CARE HOMES FOR OLDER PEOPLE
Avon Lee Lodge Preston Lane Burton Christchurch Dorset BH23 7JU Lead Inspector
Trevor Julian Unannounced Inspection 2nd May 2006 09:30 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.V293118.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.V293118.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 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.V293118.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th January 2006 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 £392.00 and £530.00 per week for personal care and accommodation. Avon Lee Lodge DS0000064926.V293118.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Tuesday 2nd May 2006 between 09:30 and 15:45. Mr & Mrs Kennedy remained on the premises throughout the visit. This was the second visit to the home since Mr & Mrs Kennedy took over in November 2005. Evidence for the inspection was obtained through a review of information received since the last visit, discussion with resident, visitors staff and owners, observation, inspection of records and procedures and a tour of the premises. For the purpose of this report, the terms resident and service user are interchangeable. This visit looked at the key standards and will determine the frequency of future inspections. At the time of the visit there were 12 resident, including 2 males. What the service does well:
The home has good pre-admission procedures and there was a range of sources of information available to potential residents and their carers. These included leaflets, service user guide and a website. Several people were spoken to none could recall the admission process but some said their families had visited the home to look around before the trial period started. Residents seen during the day described life at the home as good, no one identified any unmet needs or wants. They felt the staff and owners called for medical assistance when needed, this was confirmed by a visiting community nurse. Residents were encouraged to retain past hobbies and pastimes, one person seen was enjoying a game of scrabble with a visitor and another was knitting. Several people were avid readers and enjoyed the visits by library volunteers. A number of people have daily newspapers delivered to the home. Visitors said they were made welcome and could visit at any time. Religious and spiritual preferences were considered during admission and the home has monthly Anglican services, one person retains close links with the Catholic Church and enjoys weekly meetings with lay visitors. The owners prided themselves on the standard of food provided. Staff felt the quality and variety of food had improved. The meal seen during the visit was wholesome and appetising, during the morning a good quantity of fresh Avon Lee Lodge DS0000064926.V293118.R01.S.doc Version 5.1 Page 6 vegetables were being prepared; several residents accepted extra portions of the vegetables offered during the meal. Basic nutritional assessments took place during admission, at the time of the inspection all had healthy appetites although staff monitored food and fluid intakes informally. Meal records showed the range and choice of meals provided. Residents and visitors said they were comfortable about raising concerns with the owners or staff. The complaints procedure was included in the contract and also displayed in the entrance lobby. The home benefits from a stable workforce allowing good continuity of care. The new owners were introducing a new training package to ensure the staff were trained and competent carers. Residents said the staff were kind and helpful. One member of staff was overheard explaining to a resident about the medication she was giving, the carer was very patient and gave the resident clear information about what was happening. The home was well managed and the new owners were gradually introducing changes. The home did not manage finances for any resident for personal expenditure e.g. hairdressing, newspaper bills etc. either the residents’ settled their own bills or an invoice was provided by the home. What has improved since the last inspection? What they could do better:
As stated above the home had introduced a monitored dosage system to improve management of medication in the home. Any handwritten amendments or additions to the record sheets should be checked by a second person to reduce the risk of transcription errors. The record sheet should show any allergic reaction to medication or marked as “none known”. The home had a system for regulating the surface temperature of radiators. It was recommended that regular temperature readings should be recorded to ensure the system of regulation is effective. It was also recommended that rooms should be checked to ensure beds are not placed against radiators which could lead to injury of the resident.
Avon Lee Lodge DS0000064926.V293118.R01.S.doc Version 5.1 Page 7 During the visit it became apparent that the owners had omitted to inform the Commission of two events in the home affecting the well being of the residents. 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.
