms and conditions applying to the placement. The home maintained good communication with the local healthcare services; a visiting nurse said that the staff in the home followed any advice given. GP’s responding to the survey identified no concerns about the standard on care. Residents reported that they were treated with respect and dignity and this was observed during the visit. The interaction between staff and residents was unrushed with the staff were giving appropriate support and encouragement where needed. The home produced a regular newsletter for residents and visitors. It contained information on past and planned events in the home including the range of activities offered. Recently residents had been in the local paper displaying their computer and gaming skills. One resident told the inspector that she had been helped by Mr Kennedy to send and receive emails to an Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 6 overseas relative and she was particularly pleased with some photographs, which had been sent. All residents were able to follow the religion of their choice. In recent local government elections, all residents were able to vote using postal ballot papers. Food continued to receive praise from the residents. The home had regular deliveries of locally supplied fish, meat, fruit and vegetables. Residents said the food was well presented and nutritious and the portions were varied according to individual preferences. Nutritional assessments were carried out to monitor for changes in weight. There was also evidence that when concerns were noted that the matter was referred to the GP. The home had a complaints procedure, which was displayed in the main hallway to allow residents and visitors to raise concerns. The premises were maintained to a good standard. The plans for the extension will further improve facilities. Residents particularly enjoyed the secluded garden where there was a summerhouse for their use. At the time of the visit, staffing levels were appropriate to the needs of the residents. All new staff undergo induction training through an approved programme. Work was underway to review training needs for all staff; this included more staff undertaking NVQ level 2 in care. Staff supervision was in place to consider training and development needs of the care staff the frequency of the meetings was being improved. The home did not assist any resident to manage their finances. One person deposits an allowance with the home to cover personal expenditure a check showed that the transaction records matched the balances held. Any other unplanned expenditure by the residents is invoiced to the person responsible for the individuals’ finances. What has improved since the last inspection?
Mr & Mrs Kennedy had completed a survey of residents, visitors and staff. They had found the results very helpful and used them to help identify where improvements could be made. Some of the surveys returned to the Commission before the inspection, showed that the ideas made in the home’s survey had been considered and addressed. There had been concerns raised with the Commission that the home had placed a table to prevent a resident leaving the home at night. The matter
Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 7 was considered during a random inspection by which time the circumstances had changed and the practice had stopped. Improvements to the medication system had helped to reduce the risk of errors. The brief audit showed the records were up to date and the medication safely stored. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request.
Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home only accepts new residents once a review had been completed to confirm the home has capacity to meet the assessed needs. EVIDENCE: The home had several new admissions since the last visit. In the three files seen there were comprehensive and considered the required topics. It was noted that the assessments seen were not signed or dated and could have been improved by identifying who had been consulted. One visitor seen said that there had been an assessment at the resident’s former address. He was clear about the information provided by the home. Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 10 The home produces a range of information for prospective residents including a website giving details of the services provided. Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans generally provide the staff with information on how care needs were to be met. The home works with community healthcare teams to meet the health needs of the residents. Medication management in the home helps to ensure the residents’ medication is safely administered. The residents were treated well to ensure that their basic rights were respected. Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 12 EVIDENCE: Each file seen contained a brief care plan outlining the needs of the resident. In the case of the most recent admission, staff were using the needs identified during the pre- admission assessment while the care plan was being developed. While reviewing the file of one resident there was information recorded in the care diary about the management of her mobility however this was not transferred to the care plan or manual handling assessment. On another file there was a note showing that there had been a change in medication, although there was no information about who had authorised the change. The records showed that residents were regularly weighed and where concerns were identified this were referred to healthcare professionals. The files also showed the home had been proactive in obtaining checkups from dental and optician services. Residents said that the staff arranged for GP appointments as needed. One survey response reported that a member of staff had accompanied a resident to an outpatient appointment. During the visit, a community nurse was visiting two of the residents, she said the home contacted them for support when needed and the staff carried out any instructions given. Medication was well organised. Handwritten additions and amendments were checked and agreed by a second person to reduce the risk of transcription errors. There was a clear audit trail of items coming into the home and the records seen were up to date. During the visit, a good rapport was noted between staff and residents. Tasks were being carried out in an unrushed manner allowing the residents time to maintain their independence. The survey responses also showed that the residents were treated with dignity and respect by the care staff. Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides support to the individual residents to help meet their social needs. The home encourages family and friends to remain in contact with the resident to assist EVIDENCE: The home organises some activities within the home these include exercise sessions, hand massage, visiting entertainers and visiting library services. Mr Kennedy has introduced computer classes for residents; one person was delighted to correspond with a relative overseas and has even exchanged photographs. The home had also introduced an interactive games console and some of the residents were improving their hand – eye coordination with games of bowls, golf and boxing. Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 14 Some people had accounts with local newsagents who supplied daily newspapers. A local vicar called at the home and offered an interdenominational service and communion. One person has weekly visits from a member of the local Catholic Church. Residents said that there was enough to do at certain times of the day but there were times when there was little activity, some enjoyed time out in the summerhouse in the garden. There was a large screen TV in the lounge and most people had TV’s in their own rooms. Visitors said they were made welcome at the home at reasonable times and they were offered refreshments. All residents were registered for postal votes in the recent local council elections. The standard of food provided in the home remains very good. There are regular deliveries of fresh locally reared meat, fish, vegetables, and fruit. The portions provided are varied according to the residents’ preferences. The home’s menus offer a main choice and alternatives which were recorded. It was noted that one resident, known not to like fish, was served fish with no alternative offered. The home monitored weight regularly and took action when changes were observed. Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s complaint procedure allows residents and visitors to raise their concerns with the home’s owners. To protect residents the staff receive information on how to respond to signs and allegations of abuse. EVIDENCE: The complaint procedure was displayed in the hallway and within the guide given to new and prospective residents. There had been one complaint registered in the home since the last inspection and the matter had been responded to in the stated timescale. The residents seen said they were able to raise issues with the owners who would respond appropriately. The commission had received one anonymous concern, which was investigated during a random inspection on 21st March 2007. The home had a procedure for dealing with allegation and signs of abuse. The subject is also covered in the initial training for staff.
Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and clean environment for the residents. EVIDENCE: Following an internal quality assurance exercise, the home had introduced a new system for managing maintenance of the property. The home has a local tradesman to carry out any minor works including maintenance of the garden. There had been recent work in the home to create an en suite in one bedroom, the work had been carried out to a good standard however the work was not approved by building control and there was no extractor fan fitted. Work was underway to remedy the situation. Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 17 As stated previously, the owners hope to obtain permission to extend the premises and to improve the facilities offered including a passenger lift to improve access to the first floor. Other plans include upgrading the call alarm system. In one room, it was noted that the call alarm cord was laid across the doorway and could present a tripping hazard to the occupant of the room. Mr Kennedy agreed to make a temporary repair to reduce the risk. The home had introduced a system of random testing of radiator temperatures to ensure the surface temperatures did not exceed 43°C above which burns can occur. Bath temperatures are recorded. The home maintains good levels of cleanliness and staff had access to aprons and gloves to manage infection control. The community nurse said that the home responded positively to advice given regarding cross infection. Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels were appropriate to the needs of the residents. The staff have the skills, training and experience to meet the needs of the residents. The home’s recruitment practice did not fully protect the residents. EVIDENCE: The home’s staffing levels were in line with the recommended staffing based on the needs of the residents. There had been issues raised about the staffing of the home during the evening and night cover. There had been changes to the shift patterns in the home and were as follows: 08:00- 14:00 2 carers one additional carer 09:00-11 14:00- 19:00 2 carers 19:00- 08:00 1 carer with support from the owners in the adjoining property. In addition, the home also employs domestic and administration staff. There had been concerns about the ability of the night staff to contact the owners for assistance. The home had introduced a clear contact procedure for all the staff.
Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 19 The files of three members of staff were checked. They were well laid out and contain the required basic information. It was found that two of the recent members of staff had provided the home with copies of recent Criminal Record Checks from previous employers. The enhanced checks are not transferable between employers and so all staff should have the relevant Protection of Vulnerable Adult Checks in place before they are offered employment. The home’s induction programme for new staff is based on the Skills for Care induction standards. The administrator is developing the training records for the care staff to ensure that their training was kept up to date. The home had seen a number of changes in staffing in the past year as a result there is a programme of National Vocational Qualifications accreditation for the care staff to ensure the home has suitably trained staff. Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is operated and managed by qualified and experienced individuals. The home consults with stakeholders to help run the service in the residents best interests. Systems in place help to protect residents from the risk of financial abuse within the home. Supervision of care staff was being developed to ensure that the process was up to date and appropriate. Procedures are in place help to protect the safety of residents and staff.
Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 21 EVIDENCE: The owners have the experience and qualifications to operate the care home. There had been a quality assurance survey carried out in the home, the home had sought the views of the residents, families, staff and healthcare staff. The responses had been used to identify areas for improvement. Some of the comment cards received during this inspection showed that the home had taken notice of the issues identified and taken action to make improvements. The owners had found the exercise very useful in identifying where extra resource and attention was needed. The home did not manage the finances for any of the residents. Additional expenditure was invoiced to the person responsible for the individuals’ finances. The home helps one person with their personal allowance; records were kept of expenditure and income and receipts were kept; an audit showed that the transaction records matched the balance held. The home had a supervision procedure for the care staff to ensure that the staff were clear about the ethos of the home and to identify and training and development needs. The newest members of staff were being supervised with the recommended frequency further work was needed to increase the frequency for all care staff. The home had completed a fire risk assessment and this had been seen by an officer from Dorset Fire and Rescue Services. The fire warning system, emergency lighting and fire fighting equipment was serviced and tested regularly by a contractor. The staff tested the warning system and automated door closers each week. Monthly checks of the fire extinguishers and emergency lighting had not been recorded for some time. The current public liability insurance certificate was on display. Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 22 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 23 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. 1 Standard OP29 Regulation 19 Requirement The registered provider must ensure that staff are only appointed once the Protection of Vulnerable Abuse (POVA) checks have been completed. Timescale for action 30/06/07 Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 24 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 OP3 Good Practice Recommendations The pre-admission assessment should: • Be dated, • Identify who carried out the assessment, • Who was involved in the assessment? • Care plans should be reviewed to ensure they accurately reflect how identified needs are met. Where changes in medication occur there is clear information on who approved those changes. The registered provider should ensure compliance with all relevant legislation. The en-suite bathroom in room 3 should have Building Regulations approval. The registered person should record monthly visual tests of emergency lighting and fire fighting equipment. 2. OP7 3. OP38 4 OP38 Avon Lee Lodge DS0000064926.V339196.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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