Inspection on 09/10/07 for Avon Lodge

This inspection was carried out on 9th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Avon Lodge 30/11/06

Avon Lodge 31/05/06

Avon Lodge 19/12/05

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Avon Lodge 33 Bridgend Road Enfield Middlesex EN1 4PD Lead Inspector Susan Shamash Key Unannounced Inspection 9th October 2007 10:30 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 Lodge DS0000062486.V344934.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 Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avon Lodge Address 33 Bridgend Road Enfield Middlesex EN1 4PD 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) 01992 711729 F/P 019 9271 1693 Avon Lodge UK Ltd Mr Rakesh Mathur Care Home 36 Category(ies) of Dementia - over 65 years of age (36) registration, with number of places Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th November 2006 Brief Description of the Service: Avon Lodge is a residential care home for up to 36 older people over the age of 65 who may have a diagnosis of dementia. The property is a detached, two-storey, purpose-built property. All rooms include wash hand basins but they do not include en suite facilities. Rooms are provided on two floors accessed by a shaft lift and stairs. Each floor has two sets of bathrooms equipped with bath hoist facilities or easy access walk in showers. Communal space is provided in separate sitting, dining and recreational areas as well as a designated smoking area. A large garden area is also provided to the rear of the building. The stated aims of the home are to ‘provide a pleasant, comfortable and stimulating environment, conducive to meet the physical, emotional, cultural and religious needs of each resident, and homely surroundings to the best of their abilities. Residents are also encouraged to be independent wherever possible, and involve themselves in the decision-making process, relating to the daily living-arrangements in the home.’ The home is situated not far from shopping facilities and amenities in Enfield. A number of bus routes serve the area. As at October 2007, weekly fees range from £475 to £525. Current CSCI inspection reports are available for residents and relatives to see from the manager’s office at the home. Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit lasted approximately eight hours. I was assisted by the registered manager for the home, who cooperated fully with the inspection process, and enabled me to move freely about the home. I spoke to approximately seven residents, and seven staff members (in a group) and also carried out an intensive observation of routines in the dining area for approximately one and a half hours. I also had the opportunity to speak to the area manager for the home and two healthcare professionals visiting the home. Information provided by the registered manager in the Annual Quality Assurance Assessment completed for the home was taken into account. A tour of the home was conducted, and staff, residents’ and a range of other records maintained at the home were inspected. What the service does well: The home is well decorated and is bright and inviting. There is generally a high standard of furnishings, decoration and cleanliness in the home, and the home is well equipped to meet people’s needs. Detailed assessments are undertaken before people are admitted to the home and care plans are reviewed regularly to ensure that they are up to date. Residents are encouraged to maintain contacts with their friends and relatives. There is an open atmosphere within the home so that managers and staff are readily available to talk to relatives and residents. Residents and relatives speak highly of the support provided by staff at the home and their professionalism and the caring environment that has been produced. A thorough recruitment system is in place to protect residents and staff are generally well qualified, with over 50 trained to at least NVQ level 2 in care. Health and safety records are maintained to a high standard at the home so that residents are protected appropriately. The home is well managed with clear policies and procedures regarding its operation and clear systems in place to protect people living at the home from abuse. Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 6 The home provides sensitive and effective support to residents who have challenging behaviour. The manager is very experienced in working with people who have dementia and relatives speak highly regarding the support he provides to them, particularly when residents are newly admitted to the home or unwell. What has improved since the last inspection? What they could do better: It is recommended that pictures be included in the home’s brochure and in the home’s menus to make them more accessible to people who are diagnosed with dementia. More alternatives for each meal should also be available to ensure that sufficient choices are offered to people. Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 7 People who do not join in group-activities must be provided with sufficient stimulation. It is recommended that larger and better-equipped staff room facilities should be provided for the comfort of staff members, and the number of staff working on the early shift should be reviewed to ensure sufficient stimulation for people living at the home. Further staff training must be provided in a number of key areas to ensure that people’s needs are met appropriately. More frequent supervision sessions, annual appraisals and regular staff meetings should be held to ensure that staff work in line with best practice in supporting people living at the home. 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 Lodge DS0000062486.V344934.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 Lodge DS0000062486.V344934.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): 1, 3 and 5. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents and their relatives have the opportunity to visit the home, and their needs are assessed before they move in, to ensure that these can be met. Detailed information about the home is available to prospective residents so they can make an informed decision about whether to move into the home. Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 10 EVIDENCE: A detailed statement of purpose and service users guide are available for the home as appropriate. As recommended an alternative format had been produced for the brochure using large print and a clearer layout. It is also recommended that the service users guide be available in a pictorial format so that it is more accessible to people who are diagnosed with dementia. The statement of purpose indicates that the home upholds people’s right to be treated with respect whatever their race, religion or lifestyle choices. Assessments in residents’ files indicated that a detailed assessment of residents’ needs takes place prior to their admission including information about their lifestyle choices, cultural and religious needs. This was confirmed by residents, and staff spoken to. Staff and people living at the home also confirmed that there had been opportunities to visit the home prior to admission. Avon Lodge DS0000062486.V344934.