Avon Lee Lodge DS0000064926.V293118.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.V293118.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): 1, 2, 3, 4, 5. Intermediate care, standard 6, is not offered at the home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good access to information about the services offered and the assessment helps to ensure that the home only offers accommodation to people whose needs can be met. EVIDENCE: The home’s website gives information to prospective residents about the services offered in the home. The owners have also produced a leaflet to compliment the service user guide; these were freely available in the entrance hall. The files of two recent admissions were checked and both showed that an assessment had been carried out to ensure that the home could manage the care needs. Avon Lee Lodge DS0000064926.V293118.R01.S.doc Version 5.1 Page 10 Since the last inspection the letter confirming the offer of a placement in the home had been amended to confirm that the home was able to meet the individual’s assessed needs. The letter identified the initial four weeks as a mutual trial period. Files seen contained completed contracts. The residents seen during the visit were unable to recall the details of their admission. One person was aware that his family had visited the home before deciding to accept the placement. A new resident said he had settled very well and was impressed by the help and assistance available to him. He added, “I didn’t know places like this existed…its marvellous”. Avon Lee Lodge DS0000064926.V293118.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall, the home manages care of the residents very well; some revision of medication will further safeguard the residents. EVIDENCE: The home caters for people with low to medium care needs. The care recording was appropriate to those needs. The files of three residents were reviewed. They clearly identified the care needs and how those needs were to be met. Records showed that the needs were reassessed regularly with the residents confirming their agreement with the proposed plan of care. Resident seen during the visit confirmed that GP’s were called as needed. This was also observed during the visit when a GP and community nurse were called in to check on two residents.
Avon Lee Lodge DS0000064926.V293118.R01.S.doc Version 5.1 Page 12 The community nurse said the home made appropriate referrals for visits and did not have any concerns about the home. Residents spoken to said that the home looked after their medication and that the staff took care to avoid mistakes. Since the last visit the owners had introduced a monitored dosage system for the management of medication. An audit of the system showed the items correctly stored. The home did not have a dedicated fridge for storing temperature sensitive medication. These items were stored in a separate container but the one used was not lockable. Medication administration records were well kept and up to date. Handwritten sheets were provided as a temporary measure for the newest resident. Any handwritten additions or amendments should be verified by a second person to reduce the risk of transcription errors. Two members of staff, who managed the medication, said the new process provided a simple management system which allowed medication to be tracked and audited. During the visit staff were observed interacting with the residents, the staff were supportive and caring in their approach. One member of staff was overheard explaining a process to a resident, this was achieved in a calm and patient manner which appeared to be appreciated by the resident. Bedroom doors were fitted with locks, however no one locked their doors. Residents said that the staff were helpful. One person did use the call alarm and the staff responded promptly. Avon Lee Lodge DS0000064926.V293118.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are actively encouraged to exercise choice in their daily lives in order to continue to lead fulfilled lives. EVIDENCE: Residents felt they were offered reasonable level of choices in their daily lives. One person said that she got up at her preferred time and sometimes opted to take her main meal in her own room rather than going to the dining room. Another person said that they were allocated weekly bath times, however they could request additional baths at any time. Several people said they appreciated the flexible approach in the home. The home was planning to restart regular exercise session. A singer had visited the home twice recently and was well received by the residents. Volunteers provide a visiting library service. A visiting hairdresser calls at the home fortnightly and offers a unisex service. She had initially visited a relative placed at the home. She said the home was well run and the staff dedicated and supportive.