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 and 10. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs have been assessed and care plans are in place for each person living at the home to ensure that these are met. Appropriate administration and recording of medicines ensures that people’s medication needs are fully met. People living at the home feel that they are treated with respect and consideration by the staff team. EVIDENCE: Five care plans were inspected and these were found to be detailed with regular monthly reviews as appropriate. Care plans reflected people’s social, cultural, religious and intellectual needs thus providing a holistic care package for people living at the home. Residents that I spoke to, told me that they were involved in choosing their preferred care routines. This consultation was Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 12 recorded on care plans as appropriate in the form of residents’ or their relatives/advocates’ signatures. A helpful level of detail was included within monthly reviews of care plans to indicate any changes in people’s care needs. Risk assessments had been undertaken for all people living at the home including recording of agreements regarding any limitations placed on residents as a result of these assessments. As required at the previous inspection, records indicated that these risk assessments were being reviewed monthly. Recorded evidence also confirmed that residents’ health needs are being met through consultation with a variety of health care professionals and this was confirmed by staff, residents and two healthcare professionals that I spoke to. On the day of the inspection a district nurse and chiropodist were visiting people at the home, and I was also told that the GP visits people at the home at least weekly. Flu jabs were due to be administered to people living at the home on the day after the inspection. The receipt, storage and disposal of medicines at the home were found to be appropriate. Medication records within the home were satisfactory, with no gaps in the medical administration record (MAR) sheets. Use of the code ‘F’ on medication administration records was accompanied by an explanation of its meaning in each case to avoid confusion. As required previously, the administration of medicines in the form of creams or lotions was being recorded on medication administration records as appropriate. Residents and health care professionals that I spoke with, confirmed that their privacy and dignity were respected and also spoke very positively about the support and accessibility of the home’s management. This was confirmed by observations of routines within the home on the day of the inspection. Avon Lodge DS0000062486.V344934.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 and 15. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. There had been an improvement in the number of activities available to people living at the home with support from staff and involvement within the local community, to cater for people with disparate tastes. Residents are encouraged to maintain contact with their family members and friends and are given choices about the way in which their care is provided. Residents are satisfied with the quality of food provided at the home, however there is room for improvement in the number of choices available to people at meal times, so that their preferences are fully catered for. EVIDENCE: Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 14 A number of activities are available to residents including board games, painting, skittles, singing, gentle exercise, entertainers and video afternoons. Cookery classes were also due to commence for people living at the home, during the week of the inspection and a bonfire night party with fireworks was being planned. People living at the home spoken to confirmed that their relatives and friends were encouraged to visit, and this was confirmed by entries in the visitors books and staff accounts. In addition to friends and relatives, and health and social care professionals, the manager advised that a mobile library and a hairdresser visit the home and magazines and newspapers can also be ordered by residents at the home. One resident attends a local church and representatives from two local churches visit the home regularly. The manager advised that residents of other religions are offered support to attend their places of worship, but currently choose to be supported by their family members. This was confirmed by those spoken to. However although there appeared to have been an improvement in this area, insufficient evidence was still available in residents’ daily records or through observation of activities at the home, that the residents who choose or are unable to join in the group activities, receive sufficient stimulation in the home. I remained concerned that the inclusion of residents’ laundry among staff duties, may detract from the time staff have to spend with residents in carrying out activities of their choice. A recommendation is made accordingly. Residents spoken to said that staff members offer them choices about their care and activities to be undertaken at the home. The manager advised that staff occasionally take residents out on trips to the local shops. As required at the previous inspection regular trips out to places of interest in the local community were now being arranged for people living at the home. This is an important improvement providing residents with the opportunity to be involved in the local community. Recent trips had included visits to Forty Hall, Capel Manor, Epping, parks, garden centres and country rides. Residents that I spoke to advised that they were generally happy with the quality of food served at the home and several spoke enthusiastically about the meals provided. Discussions with residents indicated that, although they were able to choose alternatives if they did not like the main meal, this was still something relatively rarely done. In the past the home has catered for people with cultural dietary needs, however no residents currently choose to have cultural meals provided. One person that I spoke to advised that they enjoyed all the food provided at the home, and could always have cultural foods when they visited their family, so in this case this did appear to have been their choice. Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 15 A full time chef, and kitchen assistant are employed at the home to meet the needs of a full occupancy of residents. As required there was better recording of the food served to residents in the home, and storage temperatures of refrigerated and frozen foods. However there was insufficient recording of alternatives available to residents so that it was not clear if these were always available. Fresh fruit and vegetables were stocked in the kitchen, and a large selection of tinned and dry foods were available, although it remains recommended that the home be less reliant on ‘value’ products. It remains recommended that pictorial formats be produced to illustrate the home menus for residents and assist them in making choices for each meal. The manager advised that he had commenced taking photographs in order to produce these formats. Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 16 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 and 18. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home can be sure that their concerns about the home will be addressed appropriately. An adult protection policy is available for the home, and the majority of staff have undertaken training in this area to ensure that the risk of people being abused, is minimised. EVIDENCE: Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 17 The home’s complaints procedure is appropriate to protect the interests of residents. Feedback from residents indicated that they felt able to express concerns about the home, and that the management were receptive to their opinions. The complaint record was maintained up to date including detailed actions taken to address each concern or complaint as appropriate. The home has an appropriate procedure regarding the protection of vulnerable adults, and since the previous inspection further staff members had undertaken training in this area, so that almost all staff have now undertaken this training. Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 18 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 and 26. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a pleasant environment that is well furnished, clean and hygienic and purpose built to meet their needs. They have access to a range of comfortable communal areas both inside and outside of the home. There had been an improvement in the standard of cleanliness within the home and a schedule for redecoration was in place to ensure the comfort of people living at the home. Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 19 EVIDENCE: The home remains well decorated and furnished, with a bright and inviting appearance. Feedback from residents indicated that a high standard of housekeeping is provided at the home. Bedrooms and communal areas are comfortable and well furnished. The home has adequate communal areas and a sufficient number of toilets and bathrooms. New garden furniture had been provided and security lighting had been installed around the building. As required at the previous inspection action was being taken to ensure that there are no unpleasant odours in the home and light fittings in the corridors had been cleaned from insect debris. The manager advised that housekeeping staff clean a number of carpets in the home each day, and that this is usually very effective. I noted that there had been some problems arising from the laundering of residents’ clothes in the months prior to the inspection, however action had been taken by the manager to address this problem. As recommended, a further COSHH cupboard (for hazardous chemicals) was provided on the first floor of the home for use by care and domestic staff. Although the staff room had been slightly improved, with new lockers provided for staff, I was concerned that this area is still not sufficiently large or appealing for the use of the staff team. It remains recommended that larger and better-equipped staff room facilities be provided for staff members, as the current staff room is too small to meet the needs of the staff members on duty. A possible site on the first floor was discussed with the registered manager. As required, a schedule for redecoration had been produced to address the wear on tear in people’s bedrooms, with several rooms already redecorated where needed. Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 20 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 and 30. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home operates safe recruitment practices, and people living at the home are confident about the ability of staff to meet their needs effectively. Management are aware of staff training needs and progress has been made in meeting these with plans in place to ensure that remaining needs are addressed. Further staff need to undertake training in dementia, fire safety, first aid and challenging behaviour to ensure the protection of people living at the home. Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 21 EVIDENCE: Four staff files were inspected and these were found to contain application forms, two references, proof of identity documents and the other records specified under Schedule 4(6) of the Care Homes Regulations 2001. Satisfactory Criminal Record Bureau (CRB) disclosures were available for these staff members as appropriate. Training certificates were available for training completed by staff members and the manager indicated that approximately 80-90 of care staff were trained or undertaking training to NVQ level two in care or above. Staff spoken to were knowledgeable about their role and responsibilities within the home and had a good understanding of people’s cultural and lifestyle preferences. In Annual Quality Assurance Assessment the manager advised that there were 29 care staff and 5 other staff working at the home. At a previous inspection I noted that at least half of the staff had undertaken training in dementia, first aid, health and safety, manual handling and medication for older people. Since then certificates were available evidencing that further staff had undertaken training in adult protection, infection control, manual handling, constipation management and food hygiene, and within the last year six staff had undertaken training in dementia, challenging behaviour and adult protection, five in manual handling, two in managing constipation, and eight in medication administration. Other training undertaken by some staff included computer training, continence training and tissue viability training. The manager advised that five staff members were booked to undertake training in epilepsy, diversity, care planning, record keeping and effective communication, and four people were booked to undertake four day first aid training and a course entitled ‘Spicing up life for people with dementia,’ within the next few months. It remains required that all staff undertake training in fire safety. This requirement is restated from the previous inspection and must be addressed as a matter of urgency. Further staff also need to undertake training in first aid, managing challenging behaviour and care planning as required at the previous inspection. As recommended the staff application form had been updated to include a statement by prospective staff members as to why they are suitable for the position. The manager also advised that he was proposing to address the issue of use of restraint at the next staff meeting, providing clear guidance to all staff about appropriate and inappropriate interactions. Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 22 Induction records were available for all new staff as required at the previous inspection, indicating that appropriate induction training is provided. This was confirmed by staff members spoken to. Although there had been an improvement in this area, there remain insufficient supervision records to meet the standard of at least six times annually. This requirement is therefore restated. Following discussion with staff and residents, observation of procedures in the home and records of activities and stimulation provided to people living at the home, it is recommended that the number of staff working in the home on the early shift be reviewed again, to ensure sufficient cover for laundry duties and activities/stimulation. Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 23 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 and 38. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home manager is appropriately qualified and experienced and remains commended regarding the relationship that he has developed with residents and relatives and his leadership of the home in the best interests of residents. Frequent monitoring visits and quality assurance procedures for the home ensure that the home is run to a high standard. But staff do not receive frequent supervision and staff meetings to ensure that the home is run in the best interests of residents. People living at the home are safeguarded from financial abuse by procedures in place to support them in managing their finances. There is a high standard of practice in health and safety at the home to protect the safety of residents. Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager for the home has been successfully registered with the CSCI and has over fourteen years of experience working with older people including those diagnosed with dementia. He has obtained the Registered Managers Award at NVQ level 4 and an NVQ level 4 qualification in care, and is an active member of the Alzheimer’s Society. Unfortunately due to an injury he had been absent from the home for an extended period during the year. Discussion with staff and people living at the home and observation of routines indicated that there are clear communication channels at the home. Residents and healthcare professionals spoken to remain very satisfied with the manager’s leadership of the home, and his availability to meet with them about any issues of concern within the home throughout the day. The manager is commended for his performance in this area. The manager advised that he continues to receive significant support from the area manager for the home. The majority of residents manage their own finances with support from their family or solicitors. Where the home is asked to keep residents’ funds for safekeeping, records are maintained. Inspection of the records for three residents indicated that these records were being maintained accurately, matching the actual monies stored for each resident in each case. As required a record was being maintained of all valuables stored on behalf of residents including details of when they are returned and the location of these items. A detailed set of policies are available for the home covering relevant areas for the day to day running of the home, including policies regarding equality and diversity. Since the previous inspection, records indicated that the frequency of staff receiving one-to-one supervision had improved, however not sufficiently to meet the national minimum standard of at least six times annually. Nor were annual appraisal meetings taking place for all staff. Only three staff meetings had been held throughout the year and it remains required that the frequency of these meetings also be increased. This may be due in part to the managers absence from the home due to an injury for an extended period this year and insufficient delegation of tasks. Records indicated that regular residents meetings continue to be held and this was confirmed by staff and residents spoken to. Records were available of the content of these meetings, which were being undertaken in small groups of Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 25 approximately six residents, and useful feedback had been obtained as appropriate. Monthly inspections by the area manager for the home continue to take place and a quality assurance audit had also been undertaken for the home including feedback forms from people living at the home and visitors. This had resulted in a development plan being produced for 2007/08. Health and safety checks for the home were maintained to a very high standard including up to date safety certificates for electrical and gas safety, portable appliances, hoists, legionella, the call system, fire fighting and prevention equipment and regular fire safety checks. Records were also available for the hot water temperature from outlets available to residents, specifying hot water outlets that have been tested on each occasion to ensure that these did not exceed 43°C. For the second key inspection, over two years, I did not encounter any issues of concern to the health and safety residents during the visit. The home is commended for its practice in this area. Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 26 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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 2 X 3 Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES 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 OP12 Regulation 16(mn) Requirement Timescale for action 14/12/07 2. OP30 18(1ci) 3. OP36 18(1ci)(2) The registered person must ensure that service users who do not join in group-activities receive sufficient stimulation and that this is recorded. (Previous timescale of 02/02/07 partially met). 25/01/08 The registered persons must ensure that all staff are provided with training in first aid, challenging behaviour, fire safety and care planning, and that more staff receive training in working with people who have dementia to ensure that people’s needs are met appropriately within the home. (Previous timescales of 31/03/06, 29/9/06 and 30/03/07 partially met). 14/12/07 The registered persons must ensure that more frequent supervision sessions, annual appraisals and regular staff meetings are held to ensure that staff work in line with best practice. (Previous timescale of 16/02/07 partially met). Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 28 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 OP1 OP15 Good Practice Recommendations It is recommended that a pictorial format be considered for the service users guide to make it more accessible to service users who are diagnosed with dementia. It remains recommended that pictorial formats be produced to illustrate the home menus for service users and assist them in making choices for each meal. More alternatives for each meal should also be available to ensure that sufficient choices are offered to people. It is recommended that larger and better-equipped staff room facilities be provided for the comfort of staff members. It remains recommended that the number of staff working in the home on the early shift be reviewed to ensure sufficient cover for laundry duties and stimulation for people living at the home. 3. 4. OP19 OP27 Avon Lodge DS0000062486.V344934.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 3rd Floor Caledonia House 223 Pentonville Road London N1 9NG 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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