Avon Lee Lodge DS0000064926.V293118.R01.S.doc Version 5.1 Page 14 There were two people visiting relatives and friends in the home. Both said that they were always made welcome and felt they could visit at any time if they wished. Some residents had their own telephone lines to keep in contact with family and friends. There was also a telephone available to the other people. The residents seen said that there was enough going on in the home to keep them occupied, one person kept busy knitting for her family and another was an avid reader. One visitor came to the home each week to play scrabble with one of the residents. People said there was a monthly visit from the Anglican church, another has weekly visits from a member of her church. Residents described the food as very good, one person said there was always a good selection of fresh vegetables, and that fruit was provided. Most residents took their main meal in the dining area. On the day of the visit all residents had selected the main dish although the menu records showed that alternatives were always offered. Fresh vegetables were being prepared during the morning; during the mealtime, extra portions were offered and accepted. The meal was appetizing and nutritious. A basic nutritional assessment was completed on admission and then regularly monitored, staff said that all residents had good appetites but they informally monitored intakes. Avon Lee Lodge DS0000064926.V293118.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. 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 procedures allow residents and visitors to raise concerns without repercussions. EVIDENCE: The home’s procedure for raising concerns was posted in the entrance lobby. The contracts seen also described the process and gave contact details for the Commission. None of the residents or the visitors were aware of the complaints procedure but all said they were able to raise issues with the staff and owners. The home had a record of the complaints and compliments received and dealt with in the home. The Commission had received no issues or concerns. The home had a procedure for responding to allegations of abuse. The topic was discussed with two members of staff, both were aware of their responsibilities and where onward referrals should be made. Avon Lee Lodge DS0000064926.V293118.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises provide a clean, comfortable and safe environment. EVIDENCE: The home was clean and well presented. There were no plans for any building work although consideration was being given to converting one bathroom into a shower room and renovation of the kitchen. Residents said the home had been kept warm throughout the winter months and that the staff helped them to keep their rooms clean and tidy. The hot water temperatures for the bath are tested and recorded. The temperature of the radiators is managed by restricting the boiler output. It was suggested that in order to confirm that the surface temperatures were kept below 43°C radiators and pipe should be routinely tested. In one of the
Avon Lee Lodge DS0000064926.V293118.R01.S.doc Version 5.1 Page 17 rooms visited, it was noted that the bed was placed against a radiator. This could result in burns therefore consideration should be given to the bedroom layout. The laundry is located away from food preparation and storage areas, the room housed a domestic washing machine and dryer. Residents praised the laundry system, one person said that the staff ironed her blouses and items were returned to the rightful owner. Avon Lee Lodge DS0000064926.V293118.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was appropriately staffed to ensure residents were given appropriate assistance. EVIDENCE: The staffing roster showed the actual and planned shift patterns. Staffing levels were appropriate to the needs of the residents. At night there is one wakeful member of staff on duty supported by the owners who live in the adjoining property. Two of the staff on duty confirmed that they had completed their NVQ level 2 in care. A new programme of training was being introduced to ensure that the staff were kept up to date. Staff records were seen for two recent recruits both had the required documentation. Avon Lee Lodge DS0000064926.V293118.R01.S.doc Version 5.1 Page 19 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, 33, 35, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was well managed, there was no involvement in residents’ finances helping to reduce the risk of financial abuse while in the home. Some best practice recommendations were made to provide further improvements. EVIDENCE: The owners have the required experience and qualifications to manage the home. Residents said the owners and staff were approachable. Staff confirmed that staff meetings were held and they were able to make suggestions at any time. The owners had been gradually introducing new ideas and processes. Avon Lee Lodge DS0000064926.V293118.R01.S.doc Version 5.1 Page 20 During the visit it was noted that not all significant events in the home had been notified to the commission, information and advice on the matter was provided. The quality assurance system was being developed and a survey of all stakeholders planned for later in the year. This would then allow a business development programme to be produced. The home did not manage finances for any of the residents, most people looked after their own personal allowances incidental expenditure eg chiropody and hairdressing was covered by the individual or included in an invoice. The visitor to the home confirmed this process. During the tour of the premises, some safety equipment was checked and had been serviced within the correct period. Some advice was given to ensure safety systems in place were routinely checked. Overall, health and safety was well managed helping to contribute to a safe environment. Avon Lee Lodge DS0000064926.V293118.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Avon Lee Lodge DS0000064926.V293118.R01.S.doc Version 5.1 Page 22 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 OP38 Regulation 37 Requirement The registered person must inform the Commission of significant events in the home within 24 hours. The home must introduce a formal quality assurance system to seek the views of all stakeholders Timescale for action 30/06/06 2. OP33 24 30/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP25 Good Practice Recommendations Handwritten amendments and additions to medication records should be verified by a second person to reduce the risk of transcription errors. • It is recommended that the surface temperature of radiators are routinely tested to ensure that systems in place to limit the temperature are operating correctly. • Beds should not be placed against radiators as there could be a risk of limbs becoming trapped. Avon Lee Lodge DS0000064926.V293118.R01.S.doc Version 5.1 Page 23 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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